Role of Transesophageal Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Lung Cancer

摘要

Study objective: Bronchoscopic methods fail to diagnose lung cancer in up to 30% of patients. Wenstudied the role of transesophageal endosonography (EUS)-guided fine-needle aspiration (FNA;nEUS-FNA) in such patients.nDesign: Prospective study. The final diagnosis was confirmed by cytology, histology, or clinicalnfollow-up.nSetting: University hospital.nPatients: Thirty-five patients (30 male and 5 female; mean age, 60.9 years; range, 34 to 88 years)nwith suspected lung cancer in whom bronchoscopic methods failed. Patients with a knownndiagnosis, recurrence of lung cancer, or mediastinal metastasis from an extrathoracic primarynwere excluded.nInterventions: EUS and guided FNA of mediastinal lymph nodes.nResults: The procedure was uneventful, and material was adequate in all. The final diagnosis bynEUS-FNA was malignancy in 25 patients (11 adenocarcinoma, 10 small cell, 3 squamous cell, andn1 lymphoma) and benign disease in 9 patients (5 inflammatory, 2 sarcoidosis, and 2 anthracosis).nAnother patient with a benign result had signet-ring cell carcinoma diagnosed on pleural fluidncytology (probably false-negative in EUS-FNA). The sensitivity, specificity, accuracy, and positivenand negative predictive values were 96, 100, 97, 100, and 90%, respectively. There were noncomplications. Reviewing the EUS morphology, the nodes were predominantly located in levelsn7 and 8 of American Thoracic Society mediastinal lymph node mapping (subcarinal andnparaesophageal region). In seven patients, the punctured nodes were < 1 cm (four malignant andnthree benign), which are difficult to sample by other methods. The malignant nodes had anhypoechoic, homogenous echotexture.nConclusions: EUS-FNA is a safe, reliable, and accurate method to establish the diagnosis of suspectednlung cancer when bronchoscopic methods fail, especially in the presence of small nodes.