Abstract
7606 Background: Patients with limited (cT1–3N0–1) malignant pleural mesothelioma (MPM) are potential candidates for trimodality therapy with induction chemotherapy, extrapleural pneumonectomy and hemithoracic irradiation. Since invasion of the mediastinal lymph nodes (MLN) is a negative prognostic factor, cervical mediastinoscopy has been recommended for staging. Transesophageal endoscopic ultrasound (EUS) and real-time guided fine needle aspiration (FNA) enables MLN staging in lung cancer patients with high accuracy. This study determined the feasibility and diagnostic yield of EUS-FNA in MPM, in comparison to the gold standard surgical-pathological staging. Methods: In this prospective two-center study, eligible patients had pathologically confirmed and potentially resectable MPM. Staging was performed by spiral-CT, PET, EUS-FNA and, irrespective of the EUS-FNA results, by cervical mediastinoscopy. Subsequently, patients had cisplatin and pemetrexed chemotherapy, which was in case of response or stable disease, followed by extrapleural pneumonectomy and MLN dissection. Results: Thirty-two consecutive patients (26 males; 25 right-sided) were registered from June 2004 until January 2007. Median age was 59 years (range 40–67). There were 2 sarcomatous, 26 epithelial and 4 biphasic subtypes. EUS was performed in all patients, in 7/32 without FNA since no lymph nodes > 5 mm were seen. EUS-FNA showed malignant cells amid a lymphocyte background in 4 (19%). Cervical mediastinoscopy was subsequently performed in 27 (84%) patients, which revealed no additional patients with MLN metastasis. In 11 patients, negative EUS-FNA was not confirmed by thoracotomy, mainly due to disease progression and clinical deterioration. Thoracotomy revealed a single level MLN metastasis at Naruke 4R in one patient, which was detected by neither EUS-FNA nor mediastinoscopy. Sensitivity of EUS- FNA for MLN metastases was 80% (95%-confidence limit 28–99%), specificity 95% (79–100%), NPV 94% (71–99%) and PPV 100% (39–100%). Conclusions: This is the first prospective study of EUS-FNA in MPM. EUS-FNA seems both a feasible and reliable tool for mediastinal staging in patients with potentially resectable MPM. Cervical mediastinoscopy in addition to EUS-FNA did not contribute to the detection of MLN metastases. No significant financial relationships to disclose.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
