title: Endoscopic ultrasound in non-small cell lung cancer and negative mediastinum on computed tomography.
abstract: Despite technical advances in staging non-small cell lung cancer (NSCLC), accurate staging remains a challenge. Endoscopic ultrasound is useful in staging NSCLC when lymphadenopathy is present on a computed tomography (CT), but its role in the absence of lymphadenopathy on CT has not been well defined. Therefore, we sought to determine the clinical impact of endoscopic ultrasound (EUS) in staging NSCLC in absence of mediastinal lymphadenopathy on CT. Seventy-six patients with NSCLC with absence of mediastinal lymphadenopathy on CT were enrolled and followed prospectively. EUS-guided fine-needle aspiration was performed on sites that were suspicious for metastases. Surgical pathology after thoracotomy was used as the reference standard for assessing accuracy. Sixty-two (86%) patients underwent surgery, and 10 (13%) did not. EUS precluded surgery in 9 patients (12%) and influenced management in 18 (25%) of all patients in this study. EUS detected malignant mediastinal lymphadenopathy more frequently in patients with lower lobe and hilar cancers combined compared with upper lobe cancers (p = 0.004). EUS played a significant role in identifying patients with unresectable (N3) NSCLC when adenopathy was not present on CT imaging and appears to be more sensitive in detecting lymph node metastases in lower lobe and hilar NSCLC compared with upper lobe NSCLC.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Pulmonology and Oncology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA. juleblan@iupui.edu
authors.forename: Julia K
authors.initials: JK
authors.lastname: LeBlanc
authors.forename: Benedict M
authors.initials: BM
authors.lastname: Devereaux
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.forename: Ken
authors.initials: K
authors.lastname: Kesler
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.forename: Oscar
authors.initials: O
authors.lastname: Cummings
authors.forename: Donato
authors.initials: D
authors.lastname: Ciaccia
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Praveen
authors.initials: P
authors.lastname: Mathur
authors.forename: Dewey
authors.initials: D
authors.lastname: Conces
authors.forename: Joann
authors.initials: J
authors.lastname: Brooks
authors.forename: Melissa
authors.initials: M
authors.lastname: Chriswell
authors.forename: Lawrence
authors.initials: L
authors.lastname: Einhorn
authors.forename: Edith
authors.initials: E
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed