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Published ahead of print on August 6, 2003, doi:10.1164/rccm.200301-050OC
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American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 1293-1297, (2003)
© 2003 American Thoracic Society

Endoscopic Ultrasound, Positron Emission Tomography, and Computerized Tomography for Lung Cancer

Annette Fritscher-Ravens, Bruce L. Davidson, Hans-Peter Hauber, Karl H. Bohuslavizki, Christoph Bobrowski, Christian Lund, Wolfram Trudo Knöfel, Nib Soehendra, Lars Brandt, Margaret S. Pepe and Almuth Pforte

Departments of Interdisciplinary Endoscopy, Internal Medicine (Pulmonology), Nuclear Medicine, Radiology, and General Surgery, University Hospital, Hamburg, Germany; Pulmonary-Critical Care Division, University of Washington School of Medicine and Swedish Medical Center; and Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington

Correspondence and requests for reprints should be addressed to Bruce L. Davidson, M.D., M.P.H., 801 Broadway, Suite 915, Seattle, WA 98122. E-mail: brucedavidson{at}pobox.com

Staging of patients with lung cancer to determine operability is intended to efficiently limit futile thoracotomies without denying possibly curative surgery. Currently available staging tests are imperfect alone and in combination. Imaged suspected metastases often require tissue confirmation before surgery can be denied. Endoscopic ultrasound (EUS) may help identify inoperable patients by providing tissue proof of inoperability in a single staging test, with similar sensitivity for identifying inoperable patients as other staging tests. Therefore, we compared computed tomography, positron emission tomography (PET), and EUS with fine-needle aspiration under conscious sedation, each test interpreted blinded with respect to the other tests, for identifying inoperable patients in a consecutive cohort of 79 potentially operable patients with suspected or proven lung cancer. An economic analysis was also performed. Thirty-nine patients were found inoperable (a 40th patient's inoperability was missed by all preoperative staging tests). The sensitivity of computerized tomography was 43%. PET and EUS each had similar sensitivities (68 and 63%, respectively) and similar negative predictive values (64 and 68%, respectively), but EUS's superior specificity (100 vs. 72% for PET) and considerably lower expense means it may be preferred to PET early in staging to identify inoperable patients.

Key Words: staging • mediastinum • metastasis • cost-effectiveness




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