EUS-FNA in the preoperative staging of non-small cell lung cancer

Talebian, M.; von Bartheld, M.B.; Braun, J.; Versteegh, M.I.M.; Dekkers, O.M.; Rabe, K.F.; Annema, J.T.

doi:10.1016/j.lungcan.2009.08.016

« Previous Next »Lung Cancer
Volume 69, Issue 1 , Pages 60-65, July 2010

EUS-FNA in the preoperative staging of non-small cell lung cancer

M. Talebian
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
M.B. von Bartheld
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
J. Braun
- Department of Cardio-thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
M.I.M. Versteegh
- Department of Cardio-thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
O.M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
K.F. Rabe
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
J.T. Annema
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
- Corresponding author at: Department of Pulmonology, Leiden University Medical Center, Staf longziekten C3-P, Leiden, Netherlands. Tel.: +31 71 526 2950; fax: +31 71 526 6927.

Received 30 June 2009; received in revised form 15 August 2009; accepted 19 August 2009. published online 17 September 2009.

Abstract

Background

According to current guidelines, transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) can be performed as an alternative for surgical staging to confirm mediastinal metastases in patients with non-small cell lung cancer (NSCLC). To date however, data regarding the routine use of EUS-FNA in the preoperative staging of unselected patients with NSCLC are limited.

Aims and objectives

(1)To evaluate the diagnostic value of EUS-FNA in consecutive, patients with NSCLC regardless of nodal size at CT.

(2)To determine the impact of EUS-FNA on the prevention of surgical staging procedures.

(3)To assess the accuracy of mediastinal staging by combining EUS-FNA and mediastinoscopy.

(4)To investigate whether a subgroup of patients exists that can be accurately staged by EUS-FNA alone.

Methods

152 consecutive operable patients with proven or suspected NSCLC who underwent EUS-FNA were retrospectively analyzed. In the absence of mediastinal metastases, mediastinoscopy and/or thoracotomy with lymph node dissection was performed.

Results

The prevalence of mediastinal metastases was 49%. Sensitivity, negative predictive value (NPV) and accuracy of EUS-FNA for N2/N3 disease were 74%, 73% and 85% respectively, whereas these values for the combined staging of EUS-FNA and mediastinoscopy were 92%, 85% and 95%. Additional surgical staging in patients staged N0 at EUS-FNA reduces the false negative EUS-findings by 55%. The NPV of EUS-FNA for left-sided tumors was 68%. EUS-FNA prevented surgical staging procedures in 60 of 152 patients (39%). No major complications occurred during EUS-FNA.

Conclusion

Routine use of EUS-FNA in unselected patients with NSCLC reduces the need for surgical staging procedures in nearly half of patients. Additional surgical staging in patients without nodal metastases at EUS-FNA reduces the false negative EUS-FNA findings considerably regardless of the location of the primary lung tumor.

Keywords: Transesophageal ultrasound-guided fine needle aspiration, Preoperative staging, Non-small cell lung cancer, Diagnostic accuracy, Mediastinum