4588 Endoscopic ultrasound as a first-line diagnostic and staging test after ct in patients with suspected or proven lung cancer: yield in 122 consecutive patients.

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Background: 50% of lung cancer patients have mediastinal lymph node metastases. Proof of ipsilateral node (N2) or contralateral node (N3) involvement contraindictates surgery as primary treatment, but usually requires mediastinoscopy. EUS-guided fine needle aspiration (FNA) provides access to posterior mediastinal nodes and may therefore prevent mediastinoscopy and document surgically incurable disease. Aim: To verify the yield of EUS as a first-line diagnostic and staging modality in patients with suspected or proven lung cancer by CT and/or bronchoscopy. Methods: EUS-FNA was used as a first-line diagnostic and/or staging test in consecutive patients with suspected or proven lung cancer in whom CT showed mediastinal disease accessable for EUS-FNA. Results: 122 consecutive patients had disease that appeared amenable to EUS-FNA: 70 with suspected and 52 with proven lung cancer. Overall, EUS was attempted in 118 (97%) cases: 10 masses and 108 nodes (47% level 7 [AP window]; 32% level 5 [subcarina]; 15% levels 5 & 7; and 6% other node levels). There were no complications. A cytological diagnosis of cancer was obtained in 46/70 (69%) of suspected cancers. The yield for nodal staging was calculated on an "intent to stage" basis. Mediastinal node involvement was documented cytologically in 73/112 (60%) cases where staging was the aim: 37/112 (33%) N2 and 36/112 (32%) N3 nodes. See Table. Conclusions: 1) EUS has a high yield in patients with suspected or proven lung cancer with mediastinal disease by CT. 2) A cytological diagnosis of cancer is obtained in 2/3 patients with suspected cancer. 3) Cytological proof of mediastinal ipsilateral or contralateral disease is obtained in 2/3 patients.