Does endoesophageal ultrasound-guided fine-needle aspiration replace mediastinoscopy in mediastinal staging of thoracic malignancies?☆

Abstract

EUS-FNA sensitivity depends on the localisation of the primary tumour, and extent and location of mediastinal disease. For left-sided tumours, EUS-FNA improves mediastinal staging by assessing stations 5 and 6 inaccessible to conventional mediastinoscopy. For extended mediastinal disease, mediastinoscopy can be avoided or spared for restaging after neoadjuvant therapy. Exclusion of mediastinal involvement requires mediastinoscopy or open lymphadenectomy. Beyond mediastinal nodal staging, EUS-FNA may detect T4 and M1 situations. Thus, EUS-FNA is a useful supplement to and not the replacement of mediastinoscopy.

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

“…This high proportion is in concordance with other studies in which patients were included who were selected by CT or PET [4,9,12]. Our retrospective study thus confirms that EUS-FNA, as a minimally invasive alternative to surgical staging, reduces the need for surgical procedures.…”

“…In a recent study, a high EUS-FNA sensitivity was found for leftsided tumors [12]. Left-sided tumors predominantly metastasize to lymph node stations 4L and 7 that can accurately be assessed by EUS-FNA.…”

EUS and EBUS in Non–Small Cell Lung Cancer

“…19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] In a meta-analysis of 18 studies of EUS FNA for the mediastinal staging of lung cancer, sensitivity was 83% (95% confidence interval [CI], 78% to 87%) and specificity was 97% (95% CI, 96% to 98%). 39 In those patients with enlarged lymph nodes, sensitivity was 90% (95% CI, 84% to 94%).…”

Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed?

“…Unlike for other modalities, the sensitivity of EUS-FNA seems to be affected by variables such as node size, location of the tumor, and nodal station. One study showed that sensitivity can be as high as 91.7 % for bulky lymph nodes and as low as 43.8 % for nodes smaller than 1 cm on CT scan [32]. It was also shown that sensitivity for right-sided tumors (50 %) was lower than for left-sided tumors (96.6 %), and that sensitivity was highest (80.6 %) for station 7 and lowest (23.8 %) for station 4R.…”