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Clinical Investigations: LUNG CANCER |

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

Annette Fritscher-Ravens, MD; Nib Soehendra, MD; Lars Schirrow; Parupudi V. J. Sriram, MD; Andreas Meyer, MD; Hans-Peter Hauber, MD; Almuth Pforte, MD
Author and Funding Information

*From the Department of Endoscopic Surgery (Drs. Fritscher-Ravens, Soehendra, Sriram, and Mr. Schirrow), and the Department of Internal Medicine, Pulmonology (Drs. Meyer, Hauber, and Pforte), University Hospital Eppendorf, Hamburg, Germany.

Correspondence to: Annette Fritscher-Ravens, MD, Department of Endoscopic Surgery, University Hospital Eppendorf, 52 Martinistrasse, 20246, Hamburg, Germany



Chest. 2000;117(2):339-345. doi:10.1378/chest.117.2.339
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Study objective: Bronchoscopic methods fail to diagnose lung cancer in up to 30% of patients. We studied the role of transesophageal endosonography (EUS)-guided fine-needle aspiration (FNA; EUS-FNA) in such patients.

Design: Prospective study. The final diagnosis was confirmed by cytology, histology, or clinical follow-up.

Setting: University hospital.

Patients: Thirty-five patients (30 male and 5 female; mean age, 60.9 years; range, 34 to 88 years) with suspected lung cancer in whom bronchoscopic methods failed. Patients with a known diagnosis, recurrence of lung cancer, or mediastinal metastasis from an extrathoracic primary were excluded.

Interventions: EUS and guided FNA of mediastinal lymph nodes.

Results: The procedure was uneventful, and material was adequate in all. The final diagnosis by EUS-FNA was malignancy in 25 patients (11 adenocarcinoma, 10 small cell, 3 squamous cell, and 1 lymphoma) and benign disease in 9 patients (5 inflammatory, 2 sarcoidosis, and 2 anthracosis). Another patient with a benign result had signet-ring cell carcinoma diagnosed on pleural fluid cytology (probably false-negative in EUS-FNA). The sensitivity, specificity, accuracy, and positive and negative predictive values were 96, 100, 97, 100, and 90%, respectively. There were no complications. Reviewing the EUS morphology, the nodes were predominantly located in levels 7 and 8 of American Thoracic Society mediastinal lymph node mapping (subcarinal and paraesophageal region). In seven patients, the punctured nodes were< 1 cm (four malignant and three benign), which are difficult to sample by other methods. The malignant nodes had a hypoechoic, homogenous echotexture.

Conclusions: EUS-FNA is a safe, reliable, and accurate method to establish the diagnosis of suspected lung cancer when bronchoscopic methods fail, especially in the presence of small nodes.

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