title: Accuracy of EUS criteria and primary tumor site for identification of mediastinal lymph node metastasis from non-small-cell lung cancer.
abstract: BACKGROUND
  EUS with FNA is useful for staging non-small-cell lung cancer. However, benign mediastinal adenopathy is common. The aims of this study were to identify clinical factors, especially primary tumor location, and EUS lymph nodal characteristics predictive of aortopulmonary window and subcarinal lymph node metastases of non-small-cell lung cancer.
  
  
  METHODS
  Patients with known or suspected non-small-cell lung cancer underwent EUS staging at which EUS-FNA was performed for all identified mediastinal lymph nodes. Clinical characteristics, primary tumor data, EUS findings, and histopathology were reviewed. Exact tests were performed for both aortopulmonary window and subcarinal lymph nodes to identify factors predictive of malignant cytology.
  
  
  RESULTS
  Ninety-two patients with non-small-cell lung cancer were included. Fifty-one had aortopulmonary window, and 73 had subcarinal lymph nodes on EUS. The EUS with FNA specimens were interpreted as suspicious or diagnostic for malignancy for 9 aortopulmonary window and 9 subcarinal lymph nodes. When comparing benign vs. malignant EUS with FNA findings for aortopulmonary window and subcarinal lymph nodes, only lymph node size of 1 cm or greater and sharp lymph nodal edges were associated with malignancy in lymph nodes at both sites, whereas primary tumor site, lymph node shape, and echogenicity were associated with malignant subcarinal nodes. When 4 classic lymph nodal features of malignancy were evaluated, the presence of 3 or more typical features had positive and negative predictive values of, respectively, 41% and 96%.
  
  
  CONCLUSIONS
  Although tumor location and EUS lymph nodal characteristics are associated with malignant involvement of lymph nodes, the accuracy of these predictors does not obviate the need for cytologic evaluation. EUS with FNA should be performed for all lymph nodes when an abnormal finding will alter management.
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Wildi
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: Stacey
authors.initials: S
authors.lastname: Roberts
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Hoffman
authors.forename: Valerie
authors.initials: V
authors.lastname: Durkalski
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Silvestri
authors.forename: Mark I
authors.initials: MI
authors.lastname: Block
authors.forename: Carolyn
authors.initials: C
authors.lastname: Reed
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012189:Retrospective Studies