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The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Depts of ¹ Gastroenterology, and ² Respiratory Medicine, and ³ Cardiothoracic Care Centre, St Vincent's Hospital, Melbourne, Victoria, Australia

CORRESPONDENCE: G. Caddy, Dept of Gastroenterology, St Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, Victoria 3065, Australia. Fax: 61 392883590. E-mail: caddygr@svhm.org.au

Keywords: Endoscopic ultrasound, endoscopic ultrasound-guided fine-needle aspiration, lung cancer, lymphadenopathy, staging

Received: August 4, 2004
Accepted November 12, 2004

Optimal management of nonsmall cell lung cancer (NSCLC) depends on tissue diagnosis and accurate staging. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is minimally invasive and provides cytological confirmation of malignant mediastinal disease. The aim was to assess the accuracy of EUS-FNA in cases of enlarged mediastinal lymphadenopathy (LN) of unknown aetiology and in the staging of NSCLC.

A total of 52 consecutive patients with stage I–IIIb NSCLC or enlarged mediastinal LN of unknown aetiology underwent EUS-FNA. Negative results were confirmed with a surgical procedure: mediastinoscopy, video-assisted thoracic surgery (VATS) or lobectomy with systematic mediastinal lymph node dissection.

In total, 34 patients had EUS-FNA performed for diagnosis, whilst the remaining 18 had EUS-FNA for staging. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (95% confidence interval) were 93% (77–99), 100% (78–100), 100% (87–100), 88% (63–99) and 95% (84–99), respectively. When EUS-FNA was used in patients with NSCLC, the sensitivity, specificity, PPV, NPV and accuracy were 92% (73–99), 100% (69–100), 100% (85–100), 83% (51–98) and 94% (80–99), respectively. For mediastinal LN of unknown aetiology, no malignant disease was missed.

Endoscopic ultrasound-guided fine-needle aspiration is an accurate tool for assessing mediastinal lymph node involvement in nonsmall cell lung cancer and in the diagnosis of unexplained mediastinal lymphadenopathy. Endoscopic ultrasound-guided fine-needle aspiration is a minimally invasive procedure that can be used as an adjunct or alternative to mediastinoscopy.

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