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Published ahead of print on October 22, 2004, doi:10.1164/rccm.200405-581OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 2, January 2005, 177-182

A more recent version of this article appeared on January 15, 2005
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Submitted on May 5, 2004
Accepted on October 18, 2004

Endoscopic Ultrasound in Non-Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography

Julia K LeBlanc1*, Benedict M Devereaux1, Thomas F Imperiale2, Ken Kesler3, John M DeWitt1, Oscar Cummings4, Donato Ciaccia1, Stuart Sherman1, Praveen Mathur5, Dewey Conces6, Joann Brooks3, Melissa Chriswell1, Lawrence Einhorn7, and Edith Collins1

1 Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, Indianapolis, IN, USA, 2 Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, Indianapolis, IN, USA; Department of Medicine, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Medicine, The Regenstrief Institute, Inc, Indianapolis, IN, USA, 3 Department of Surgery, Thoracic Division, Indiana University Medical Center, Indianapolis, IN, USA, 4 Department of Pathology, Indiana University Medical Center, Indianapolis, IN, USA, 5 Department of Medicine, Division of Pulmonology, Indiana University Medical Center, Indianapolis, IN, USA, 6 Department of Radiology, Indiana University Medical Center, Indianapolis, IN, USA, 7 Department of Medicine, Division of Oncology, Indiana University Medical Center, Indianapolis, IN, USA

* To whom correspondence should be addressed. 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 CT, but its role in the absence lymphadenopathy on CT has not been well defined. Therefore, we sought to determine the clinical impact of EUS in staging NSCLC in absence of mediastinal lymphadenopathy on CT. Seventy-six NSCLC patients with absence of mediastinal lymphadenopathy on CT were enrolled and followed prospectively. Endoscopic ultrasound-guided fine needle aspiration was performed on sites that were suspicious for metastases. Surgical pathology following 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 to upper lobe cancers [p=0.004]. EUS played a significant role in identifying patients with unresectable (N3) NSCLC in 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 to upper lobe NSCLC.
Key words: endoscopic ultrasound, fine needle aspiration, Non-small cell lung cancer, mediastinal lymphadenopathy thoractomy




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