Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) An Accurate Modality in the Diagnosis of Recurrent Lung Cancer

Abstract

Background: Despite surgical resection or chemo- radiation a significant percentage of patients with lung cancer develop recurrent disease. Although mediastinoscopy is a proven tool in the initial staging of patients, it is more difficult to perform after treatment in patients with suspected lung cancer recurrence. Thus alternative accurate and less invasive methods are needed. Objectives: Our goal was to assess the utility of Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) in confirming suspected recurrences in patients who were previously treated for lung cancer. Patients and Methods: We retrospectively reviewed the charts of all patients that underwent EUS-FNA for diagnosis of suspected recurrent lung cancer between July 2003 through May 2006. Results: We identified 11 patients who underwent an EUS-FNA performed for suspected recurrent lung cancer. 9 patients had a previous diagnosis of non small cell lung cancer (NSCLC) and 2 patients had a previous diagnosis of small cell lung cancer (SLC).8 patients had prior thoracic surgeries (2 thoracotomies, 2 mediastinoscopies, and 4 both) with or without chemotherapy and/or radiation and 3 had only chemotherapy and/or radiation. All patients had abnormal imaging including chest CT and/or Positron Emission Tomography (PET) suggesting recurrent disease. All patients had the EUS-FNA performed at least 4 months after the completion of their therapy, with an average time of 19 months (range: 4 to 60 months). 8 patients underwent FNA of either a mediastinal lymph node or mass (average size 29 mm, range 10 to 38 mm), while 3 patients underwent FNA of an enlarged adrenal mass (average size 42 mm, range of 25 to 62 mm). EUS-FNA confirmed recurrence of lung cancer in 8 out of 11 patients: 6 had a positive FNA of mediastinal lymph nodes or masses, and 2 patients had a positive FNA of a left adrenal mass. Of the remaining 3 patients with a negative EUS-FNA, 1 had a follow-up mediastinoscopy with a left lower lobe biopsy that was positive for moderately differentiated squamous cell carcinoma with lymph node involvement. The other two patients have remained in remission with a follow up time of 20 and 11 months respectively. There were no procedure related complications noted. Conclusions: Our results suggest that EUS-FNA may be an effective and safe modality to evaluate for recurrent lung cancer after either a thoracotomy, mediastinoscopy or chemo-radiation. However further prospective studies will be needed to confirm our results.