title: Mediastinal restaging: EUS-FNA offers a new perspective.
abstract: OBJECTIVE
  We hypothesized that transoesophageal endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has the potential to be a valuable and accurate new diagnostic technique for mediastinal restaging in non-small cell lung cancer (NSCLC) after induction chemotherapy. The current restaging modalities either have a low diagnostic accuracy (computed tomography (CT) scan of the thorax) or they are invasive, can be technically difficult and are therefore not commonly performed (remediastinoscopy).
  
  
  METHODS
  Nineteen consecutive patients with NSCLC and proven ipsilateral or subcarinal lymph node metastases (N2 disease) who had been treated with induction chemotherapy underwent mediastinal restaging by EUS-FNA. Patients had either a partial response (n=14) or stable disease (n=5) based on sequential CT scans of the thorax.
  
  
  METHODS
  EUS-FNA was performed in an ambulatory setting with biopsy of mediastinal lymph nodes (LN). No complications occurred. When EUS-FNA restaged the mediastinum as no regional lymph node metastasis (N0), surgical resection of the tumour with lymph node sampling or dissection was performed.
  
  
  RESULTS
  The positive predictive value, negative predictive value, sensitivity, specificity and diagnostic accuracy of EUS-FNA in restaging mediastinal LN were 100, 67, 75, 100 and 83%, respectively.
  
  
  CONCLUSIONS
  EUS-FNA qualifies as an accurate, safe and minimally invasive diagnostic technique for the restaging of mediastinal lymph nodes after induction therapy in NSCLC. In the future EUS-FNA might play an important role in the mediastinal restaging in NSCLC, particularly to identify the subgroup of down staged patients who benefit most from further surgical treatment.
authors.affiliation: Department of Pulmonology C3 P, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden University Medical Center, Leiden, The Netherlands. j.t.annema@lumc.nl
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Annema
authors.forename: Maud
authors.initials: M
authors.lastname: Veseliç
authors.forename: Michel I M
authors.initials: MI
authors.lastname: Versteegh
authors.forename: Luuk N A
authors.initials: LN
authors.lastname: Willems
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D015203:Reproducibility of Results