American Journal of Respiratory and Critical Care Medicine

American Journal of Respiratory and Critical Care Medicine...

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Endoscopic Ultrasound in Non–Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography Julia K. LeBlanc, Benedict M. Devereaux, Thomas F. Imperiale, Ken Kesler, John M. DeWitt, Oscar Cummings, Donato Ciaccia, Stuart Sherman, Praveen Mathur, Dewey Conces, Joann Brooks, Melissa Chriswell, Lawrence Einhorn, and Edith Collins Department of Medicine, Division of Gastroenterology, Pulmonology, and Oncology; Department of Surgery, Thoracic Division; Department of Pathology; Department of Radiology; Roudebush VA Medical Center; and The Regenstrief Institute, Inc., Indiana University Medical Center, Indianapolis, Indiana Despite technical advances in staging non–small cell lung cancer (NSCLC), accurate staging remains a challenge. Endoscopic ultra- sound is useful in staging NSCLC when lymphadenopathy is present on a computed tomography (CT), but its role in the absence of lymphadenopathy on CT has not been well defined. Therefore, we sought to determine the clinical impact of endoscopic ultrasound (EUS) in staging NSCLC in absence of mediastinal lymphadenopathy on CT. Seventy-six patients with NSCLC with absence of mediastinal lymphadenopathy on CT were enrolled and followed prospectively. EUS-guided fine-needle aspiration was performed on sites that were suspicious for metastases. Surgical pathology after thoracotomy was used as the reference standard for assessing accuracy. Sixty- two (86%) patients underwent surgery, and 10 (13%) did not. EUS precluded surgery in 9 patients (12%) and influenced management in 18 (25%) of all patients in this study. EUS detected malignant mediastinal lymphadenopathy more frequently in patients with lower lobe and hilar cancers combined compared with upper lobe cancers (p 5 0.004). EUS played a significant role in identifying patients with unresectable (N3) NSCLC when adenopathy was not present on CT imaging and appears to be more sensitive in de- tecting lymph node metastases in lower lobe and hilar NSCLC com- pared with upper lobe NSCLC. Keywords: endoscopic ultrasound; fine-needle aspiration; mediastinal lymphadenopathy; thoracotomy; non–small cell lung cancer Lung cancer is our nation’s leading cancer killer of men and women (1–2). An unpublished report from the Society of Cardio- thoracic Surgeons of Great Britain and Ireland (1985) revealed that approximately one in Fve thoracotomies performed for lung cancer were “open and close.” Certainly, thoracotomy for unre- sectable non–small cell lung cancer (NSCLC) is not only costly but would be expected to impact negatively on the patient’s quality of life. The accuracy of computed tomography (CT) staging of lung cancer varies widely (3–10). Because of the lack of contrast within the mediastinum and signal averaging, CT detects abnor- mal lymph nodes that are greater than 1 cm. However, lymph nodes that are undetected by CT may harbor metastases, and benign lymph nodes are often greater than 1 cm (5–19). Based on CT Fndings, approximately 23% of NSCLC patients are overstaged, and 19% are understaged (20). Although many stud-
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This note was uploaded on 02/23/2011 for the course HTEC 50 taught by Professor Hassel,patricia during the Spring '11 term at DeAnza College.

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American Journal of Respiratory and Critical Care Medicine...

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