Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study.
BACKGROUND
Multiple tests are required for the management of lung cancer.


OBJECTIVE
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was evaluated as a single test for the diagnosis and staging (thoracic and extrathoracic) of lung cancer.


METHODS
Consecutive subjects with computed tomography (CT) findings of a lung mass were enrolled for EUS and results were compared with those from CT and positron emission tomography scans.


RESULTS
Of 113 subjects with lung cancer, EUS was performed as a first test (after CT scan) for diagnosis in 93 (82%) of them. EUS-FNA established tissue diagnosis in 70% of cases. EUS-FNA, CT, and positron emission tomography detected metastases to the mediastinal lymph nodes with accuracies of 93, 81, and 83%, respectively. EUS-FNA was significantly better than CT at detecting distant metastases (accuracies of 97 and 89%, respectively; p = 0.02). Metastases to lymph nodes at the celiac axis (CLNs) were observed in 11% of cases. The diagnostic yields of EUS-FNA and CT for detection of metastases to the CLNs were 100 and 50%, respectively (p < 0.05). EUS was able to detect small metastases (less than 1 cm) often missed by CT. Metastasis to the CLNs was a predictor of poor survival of subjects with non-small cell lung cancer, irrespective of the size of the CLNs. Of 44 cases with resectable tumor on CT scan, EUS-FNA avoided thoracotomy in 14% of cases.


CONCLUSIONS
EUS-FNA as a first test (after CT) has high diagnostic yield and accuracy for detecting lung cancer metastases to the mediastinum and distant sites. Metastasis to the CLNs is associated with poor prognosis. EUS-FNA is able to detect occult metastasis to the CLNs and thus avoids thoracotomy.
Singh
Pankaj
P
Division of Gastroenterology, Central Texas Veterans Health Care System, Temple, TX 76504, USA. pankaj1110@hotmail.com
Camazine
Brian
B
Jadhav
Yashodeep
Y
Gupta
Rahul
R
Mukhopadhyay
Phalguni
P
Khan
Ahmed
A
Reddy
Rama
R
Zheng
Qi
Q
Smith
David D
DD
Khode
Renu
R
Bhatt
Bankim
B
Bhat
Sanjay
S
Yaqub
Yasir
Y
Shah
Rajnikant S
RS
Sharma
Ashish
A
Sikka
Pawan
P
Erickson
Richard A
RA
D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D019160:Endosonography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18