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Endoscopic Ultrasound-Guided Fine-Needle Aspiration Staging of Lung Cancer : Is It Time To Go Beyond Cytology?

Manoop S. Bhutani, MD; Dennie V. Jones, Jr, MD; Joseph B. Zwischenberger, MD, FCCP
Author and Funding Information

Affiliations: Galveston, TX
 ,  Dr. Bhutani is Professor of Medicine, Director, Center for Endoscopic Ultrasound, Co-Director, CERTAIN (Center for Endoscopic Research, Training and Innovation); Dr. Jones is an Associate Professor of Medicine and Interim Chief of Division of Hematology-Oncology; and Dr. Zwischenberger is Professor of Surgery, Medicine, Radiology, and Director of General Thoracic Surgery, University of Texas Medical Branch.

Correspondence to: Manoop S. Bhutani, MD, Professor of Medicine, University of Texas Medical Branch, 301 University Blvd, Route 0764, Galveston, TX 77555-0764; e-mail: msbhutan@utmb.edu



Chest. 2005;127(2):418-420. doi:10.1378/chest.127.2.418
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Extract

Endoscopic ultrasonography (EUS) is a unique imaging modality in which a high-frequency ultrasound transducer is incorporated into the tip of an endoscope to provide high-resolution images of the GI wall and structures in close proximity to the GI tract. Linear echoendoscopes that can image parallel to the long axis of the instrument allow visualization of a projecting needle, relative to the adjacent tissue, making EUS-guided aspiration or intervention possible. Transesophageal EUS-guided real-time fine-needle aspiration (FNA) of mediastinal lymph nodes has become a clinically useful, minimally invasive, and safe method for detecting malignant lymph node invasion to stage the mediastinum.15 In patients with known non-small cell lung cancer (NSCLC) who have enlarged mediastinal lymph nodes on CT scan, the accuracy of EUS-guided FNA is approximately 96%.1 When a primary lung mass is suspected on CT, and enlarged mediastinal lymph nodes are seen in the posterior mediastinum, EUS-guided mediastinal FNA can provide a primary diagnosis and simultaneous staging information.56 Furthermore, EUS can also play a significant role in evaluating mediastinal lymphadenopathy of unknown origin with no primary lung mass on CT. Even when transbronchial FNA results are negative, EUS-guided FNA can provide a diagnosis of malignancy.2,6

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