[Assessment of mediastinal tumor involvement (T factor) in lung cancer with transesophageal ultrasonography].
Transesophageal sonography was originally used to assess esophageal-gastric neoplasm. The technique may also be useful in the evaluation of pulmonary neoplasms for possible mediastinal involvement, with regard to both T and N factors.


OBJECTIVE
To consider the validity of this minimally-invasive technique for assessing possible mediastinal involvement by direct tumoral invasion (T4) and to help obtain the most accurate staging of lung cancer.


METHODS
Sixteen patients with confirmed histopathological diagnoses of pulmonary neoplasm were examined by transesophageal sonography in order to evaluate possible mediastinal involvement. They had previously been classified by computed tomography as T4 (12 patients) or possible T4 (4 patients). Mediastinal involvement was also assessed by mediastinotomy or thoracotomy in 15 of the 16 patients.


RESULTS
Transesophageal sonography revealed mediastinal involvement in eight of the 16 patients; the rest had no such involvement. Surgical exploration of the mediastinum confirmed involvement in seven of those who had been so classified by sonography (with the remaining patient not having been assessed surgically). Among the eight patients who were considered free of mediastinal involvement, there was in fact none, although we found previously undetected infiltration of the posterior surface of the right pulmonary artery in one patient. Sensitivity was 87.5%, specificity 100% and accuracy 93.3%.


CONCLUSIONS
Transesophageal ultrasound is a diagnostic tool that can provide additional information to complement other diagnostic strategies.
Duque Medina
J L
JL
Servicio de Cirugía Torácica, Hospital Universitario de Valladolid.
Ramos
G
G
San Román
J A
JA
López
A
A
García-Yuste
M
M
Heras
F
F
Cerezal
J
J
Matilla
J M
JM
D017548:Echocardiography, Transesophageal; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*