Utility of EUS-FNA in the Evaluation of Primary Lung Mass

Abstract

Introduction: The accuracy, safety, and cost-effectiveness of EUS-FNA in screening patients with lung cancer for mediastinal metastasis are well established. While few studies have reported that FNA of mediastinal mass in some cases yield a diagnosis of lung cancer, the utility of EUS-FNA in evaluating primary lung mass per se has not been reported. Aim: To determine the diagnostic yield and safety of EUS-FNA in evaluating primary lung mass lesions. Methods: A database search was conducted for all patients who underwent EUS-FNA of a primary lung mass. The indications for procedure, technical outcomes, complications, and clinical follow-up were obtained by review of patient records. Results: Eighteen patients (11 male, 7 female) underwent EUS-FNA of a primary lung mass over a 3-yr period (2000-2003).The indication for EUS was mediastinal staging of suspected lung cancer noted on chest-CT. Fourteen patients (78%) had right or left side lower lobe lung mass and 4 (22%) had right or left side upper lobe lung mass. All patients had failed prior attempts by CT-guided biopsy and/or bronchoscopy to establish tissue diagnosis of the primary lung mass. FNA of a lung mass was done when no mediastinal lymph node was available for sampling or if after three passes on a mediastinal lymph node no preliminary diagnosis was established or if the lymph node stations could not be well visualized due to mediastinal invasion. EUS-FNA yielded tissue for diagnosis in 100% of patients: 15 had non-small cell lung cancer, 1 small cell lung cancer, and 2 had metastatic cancer. Ten of 18 patients had mediastinal invasion (T4) and in eight the mass was confined to the lung parenchyma. The mean number of passes to establish a diagnosis was 2 (range, 1-6). No complications were encountered at a mean follow-up of 141 days (range, 72-396). Five patients underwent curative surgery and 13 were palliated with chemoradiation. Conclusions: EUS-FNA of primary lung mass is safe and establishes a diagnosis in 100% of patients with lesions that are accessible for fine needle aspiration. This may be particularly relevant for patients with suspected lung cancer but without mediastinal adenopathy.