Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer

A comparison study

Frank G. Gress, Thomas J. Savides, Alan Sandler, Kenneth Kesler, Dewey Conces, Oscar Cummings, Praveen Mathur, Steven Ikenberry, Sandy Bilderback, Robert Hawes

Research output: Contribution to journalArticle

264 Citations (Scopus)

Abstract

Background: Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. Objective: To assess the utility of endoscopic ultrasonography, fine-need e aspiration biopsy guided by endoscopic ultrasonography and computed tomography for the detection of metastases to the poster or mediastinal lymph nodes in non-small-cell lung cancer. Design: Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Setting: Referral-based academic medical center. Patients: 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. Interventions: All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. Results; 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography with- out aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P< 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of the 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients; the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography- guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. Conclusions: Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or 'bulky' subcarinal nodes.

Original languageEnglish
Pages (from-to)604-612
Number of pages9
JournalAnnals of Internal Medicine
Volume127
Issue number8 I
StatePublished - 1997

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Endosonography
Fine Needle Biopsy
Non-Small Cell Lung Carcinoma
Tomography
Lymph Nodes
Needle Biopsy
Ultrasonography
Neoplasm Metastasis
Cell Biology
Posters
Neoplasms
Surgical Pathology
Thoracotomy
Dissection
Thorax
Referral and Consultation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer : A comparison study. / Gress, Frank G.; Savides, Thomas J.; Sandler, Alan; Kesler, Kenneth; Conces, Dewey; Cummings, Oscar; Mathur, Praveen; Ikenberry, Steven; Bilderback, Sandy; Hawes, Robert.

In: Annals of Internal Medicine, Vol. 127, No. 8 I, 1997, p. 604-612.

Research output: Contribution to journalArticle

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title = "Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer: A comparison study",
abstract = "Background: Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. Objective: To assess the utility of endoscopic ultrasonography, fine-need e aspiration biopsy guided by endoscopic ultrasonography and computed tomography for the detection of metastases to the poster or mediastinal lymph nodes in non-small-cell lung cancer. Design: Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Setting: Referral-based academic medical center. Patients: 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. Interventions: All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. Results; 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography with- out aspiration biopsy had an overall accuracy of 84{\%} for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49{\%} (P< 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of the 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients; the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography- guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96{\%}; the results of this test prompted a change in management in 95{\%} of the patients who had the procedure. Conclusions: Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or 'bulky' subcarinal nodes.",
author = "Gress, {Frank G.} and Savides, {Thomas J.} and Alan Sandler and Kenneth Kesler and Dewey Conces and Oscar Cummings and Praveen Mathur and Steven Ikenberry and Sandy Bilderback and Robert Hawes",
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T1 - Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer

T2 - A comparison study

AU - Gress, Frank G.

AU - Savides, Thomas J.

AU - Sandler, Alan

AU - Kesler, Kenneth

AU - Conces, Dewey

AU - Cummings, Oscar

AU - Mathur, Praveen

AU - Ikenberry, Steven

AU - Bilderback, Sandy

AU - Hawes, Robert

PY - 1997

Y1 - 1997

N2 - Background: Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. Objective: To assess the utility of endoscopic ultrasonography, fine-need e aspiration biopsy guided by endoscopic ultrasonography and computed tomography for the detection of metastases to the poster or mediastinal lymph nodes in non-small-cell lung cancer. Design: Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Setting: Referral-based academic medical center. Patients: 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. Interventions: All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. Results; 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography with- out aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P< 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of the 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients; the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography- guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. Conclusions: Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or 'bulky' subcarinal nodes.

AB - Background: Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. Objective: To assess the utility of endoscopic ultrasonography, fine-need e aspiration biopsy guided by endoscopic ultrasonography and computed tomography for the detection of metastases to the poster or mediastinal lymph nodes in non-small-cell lung cancer. Design: Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Setting: Referral-based academic medical center. Patients: 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. Interventions: All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. Results; 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography with- out aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P< 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of the 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients; the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography- guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. Conclusions: Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or 'bulky' subcarinal nodes.

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