Chest
Clinical InvestigationsCANCERMediastinal Lymph Node Involvement in Potentially Resectable Lung Cancer*: Comparison of CT, Positron Emission Tomography, and Endoscopic Ultrasonography With and Without Fine-Needle Aspiration
Section snippets
Patients
From May 2000 to August 2001, a total of 117 patients were referred and investigated for suspected lung cancer. All patients underwent thoracic CT, EUS and, if necessary, EUS-FNA for diagnosis and/or staging, this being the routine workup for patients with suspected lung cancer prior to therapy in the University Hospital Hamburg-Eppendorf. Of the total number of 33 consecutive patients (23 men and 10 women; mean age, 61.5 years; age range, 41 to 80 years) with clinical suspicion of or proven
Results
Sixteen of 33 patients (48%) had mediastinal nodal metastases proven by surgical histology. The size of the lymph nodes varied from 0.4 to 1.6 cm in diameter (median, 1.0 cm). In 14 patients, metastases ipsilateral to the tumor were seen; in an additional 2 patients, EUS-FNA detected contralateral involvement. These two patients underwent thoracoscopy only without resection, which confirmed N3 status. Final diagnosis was NSCLC in 30 patients, neuroendocrine tumor in 1 patient, and benign
Conclusion
CT alone was not reliable in the diagnosis of mediastinal lymph node metastases. PET alone was also inconclusive due to fp and fn results, nor was EUS alone useful, because of its relatively low specificity. The combination of CT and PET resulted in a significantly better evaluation of the mediastinum. Since thoracic CT allows evaluation of the pretracheal region as well as the rest of the thorax, and EUS-FNA yields staging information and tissue diagnosis, the combination of CT and EUS-FNA was
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Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis
2019, Journal of Thoracic OncologyCitation Excerpt :A total of 31 studies or subgroups with use of endosonography only (without additional surgical staging) were included (Fig. 2). Of these studies, 12 evaluated EBUS,11–22 seven evaluated EUS,13,23–28 and 12 evaluated combined EBUS and EUS as a staging method.13,29–37 One study was a randomized controlled trial (RCT) comparing staging by EBUS followed by EUS versus EUS followed by EBUS, and one study was an observational study comparing EBUS plus EUS versus EBUS plus EUS with use of the EBUS scope.
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