Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans.
BACKGROUND
The treatment of patients with non-small cell lung cancer (NSCLC) depends on the stage. Positron emission and computed tomography (CT) scans can identify suspicious lymph nodes that require biopsy. We prospectively evaluated the yield and accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in sampling mediastinal lymph nodes and compared its accuracy to that of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and CT in staging NSCLC.


METHODS
A consecutive series of patients with suspicious nodes on PET or CT scan in the posterior mediastinal lymph node stations (#5, 7, 8, or 9) were prospectively evaluated by EUS-FNA. The reference standard included thoracotomy with complete lymphadenectomy in patients with lung cancer or if EUS-FNA was benign, repeat clinical imaging, or long-term follow-up.


RESULTS
There were 104 patients (63 men) with 125 lesions (117 lymph nodes, 8 left adrenal glands) who underwent EUS-FNA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 92.5%, 100%, 100%, 94%, and 97%, respectively. EUS-FNA was more accurate and had a higher positive predictive value than the PET or CT (p < 0.001) scan in confirming cancer in the posterior mediastinal lymph nodes. EUS-FNA documented metastatic cancer to the left adrenal in all 4 patients with advanced disease. No deaths resulted from EUS-FNA. One patient experienced self-limited stridor.


CONCLUSIONS
EUS-FNA is a safe, accurate, and minimally invasive technique that improves the staging of patients with NSCLC. It is more accurate and has a higher predictive value than either the PET scan or CT scan for posterior mediastinal lymph nodes.
Eloubeidi
Mohamad A
MA
Department of Medicine, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA. meloubeidi@uabmc.edu
Cerfolio
Robert J
RJ
Chen
Victor K
VK
Desmond
Renee
R
Syed
Sujath
S
Ojha
Buddhiwardhan
B
D000368:Aged; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000556:secondary*; D003110:Colonic Neoplasms / Q000473:pathology; D016889:Endometrial Neoplasms / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006099:Granuloma / Q000175:diagnosis; D015614:Histiocytosis / Q000150:complications / Q000175:diagnosis; D006660:Histoplasmosis / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008171:Lung Diseases / Q000150:complications; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis; D012829:Silicosis / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D001749:Urinary Bladder Neoplasms / Q000473:pathology
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18