Published ahead of print on October 26, 2006, doi:10.1164/rccm.200606-851OC Am. J. Respir. Crit. Care Med., Volume 175, Number 4, February 2007, 345-354 A more recent version of this article appeared on February 15, 2007
Submitted on June 26, 2006 Endoscopic Ultrasound as a First Test for Diagnosis and Staging of Lung Cancer: A Prospective StudyPankaj Singh1*,1 Division of Gastroenterology, Central Texas Veterans Health Care System, Temple, Texas, USA; Department of Biostatistics and Epidemiology School of Rural and Public Health, Texas A and M University College Station, Texas, USA, 2 Department of Surgery, Henderson Memorial Hospital, Henderson, Texas, USA, 3 Department of Radiology, Central Texas Veterans Health Care System, Temple, Texas, USA, 4 Division of Oncology, Central Texas Veterans Health Care System, Temple, Texas, USA, 5 Division of Gastroenterology, Central Texas Veterans Health Care System, Temple, Texas, USA, 6 Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, Texas, USA, 7 Department of Biostatistics and Epidemiology School of Rural and Public Health, Texas A and M University College Station, Texas, USA, 8 Department of Biostatistics, City of Hope National Medical Center, Duarte, California, USA, 9 Division of Gastroenterology, VA Boston Healthcare System, Boston, Massachusetts, USA, 10 Division of Pulmonary and Critical Care, Central Texas Veterans Health Care System, Temple, Texas, USA, 11 Division of Gastroenterology and Hepatology, Scott and White Memorial Hospital, Temple, Texas, USA * To whom correspondence should be addressed. 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 extra-thoracic) of lung cancer. Methods: Consecutive subjects with CT findings of a lung mass were enrolled for EUS and the results were compared with those from CT and PET scans. Results: Of 113 subjects with lung cancer, EUS was performed as a first test (after CT scan) for diagnosis in 93 (82%) of cases. EUS FNA established tissue diagnosis in 70% of cases. EUS FNA, CT and PET detected metastases to the MLN 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 (CLN) were observed in 11% of cases. The diagnostic yields of EUS FNA and CT for detection of metastases to CLN were 100% and 50%, respectively (p<0.05). Metastasis to CLN was a predictor of poor survival in subjects with NSCLC, irrespective of size of the CLN. Of 44 cases with resectable tumor on CT scan, EUS FNA avoided thoracotomy in 14% 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 CLN is associated with poor prognosis. EUS FNA is able to detect occult metastasis to the CLN and thus avoids thoracotomy. Key words: Lung cancer, Non-small cell lung cancer, Celiac lymph nodes, EUS-FNA, Survival
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