title: Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer.
abstract: OBJECTIVE
  Bronchoscopic methods fail to diagnose lung cancer in up to 30% of patients. We studied the role of transesophageal endosonography (EUS)-guided fine-needle aspiration (FNA; EUS-FNA) in such patients.
  
  
  METHODS
  Prospective study. The final diagnosis was confirmed by cytology, histology, or clinical follow-up.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Thirty-five patients (30 male and 5 female; mean age, 60.9 years; range, 34 to 88 years) with suspected lung cancer in whom bronchoscopic methods failed. Patients with a known diagnosis, recurrence of lung cancer, or mediastinal metastasis from an extrathoracic primary were excluded.
  
  
  METHODS
  EUS and guided FNA of mediastinal lymph nodes.
  
  
  RESULTS
  The procedure was uneventful, and material was adequate in all. The final diagnosis by EUS-FNA was malignancy in 25 patients (11 adenocarcinoma, 10 small cell, 3 squamous cell, and 1 lymphoma) and benign disease in 9 patients (5 inflammatory, 2 sarcoidosis, and 2 anthracosis). Another patient with a benign result had signet-ring cell carcinoma diagnosed on pleural fluid cytology (probably false-negative in EUS-FNA). The sensitivity, specificity, accuracy, and positive and negative predictive values were 96, 100, 97, 100, and 90%, respectively. There were no complications. Reviewing the EUS morphology, the nodes were predominantly located in levels 7 and 8 of American Thoracic Society mediastinal lymph node mapping (subcarinal and paraesophageal region). In seven patients, the punctured nodes were < 1 cm (four malignant and three benign), which are difficult to sample by other methods. The malignant nodes had a hypoechoic, homogenous echotexture.
  
  
  CONCLUSIONS
  EUS-FNA is a safe, reliable, and accurate method to establish the diagnosis of suspected lung cancer when bronchoscopic methods fail, especially in the presence of small nodes.
authors.affiliation: Department of Endoscopic Surgery, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: N
authors.initials: N
authors.lastname: Soehendra
authors.forename: L
authors.initials: L
authors.lastname: Schirrow
authors.forename: P V
authors.initials: PV
authors.lastname: Sriram
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.forename: H P
authors.initials: HP
authors.lastname: Hauber
authors.forename: A
authors.initials: A
authors.lastname: Pforte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity