ENDOSCOPIC ULTRASOUND WITH FINE-NEEDLE ASPIRATION IN THE DIAGNOSIS AND STAGING OF LUNG-CANCER

Background. Esophageal endoscopic ultrasonographic (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has been intro duced only recently. The utility of EUS/FNA in diagnosing and staging bronchogenic carcinoma is unknown. Methods. After a thoracic computed tomographic scan, 27 patients with known or suspected lung cancer unde rwent EUS. Accessible abnormal mediastinal lymph nodes were aspirated under EUS guidance. Patients with positive cytologic studies did not u ndergo further testing, whereas the remaining patients underwent media stinal exploration. The sensitivity, specificity, accuracy, positive p redictive value, and negative predictive value were calculated for bot h chest computed tomography and EUS/FNA. Results. Twenty-two of 27 pat ients had mediastinal adenopathy by computed tomography scan. Sixteen patients had positive findings on EUS, 15 with positive FNA (10 non-sm all cell lung cancer; 5 small cell lung cancer) and 1 with T4 status. Fourteen patients with positive FNA had lymph nodes sampled at level 5 , level 7, or both. Of 11 patients with negative EUS/FNA, 2 had positi ve findings at operation (sensitivity 89%). The diagnosis of lung canc er was established in 7 patients. Conclusions. The results showed that EUS/FNA improves the accuracy of computed tomographic scan in the sta ging of lung cancer. By accessing lymph nodes at levels 5 and 7,EUS/FN A complements mediastinoscopy and is considered the staging modality o f choice in these regions. Positive EUS/FNA can obviate the need for f urther invasive staging.