title: The yield of endoscopic ultrasound in lung cancer staging: does lymph node size matter?
abstract: BACKGROUND
  Transoesophageal endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a minimally invasive procedure to demonstrate unresectability in lung cancer patients with enlarged malignant mediastinal lymph nodes (MLN). We compared the performance of EUS-FNA to show malignant invasion in enlarged versus small MLN.
  
  
  METHODS
  A single center analysis was performed in lung cancer patients with a suspicion for malignant MLN invasion based on the available imaging. In these patients, EUS-FNA was presumed to impact the diagnostic course since patients underwent surgical-pathologic verification only when EUS-FNA did not demonstrate MLN invasion.
  
  
  RESULTS
  We evaluated 100 lung cancer patients in whom MLN invasion was presumed based on the available imaging. In 75 patients (75%), there was at least one enlarged MLN, whereas in 25 patients (25%), only small MLN were found. The sensitivity and negative predictive value to detect malignancy in enlarged MLN was 96% (95% confidence interval [CI], 87-99) and 67% (95% CI, 29-92), respectively. The sensitivity and negative predictive value of EUS-FNA in small MLN was 93% (95% CI, 66-99) and 92% (95% CI, 61-99), respectively. EUS-FNA prevented a surgical (mediastinal) intervention in 88 and 52% of the patients with enlarged or small MLN, respectively (p < 0.001).
  
  
  CONCLUSIONS
  As the sensitivity to detect malignant MLN invasion is comparably high for both enlarged and small but suspected MLN, clinicians should consider EUS-FNA even in case computed tomography-scan shows no enlarged MLN. The impact of EUS-FNA to avoid surgical mediastinal interventions is greater when enlarged MLN are present. The moderate negative predictive value of EUS-FNA makes surgical-pathologic verification still compulsory, regardless of the size of the MLN.
authors.affiliation: Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan, Ghent, Belgium. kurt.tournoy@UGent.be
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Tournoy
authors.forename: Frédéric De
authors.initials: FD
authors.lastname: Ryck
authors.forename: Lieve
authors.initials: L
authors.lastname: Vanwalleghem
authors.forename: Marleen
authors.initials: M
authors.lastname: Praet
authors.forename: Frank
authors.initials: F
authors.lastname: Vermassen
authors.forename: Georges Van
authors.initials: GV
authors.lastname: Maele
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Meerbeeck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18