EUS-guided FNA of lung masses adjacent to or abutting the esophagus after unrevealing CT-guided biopsy or bronchoscopy

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Background

The accuracy, the safety, and the cost-effectiveness of EUS-guided FNA for screening patients with lung cancer for mediastinal metastasis are well established, but the utility of EUS-guided FNA in evaluating lung mass per se has not been investigated. This study retrospectively evaluated experience with EUS-guided FNA of lung mass lesions after unsuccessful attempts by CT-guided or bronchoscopic tissue sampling to establish a tissue diagnosis.

Methods

A database was searched for all patients who had EUS-guided FNA of lung mass lesions over a 3-year period. The diagnostic yield and safety of EUS-guided FNA were evaluated.

Observations

Eighteen patients (11 men, 7 women) underwent EUS-guided FNA of lung mass lesions adjacent to or abutting the esophagus. The indication for EUS-guided FNA was evaluation of the mediastinum of patients with lung mass of unclear etiology. EUS-guided FNA yielded tissue for diagnosis in 100% of patients: 15 non-small-cell lung cancer, one small-cell lung cancer, two metastatic lung disease. Ten patients had unresectable disease; in 8, the mass was conf ined to the lung parenchyma. The mean number of needle passes required to establish a diagnosis was two (range 1–6). No complication was encountered (mean follow-up 141 days; range 72–396 days). Five patients underwent curative surgery, and 13 had palliative chemoradiation.

Conclusions

In this study, EUS-guided FNA of lung mass was safe, and it established a diagnosis in all patients with accessible lesions. Given these preliminary data, a prospective evaluation of this new indication for EUS-guided FNA is justified.

Section snippets

Patients and Methods

The records of all patients who underwent EUS-FNA of lung parenchymal lesions from July 2000 to June 2003 were reviewed retrospectively. Patients were referred for mediastinal EUS-FNA staging of suspected lung cancer after failure by CT-guided sampling and/or bronchoscopy to establish a tissue diagnosis. Patients were referred by thoracic surgeon members of a multidisciplinary team who were highly familiar with the application of EUS in lung cancer staging. These surgeons prefer to stage lung

Observations

Eighteen patients (11 men, 7 women; mean age 62.5 years; range 41–77 years) underwent EUS because CT revealed a lung mass (Table 1). In all patients, prior attempts to establish a definitive tissue diagnosis by CT-guided tissue sampling and/or bronchoscopy had been unsuccessful (CT, 9 patients; bronchoscopy, 6; both, 3). Fourteen patients had a right- or a left-side lower lobe lung mass, and 4 had a right- or a left-side upper lobe lung mass.

Radial and linear echoendoscopy was performed in all

Discussion

This series demonstrates the feasibility of estab-lishing a tissue diagnosis by EUS-FNA in patients with lung parenchymal masses adjacent to or abutting the esophagus. In a series of 49 patients with mediastinal masses from a single center, a diagnosis of lung cancer was made by EUS-FNA in 4 patients, all of whom had previously undiagnosed lung cancer.6 There was no procedure-related complication. As an initial approach to the diagnosis of lung cancer, lung tissue usually is obtained under CT

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