This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200606-851OCv1 175/4/345    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Singh, P. Articles by Erickson, R. A. Search for Related Content PubMed PubMed Citation Articles by Singh, P. Articles by Erickson, R. A.

Endoscopic Ultrasound As a First Test for Diagnosis and Staging of Lung Cancer

A Prospective Study

¹ Division of Gastroenterology, Central Texas Veterans Health Care System, Temple, Texas; ² Department of Surgery, Henderson Memorial Hospital, Henderson, Texas; ³ Department of Radiology, Central Texas Veterans Health Care System, Temple, Texas; ⁴ Division of Oncology, Central Texas Veterans Health Care System, Temple, Texas; ⁵ Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, Texas; ⁶ Department of Biostatistics & Epidemiology, School of Rural & Public Health, Texas A&M University, College Station, Texas; ⁷ Department of Biostatistics, City of Hope National Medical Center, Duarte, California; ⁸ Division of Gastroenterology, VA Boston Healthcare System, Boston, Massachusetts; ⁹ Division of Pulmonary & Critical Care, Central Texas Veterans Health Care System, Temple, Texas; and ¹⁰ Division of Gastroenterology & Hepatology, Scott & White Memorial Hospital, Temple, Texas

Correspondence and requests for reprints should be addressed to Pankaj Singh, M.D., M.S., Central Texas Veterans Health Care System, 1901 South 1st Street, Temple, TX 76504. E-mail: pankaj1110{at}hotmail.com

Rationale: Multiple tests are required for the management of lung cancer.

Objectives: Endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) was evaluated as a single test for the diagnosis and staging (thoracic and extrathoracic) of lung cancer.

Methods: Consecutive subjects with computed tomography (CT) findings of a lung mass were enrolled for EUS and results were compared with those from CT and positron emission tomography scans.

Results: Of 113 subjects with lung cancer, EUS was performed as a first test (after CT scan) for diagnosis in 93 (82%) of them. EUS-FNA established tissue diagnosis in 70% of cases. EUS-FNA, CT, and positron emission tomography detected metastases to the mediastinal lymph nodes with accuracies of 93, 81, and 83%, respectively. EUS-FNA was significantly better than CT at detecting distant metastases (accuracies of 97 and 89%, respectively; p = 0.02). Metastases to lymph nodes at the celiac axis (CLNs) were observed in 11% of cases. The diagnostic yields of EUS-FNA and CT for detection of metastases to the CLNs were 100 and 50%, respectively (p < 0.05). EUS was able to detect small metastases (less than 1 cm) often missed by CT. Metastasis to the CLNs was a predictor of poor survival of subjects with non–small cell lung cancer, irrespective of the size of the CLNs. Of 44 cases with resectable tumor on CT scan, EUS-FNA avoided thoracotomy in 14% of cases.

Conclusions: EUS-FNA as a first test (after CT) has high diagnostic yield and accuracy for detecting lung cancer metastases to the mediastinum and distant sites. Metastasis to the CLNs is associated with poor prognosis. EUS-FNA is able to detect occult metastasis to the CLNs and thus avoids thoracotomy.

Key Words: lung cancer • non–small cell lung cancer • celiac lymph nodes • endoscopic ultrasound–guided fine needle aspiration • survival

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Endoscopic ultrasound has emerged as an alternative test for mediastinal staging of non–small cell lung cancer in selected patient populations. What This Study Adds to the Field Endoscopic ultrasound–guided fine needle aspiration has high diagnostic yield and is an accurate test for detection of extrathoracic metastases. Endoscopic ultrasound–guided fine needle aspiration established lymph nodes at the celiac axis as a common site for occult metastases, which was associated with poor survival.

 

This article has been cited by other articles:

				T Hishida, J Yoshida, M Nishimura, Y Nishiwaki, and K Nagai Problems in the current diagnostic standards of clinical N1 non-small cell lung cancer Thorax, June 1, 2008; 63(6): 526 - 531. [Abstract] [Full Text] [PDF]

				K. G. Tournoy, F. De Ryck, L. R. Vanwalleghem, F. Vermassen, M. Praet, J. G. Aerts, G. Van Maele, and J. P. van Meerbeeck Endoscopic Ultrasound Reduces Surgical Mediastinal Staging in Lung Cancer: A Randomized Trial Am. J. Respir. Crit. Care Med., March 1, 2008; 177(5): 531 - 535. [Abstract] [Full Text] [PDF]

				S. M. Janes and S. G. Spiro Esophageal Endoscopic Ultrasound/Endobronchial Ultrasound-guided Fine Needle Aspiration: A New Dawn for the Respiratory Physician? Am. J. Respir. Crit. Care Med., February 15, 2007; 175(4): 297 - 299. [Full Text] [PDF]