Interventional Pulmonology

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA
Ichiro Yasuda^a, Tatsuo Kato^b, Fumihiro Asano^d, Kenichi Okubo^c, Salem Omar^f, Nobuo Kako^e, Shigeo Yasuda^b, Kimiyasu Sano^b, Nib Soehendra^f, Hisataka Moriwaki<sup>a

a</sup>First Department of Internal Medicine, Gifu University Hospital, Departments of
^bPulmonary Medicine and
^cThoracic Surgery, National Hospital Organization Nagara Medical Center,
^dDepartment of Pulmonary Medicine, Gifu Prefectural General Medical Center, and
^eDepartment of Radiology, Kizawa Memorial Hospital, Gifu, Japan;
^fDepartment of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Address of Corresponding Author

Respiration 2009;78:423-431 (DOI: 10.1159/000235544)

  Key Words

• Computed tomography
• Endoscopic ultrasonography
• Endoscopic ultrasound-guided fine needle aspiration
• FDG-PET
• Lung cancer staging
• Mediastinal lymph node
• Non-small cell lung cancer

  Abstract

Background: Mediastinal lymph node staging (N-staging) is essential to optimize the treatment in non-small cell lung cancer (NSCLC). Transesophageal endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has recently been introduced as a complementary method. However, in most reports, EUS-FNA has been performed in patients who have demonstrated enlarged lymph nodes (LNs) on CT findings. The yield of EUS/EUS-FNA in patients without enlarged mediastinal LNs by CT has so far only been evaluated in a few reports. Aims: Our aim was to compare the diagnostic accuracy of CT and EUS with or without EUS-FNA (EUS/EUS-FNA) prospectively, for N-stage in all patients with potentially resectable NSCLC, including patients with and without mediastinal LN enlargement based on CT findings. Methods: Eighty consecutive patients with potentially resectable NSCLC based on CT findings were enrolled in this prospective comparative study, and underwent EUS/EUS-FNA. Results: Pathological N-stage was established in 78 patients, while in another 2 cases, malignant pleural effusion was proven by EUS-FNA, and we avoided further N-staging. In the 78 patients, the prevalence of malignant mediastinal LNs was 21%. The accuracy of EUS/EUS-FNA (91%) was significantly higher than that of CT (71%). The negative predictive value of EUS/EUS-FNA was 90%. In addition, EUS-FNA identified 2 patients as N3 disease in 56 patients without mediastinal LN involvement on CT. Conclusions: EUS/EUS-FNA gave more accurate N-staging in patients with possibly resectable NSCLC than CT, and is thus considered to be useful to determine the optimal treatment strategy.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Ichiro Yasuda, MD, PhD
First Department of Internal Medicine
Gifu University Hospital
1-1 Yanagido, Gifu 501-1194 (Japan)
Tel. +81 58 230 6308, Fax +81 58 230 6310, E-Mail yasudaic@aol.com

  Article Information

Received: July 24, 2008
Accepted after revision: May 28, 2009
Published online: August 11, 2009
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 4, Number of References : 36