Published ahead of print on October 22, 2004, doi:10.1164/rccm.200405-581OC
A more recent version of this article appeared on January 15, 2005
American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 177-182, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200405-581OC
Endoscopic Ultrasound in Non–Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography
Julia K. LeBlanc,
Benedict M. Devereaux,
Thomas F. Imperiale,
Ken Kesler,
John M. DeWitt,
Oscar Cummings,
Donato Ciaccia,
Stuart Sherman,
Praveen Mathur,
Dewey Conces,
Joann Brooks,
Melissa Chriswell,
Lawrence Einhorn and
Edith Collins
Department of Medicine, Division of Gastroenterology, Pulmonology, and Oncology; Department of Surgery, Thoracic Division; Department of Pathology; Department of Radiology; Roudebush VA Medical Center; and The Regenstrief Institute, Inc., Indiana University Medical Center, Indianapolis, Indiana
Correspondence and requests for reprints should be addressed to Julia Kim LeBlanc, M.D., M.P.H., Indiana University Medical Center, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202. E-mail: juleblan{at}iupui.edu
Despite technical advances in staging non–small cell lung cancer (NSCLC), accurate staging remains a challenge. Endoscopic ultrasound is useful in staging NSCLC when lymphadenopathy is present on a computed tomography (CT), but its role in the absence of lymphadenopathy on CT has not been well defined. Therefore, we sought to determine the clinical impact of endoscopic ultrasound (EUS) in staging NSCLC in absence of mediastinal lymphadenopathy on CT. Seventy-six patients with NSCLC with absence of mediastinal lymphadenopathy on CT were enrolled and followed prospectively. EUS-guided fine-needle aspiration was performed on sites that were suspicious for metastases. Surgical pathology after thoracotomy was used as the reference standard for assessing accuracy. Sixty-two (86%) patients underwent surgery, and 10 (13%) did not. EUS precluded surgery in 9 patients (12%) and influenced management in 18 (25%) of all patients in this study. EUS detected malignant mediastinal lymphadenopathy more frequently in patients with lower lobe and hilar cancers combined compared with upper lobe cancers (p = 0.004). EUS played a significant role in identifying patients with unresectable (N3) NSCLC when adenopathy was not present on CT imaging and appears to be more sensitive in detecting lymph node metastases in lower lobe and hilar NSCLC compared with upper lobe NSCLC.
Key Words: endoscopic ultrasound • fine-needle aspiration • mediastinal lymphadenopathy • thoracotomy • non–small cell lung cancer
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