Mediastinal restaging: EUS-FNA offers a new perspective.

Abstract

STUDY OBJECTIVE:

We hypothesized that transoesophageal endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has the potential to be a valuable and accurate new diagnostic technique for mediastinal restaging in non-small cell lung cancer (NSCLC) after induction chemotherapy. The current restaging modalities either have a low diagnostic accuracy (computed tomography (CT) scan of the thorax) or they are invasive, can be technically difficult and are therefore not commonly performed (remediastinoscopy).

METHODS AND PATIENTS:

Nineteen consecutive patients with NSCLC and proven ipsilateral or subcarinal lymph node metastases (N2 disease) who had been treated with induction chemotherapy underwent mediastinal restaging by EUS-FNA. Patients had either a partial response (n=14) or stable disease (n=5) based on sequential CT scans of the thorax.

INTERVENTIONS:

EUS-FNA was performed in an ambulatory setting with biopsy of mediastinal lymph nodes (LN). No complications occurred. When EUS-FNA restaged the mediastinum as no regional lymph node metastasis (N0), surgical resection of the tumour with lymph node sampling or dissection was performed.

RESULTS:

The positive predictive value, negative predictive value, sensitivity, specificity and diagnostic accuracy of EUS-FNA in restaging mediastinal LN were 100, 67, 75, 100 and 83%, respectively.

CONCLUSIONS AND SIGNIFICANCE:

EUS-FNA qualifies as an accurate, safe and minimally invasive diagnostic technique for the restaging of mediastinal lymph nodes after induction therapy in NSCLC. In the future EUS-FNA might play an important role in the mediastinal restaging in NSCLC, particularly to identify the subgroup of down staged patients who benefit most from further surgical treatment.

• Authors: Jouke T Annema, Maud Veseliç, Michel I M Versteegh, Luuk N A Willems, Klaus F Rabe
• Journal: Lung cancer (Amsterdam, Netherlands) (Lung Cancer) Vol. 42 Issue 3 Pg. 311-8 (Dec 2003) ISSN: 0169-5002 [Print] Ireland
• PMID: 14644519 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Biopsy, Fine-Needle (methods)
• Carcinoma, Non-Small-Cell Lung (drug therapy, pathology)
• Female
• Humans
• Lung Neoplasms (drug therapy, pathology)
• Lymph Nodes (pathology)
• Male
• Mediastinum (pathology)
• Middle Aged
• Neoplasm Staging
• Reproducibility of Results