TRANSCARINAL NEEDLE ASPIRATION BIOPSY IN THE STAGING OF LUNG-CANCER

Lung cancer without distant metastasis often requires an invasive surg ical procedure to document inoperability. In order to determine how of ten puncture biopsy was a valid substitute for a surgical procedure, we investigated the performance of endoscopic staging by means of tran scarinal needle aspiration biopsy during rigid bronchoscopy. Eighty lu ng cancer patients with subcarinal lymph nodes visible on computed tom ography (CT) scan were studied. Specimens were of histological quality (i.e. lymph node tissue) in 59 out of 80 (74%,) patients, and showed malignant invasion of this lymph node tissue in 43 cafes. Specimens of cytological quality (i.e. lymph node cells) were obtained in 13 out o f 80 (16%) patients, and showed malignancy in 7 cases. Therefore, adeq uate evaluation of the subcarinal lymph nodes was possible in 72 out o f 80 (90%) patients. In 50 of these 72, malignant mediastinal spread w as proven, and further invasive surgical staging could be avoided. Sub group analysis showed that this outcome tended to be more likely in pa tients with abnormal endoscopic appearance of the main carina, with lo cally extensive tumours, and with nonsquamous histology. These results indicate that transbronchial needle aspiration biopsy of subcarinal l ymph nodes can be a valuable alternative to more invasive surgical sta ging in patients selected by CT scan.