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.
study. The final diagnosis was confirmed by cytology, histology, or
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.
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,
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.