title: Endoscopic ultrasound, positron emission tomography, and computerized tomography for lung cancer.
abstract: Staging of patients with lung cancer to determine operability is intended to efficiently limit futile thoracotomies without denying possibly curative surgery. Currently available staging tests are imperfect alone and in combination. Imaged suspected metastases often require tissue confirmation before surgery can be denied. Endoscopic ultrasound (EUS) may help identify inoperable patients by providing tissue proof of inoperability in a single staging test, with similar sensitivity for identifying inoperable patients as other staging tests. Therefore, we compared computed tomography, positron emission tomography (PET), and EUS with fine-needle aspiration under conscious sedation, each test interpreted blinded with respect to the other tests, for identifying inoperable patients in a consecutive cohort of 79 potentially operable patients with suspected or proven lung cancer. An economic analysis was also performed. Thirty-nine patients were found inoperable (a 40th patient's inoperability was missed by all preoperative staging tests). The sensitivity of computerized tomography was 43%. PET and EUS each had similar sensitivities (68 and 63%, respectively) and similar negative predictive values (64 and 68%, respectively), but EUS's superior specificity (100 vs. 72% for PET) and considerably lower expense means it may be preferred to PET early in staging to identify inoperable patients.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital, Hamburg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Davidson
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hauber
authors.forename: Karl H
authors.initials: KH
authors.lastname: Bohuslavizki
authors.forename: Christoph
authors.initials: C
authors.lastname: Bobrowski
authors.forename: Christian
authors.initials: C
authors.lastname: Lund
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knöfel
authors.forename: Nib
authors.initials: N
authors.lastname: Soehendra
authors.forename: Lars
authors.initials: L
authors.lastname: Brandt
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Pepe
authors.forename: Almuth
authors.initials: A
authors.lastname: Pforte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed