title: Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma.
abstract: OBJECTIVE
  Surgical resection as part of a multimodality approach in malignant pleural mesothelioma (MPM) has a high morbidity and mortality. Because mediastinal lymph node (MLN) metastases are a negative prognostic factor, preoperative staging is of paramount importance. Transesophageal endoscopic ultrasound with real-time guided fine needle aspiration (EUS-FNA) enables accurate MLN staging in lung cancer.
  
  
  METHODS
  The feasibility and yield of EUS-FNA in MLN staging were prospectively analyzed in patients with presumed early-stage MPM considered for multimodality therapy. MLN reference pathology was defined by either pathologic staging or the formal demonstration of malignant cells by either EUS-FNA or mediastinoscopy.
  
  
  RESULTS
  Thirty-two consecutive patients (81% males; median age, 61 years) with proven MPM underwent EUS-FNA. In 11 (34%) patients, a negative EUS-FNA or mediastinoscopy was not confirmed by surgical MLN dissection because of clinical deterioration or disease progression. In 21 (66%) patients, a formal pathology of the MLN was obtained and staging with EUS-FNA was positive in 4 (19%). Mediastinoscopy did not result in a greater yield of MLN metastasis as compared with EUS-FNA. Thoracotomy with complete lymph node dissection was done in 17 (81%). The overall prevalence of MLN metastasis was 24%, and the sensitivity of EUS-FNA was 80% (95% confidence interval, 28-99%) with a specificity of 100% (95% confidence interval, 79-100%). One patient had esophageal perforation related to EUS-FNA.
  
  
  CONCLUSIONS
  EUS-FNA is feasible and sensitive for MLN staging in patients with MPM who are candidate for multimodality treatment. These data warrant further evaluation.
authors.affiliation: Department of Respiratory Medicine and Lung Oncology Network, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. kurt.tournoy@UGent.be
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Tournoy
authors.forename: Sjaak A
authors.initials: SA
authors.lastname: Burgers
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Annema
authors.forename: Frank
authors.initials: F
authors.lastname: Vermassen
authors.forename: Marleen
authors.initials: M
authors.lastname: Praet
authors.forename: Marianne
authors.initials: M
authors.lastname: Smits
authors.forename: Houke M
authors.initials: HM
authors.lastname: Klomp
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Meerbeeck
authors.forename: Paul
authors.initials: P
authors.lastname: Baas
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D018450:Disease Progression; D019160:Endosonography / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000295:instrumentation* / Q000379:methods; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D012680:Sensitivity and Specificity