Endoscopic Ultrasound, Positron Emission Tomography, and Computerized Tomography for Lung Cancer

Abstract

Staging of patients with lung cancer to determine operability is intended to efficiently limit futile thoracotomies without denying possibly curative surgery. Currently available staging tests are imperfect alone and in combination. Imaged suspected metastases often require tissue confirmation before surgery can be denied. Endoscopic ultrasound (EUS) may help identify inoperable patients by providing tissue proof of inoperability in a single staging test, with similar sensitivity for identifying inoperable patients as other staging tests. Therefore, we compared computed tomography, positron emission tomography (PET), and EUS with fine-needle aspiration under conscious sedation, each test interpreted blinded with respect to the other tests, for identifying inoperable patients in a consecutive cohort of 79 potentially operable patients with suspected or proven lung cancer. An economic analysis was also performed. Thirty-nine patients were found inoperable (a 40th patient's inoperability was missed by all preoperative staging tests). The sensitivity of computerized tomography was 43%. PET and EUS each had similar sensitivities (68 and 63%, respectively) and similar negative predictive values (64 and 68%, respectively), but EUS's superior specificity (100 vs. 72% for PET) and considerably lower expense means it may be preferred to PET early in staging to identify inoperable patients.

First endoscopic procedure for diagnosis and staging ofmediastinal lymphadenopathy

“…In contrast, both TBNA and EUS-FNA are minimally invasive and can be performed in the outpatient setting under local anesthesia and sedation. EUS-FNA permits real-time visualization of needle sampling and has been shown to be highly accurate in the mediastinal staging of lung cancer, as well as in the diagnosis of mediastinal lymphadenopathy of unknown etiology [6,[12][13][14][15][16][17][18] . The development of EBUS-TBNA for mediastinal lymph nodes has lagged behind EUS-FNA by more than a decade [19,20] .…”

Endoscopic Ultrasound : A New Hope for Patients

“…31 Staging of lung cancer by EUS-FNA is >90% accurate in nodal staging of non small cell lung cancer (NSCLC), being more sensitive than CT 32 and more specific than PET. 32,33 . This also has efficacy in assessing tumor stage, taking biopsy of tumor adjacent the oesophagus and assessment of metastatic disease in the left lobe of the liver and left adrenal gland.…”

Prognostic value of FDG-PET scans at diagnosis in small cell lung cancer

“…The role of FDG-PET in non-small cell lung cancer (NSCLC) has been widely studied, with a trend to upstaging compared to conventional CT scans along with [10][11][12][13][14][15][16][17][18][19] a change in clinical management [20][21][22][23][24][25] . In fact, the intensity of FDG uptake in NSCLC, as measured by highest standard uptake value [SUV max ] has also been shown to correlate with prognosis [26] .…”