title: [New endoscopic ultrasound (EUS) applications in lung cancer: evaluation of patients with negative mediastinal CT and re-staging after neoadjuvant treatment].
abstract: The main purpose of staging in non-small cell lung cancer (NSCLC) is to assess mediastinal lymph node involvement, with thoracic CT being the main non-invasive test for this. However, given that up to 15% of patients who show no mediastinal lymph node involvement in the CT have lymph node metastasis during surgery, other examinations are required. Endoscopic ultrasonography guided fine-needle aspiration (EUS-FNA) has shown to be able to detect advanced disease (metastatic mediastinal lymph nodes, adrenal metastasis, mediastinal invasion by the tumour) in approximately 25% of patients with a CT that suggested a non-advanced disease. Another situation in which CT has a very limited value is in the evaluation of the response to induction therapy, with its most limiting factor being its intrinsic inability to distinguish between a tumour and necrosis. In this context, EUS-FNA has shown to have a good performance, with a sensitivity, negative predictive value and precision of 75%, 67% and 83%, respectively. In conclusion, EUS-FNA may be considered a good alternative in the pre-operative staging of patients with NSCLC, with and without diseased mediastinal lymph nodes in CT, and could play an important role in the mediastinal re-staging of these patients by identifying a patient sub-group who might benefit from additional surgical treatment.
authors.affiliation: Sección de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERehd, Barcelona, España.
authors.forename: Gloria
authors.initials: G
authors.lastname: Fernández-Esparrach
authors.forename: Oriol
authors.initials: O
authors.lastname: Sendino
authors.forename: Angels
authors.initials: A
authors.lastname: Ginès
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods* / Q000639:trends; D005188:False Negative Reactions; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008482:Mediastinum / Q000000981:diagnostic imaging*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods* / Q000639:trends; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000379:methods*