title: Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography.
abstract: BACKGROUND
  Computed tomography (CT) is the most common method of staging lung cancer. We have previously shown endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) to be highly accurate in staging patients with nonsmall cell lung cancer (NSCLC) who have enlarged mediastinal lymph nodes on CT scan. In this study we report the accuracy and yield of EUS-FNA in staging patients without enlarged mediastinal lymph nodes by CT.
  
  
  METHODS
  Patients with NSCLC and CT scan showing no enlarged mediastinal lymph nodes (> 1 cm for all nodes except > 1.2 cm for subcarinal) in the mediastinum underwent EUS. Fine needle aspiration was performed on at least one lymph node, if present, in the upper mediastinum, aortopulmonary window, subcarinal, and periesophagus regions. Each specimen was evaluated with on-site cytopathology and confirmed with complete cytopathologic examination.
  
  
  RESULTS
  Sixty-nine patients without enlarged mediastinal lymph nodes were evaluated. Endoscopic ultrasound detected malignant mediastinal lymph nodes in 14 of 69 patients as well as other advanced (American Joint Committee on Cancer [AJCC] stage III/IV) in 3 others (1 left adrenal, and 2 with mediastinal invasion of tumor) for a total of 17 of 69 (25%, 95% confidence interval: 16% to 34%) patients. Eleven additional patients were found to have advanced disease by bronchoscopy (2), mediastinoscopy (2), and thoracotomy with mediastinal lymph node dissection (7). The sensitivity of EUS for advanced mediastinal disease was 61% (49% to 75%), and the specificity was 98% (95% to 100%).
  
  
  CONCLUSIONS
  Endoscopic ultrasound guided fine needle aspiration can detect advanced mediastinal disease and avoid unnecessary surgical exploration in almost one of four patients who have no evidence of mediastinal disease on CT scan. In addition to previously reported results in patients with enlarged lymph nodes on CT, these data suggest that all potentially operable patients with nonmetastatic NSCLC may benefit from EUS staging.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of South Carolina, University of South Carolina, Charleston, South Carolina, USA. wallace.michael@mayo.edu
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: James
authors.initials: J
authors.lastname: Ravenel
authors.forename: Mark I
authors.initials: MI
authors.lastname: Block
authors.forename: Mostafa
authors.initials: M
authors.lastname: Fraig
authors.forename: Gerard
authors.initials: G
authors.lastname: Silvestri
authors.forename: Stephan
authors.initials: S
authors.lastname: Wildi
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: Stacey
authors.initials: S
authors.lastname: Roberts
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Hoffman
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Reed
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D001707:Biopsy, Needle; D001999:Bronchoscopy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D019160:Endosonography; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008482:Mediastinum / Q000000981:diagnostic imaging* / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed