title: Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma.
abstract: BACKGROUND
  Radical surgery for malignant pleural mesothelioma does not improve survival in patients with nodal metastases. Imaging is poor at predicting nodal involvement and mediastinoscopy, though frequently used, is of low sensitivity. As endobronchial ultrasound (EBUS) and esophageal endoscopic ultrasound (EUS) are accurate for nodal staging of lung cancer, we hypothesized that they would be at least as sensitive as cervical video-mediastinoscopy for nodal staging of mesothelioma.
  
  
  METHODS
  Eighty-five patients with mesothelioma who were potential candidates for radical surgery underwent preoperative staging with mediastinoscopy (n = 50) or EBUS (n = 38). Eleven patients also underwent EUS.
  
  
  RESULTS
  Diagnostic yield (specimens containing lymphocytes or tumor cells) was 100% for mediastinoscopy and 84% for EBUS (p < 0.001). Mediastinoscopy identified 7 of 50 (14%) patients with nodal metastases. Thirty-eight (76%) mediastinoscopy-negative patients underwent surgery with nodal sampling and there were 18 false negatives. Endobronchial ultrasound identified 13 of 38 (34%) patients with nodal metastases. Twenty-two (58%) EBUS-negative patients underwent surgery with nodal sampling and there were 10 false negatives. Sensitivity and negative predictive value for mediastinoscopy were 28% and 49%, and 59% and 57% for EBUS. Eleven patients had EUS preoperatively, which revealed infradiaphragmatic nodal metastases in 5 patients.
  
  
  CONCLUSIONS
  Although this study is retrospective, EBUS had higher sensitivity than either mediastinoscopy or imaging studies for detection of nodal metastases. Nevertheless, the ability to accurately identify nodal involvement preoperatively in patients with mesothelioma remains suboptimal. Esophageal ultrasound may complement EBUS particularly in cases where infradiaphragmatic nodal metastases are suspected.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas, M D Anderson Cancer Center, Houston, Texas 77030, USA. drice@mdanderson.org
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Steliga
authors.forename: John
authors.initials: J
authors.lastname: Stewart
authors.forename: George
authors.initials: G
authors.lastname: Eapen
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Edith M
authors.initials: EM
authors.lastname: Marom
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008481:Mediastinoscopy; D008654:Mesothelioma / Q000473:pathology* / Q000601:surgery / Q000648:ultrastructure; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000000981:diagnostic imaging / Q000473:pathology; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011013:Pneumonectomy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020775:Thoracic Surgery, Video-Assisted; D018084:Ultrasonography, Interventional / Q000379:methods*