A prospective cost-effective evaluation of EUS directed fine needle aspiration biopsy (EUS+FNA) of mediastinal lymphadenopathy in the preoperative staging of non-small cell lung cancer (NSCLCA)

F. Gress, T. Savides, S. Ikenberry, K. Kesler, O. Cummings, D. Conces, A. Sandler, P. Mathur, S. Bilderback, R. Hawes

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Abstract

INTRODUCTION: Mediastinal lymph node (MLN) metastasis in pts with NSCLCA has significant impact on prognosis since contralateral and subcarinal MLN are contraindication to surgery CT is currently considered the gold standard in the preop evaluation for MLN. In our previous study EUS alone had a 75% accuracy in diagnosing MLN metastasis compared to 43% for CT. AIM OF STUDY: This study was undertaken to evaluate the role of EUS + FNA as a cost-effective method of evaluating MLN compared to CT, mediastinoscopy and thoracotomy in pts with NSCLCA. METHODS All pts with NSCLCA who were surgical candidates underwent preop CT and EUS + FNA using radial scanning (Olympus) or linear array endosonography (Pentax). All LNs visualized were labeled benign or malignant based on their FNA results. At surgery, LNs were dissected & categorized by location and their status determined by histopathology. RESULTS: 25 pts were enrolled in this study and underwent EUS + FNA. All pts had MLN visualized by EUS. Results for EUS+FNA & CT imaging: PATH PATH + - + - + 15 0 Acc= 96% + 10 7 Acc=58% EUS + FNA Sens= 93% CT Sens=70% Spec=100% Spec=33% - 1 9 PPV=100% - 4 4 PPV=65% NPV= 90% NPV=35% 60% (15/25 pts) had malignant cells on FNA thus precluding them from surgery. In 10 pts. with negative FNA, surgical pathology correlated in 9/10. The false negative node had a 2 mm focus of C A. A cost comparison of EUS +FNA($1,525) with currently acceptable methods for detecting MLN metastasis, specifically mediastinoscopy ($7,750)and thoracotomy ($24,020) for our study group suggests that EUS + FNA is an accurate less invasive, cost saving method for obtaining final staging of NSCLCA. SUMMARY: EUS+FNA had 96% accuracy, 100% specificity and 93% sensitivity. A significant change in management occurred in 96% (24/25). CONCLUSION: EUS+FNA is an accurate cost saving method for determining MLN metastasis in pts. with NSCLCA by avoidingmore invasive staging procedures and precluding surgery in pts where a cure is unlikely.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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