Endoscopic (oesophageal) ultrasound guided fine needle aspiration (EUS-FNA)

The management of lung cancer depends to a great extent on its histological type and the stage of disease. Although most patients with non-small cell lung cancer (NSCLC) have advanced disease at presentation, approximately 30% have tumour confined to the lung and locoregional lymph nodes. For these patients surgery offers the best hope of a cure. Despite apparent complete resection, 5 year survival rates after surgery are approximately 40–50%.¹ This highlights the importance of accurately staging lung cancer to determine resectability and provide prognostic information.

In clinical practice a presumptive diagnosis and stage are based on presentation, risk factors, and radiological appearances—particularly CT scans. Obtaining a histological diagnosis and confirming the stage of the disease often take place at the same time. One of the most difficult tasks is accurate staging of nodal involvement in the mediastinum.

It is reported that mediastinal lymph nodes contain metastatic disease in 28–38% of patients with NSCLC at the time of diagnosis.² Traditionally, CT scanning has been used to assess mediastinal lymph node involvement. Lymph nodes greater than 1 cm in short axis diameter are considered abnormal and suggest involvement. However, CT detection of lymph node spread has sensitivity and specificity rates of 61% and 79%, respectively.³ Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) is more accurate in identifying mediastinal lymph node involvement. FDG-PET in combination with CT scanning has been shown to further improve sensitivity and specificity rates in detecting lymph node involvement,³ but in much of …