Abnormal Mediastinal Lymph Nodes Research Articles

Endobronchial ultrasound sonographic characteristics of mediastinal lymph node in the evaluation of lung cancer.

Endobronchial ultrasound (EBUS) and contrast-enhanced computed tomography (CECT) are essential components of lung cancer evaluation. Features of mediastinal lymph nodes on EBUS and CECT can help in predicting metastatic disease. Clinical, radiological, and EBUS data of patients with clinico-radiological suspicion of lung cancer who have undergone EBUS with no transbronchial needle aspiration (TBNA) or nonyielding EBUS-TBNA were retrospectively collected from medical records. EBUS features of lymph nodes for metastatic disease [size >1 cm, round shape, heterogeneous echotexture, indistinct margin, coagulation necrosis (CN), absence of central hilar structures (CHS), and grade II-III vascularity] were noted. CECT findings were noted from CECT films and reports to analyze and compare with EBUS findings. Scoring criteria of EBUS sonographic characteristics from previous studies for discriminating benign and malignant lymph nodes were also assessed for possible prediction. 31 patients [male: 18 (58.1%), female: 13 (41.9); age (mean ± standard deviation): 52.9±15.7 years] with CECT findings suggesting lung cancer were studied. EBUS showed mediastinal lymphadenopathy at 82 lymph node stations in 29 patients. Size >1 cm, round shape, heterogeneous echotexture, distinct margin, CN, absence of CHS and grade II-III vascularity at 33 (40%), 28 (34%), 31 (38%), 55 (67%), 3 (4%), 77 (94%), and 6 (7.3%) lymph nodes, respectively, were found. The malignant or benign status assigned to lymph nodes using different scoring criteria was highly discordant. Compared to EBUS, CECT revealed abnormal mediastinal lymph nodes in significantly fewer patients [21 (67.7%) versus 29 (93.5%), p=0.01] involving a lower number of lymph node stations (37 versus 82, p<0.001). Lymphadenopathy frequency at different LNS on EBUS and CECT showed a weak positive but significant correlation (r=0.356; p=0.0426). EBUS characteristics and related scores have limited accuracy in differentiating benign and malignant nodes. CECT underestimates lymphadenopathy in comparison to EBUS. A larger prospective study of EBUS features with cyto/histopathology correlation may elicit its clinical significance and help to create better and more composite scoring criteria.

EBUS-TBNA in Extrathoracic Malignancies: Diagnostic and Prognostic Implications.

In patients with extrathoracic malignancies (EM) the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the assessment of abnormal mediastinal lymph nodes (MLN) is controversial. The aim of this study was to assess the diagnostic yield and prognostic significance of EBUS-TBNA in these patients. Retrospective analysis of patients with EM and abnormal MLN detected by Computed Tomography (CT) and/or Positron Emission Tomography (PET). A total of 161 patients with EM and abnormal MLN were included (93 males, 58%). The most common EM was melanoma (19%) and gastrointestinal cancer (17%). Assessed lymph nodes were mediastinal in 70% of cases and hilar in 30%. The most frequently sampled lymph nodes were subcarinal (45%) and lower right paratracheal (21%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA for the diagnosis of malignancy were 88%, 100%, 100% and 87%, respectively. These values were similar regardless the type of EM except for head and neck tumors where the NPV was particularly low (67%). The diagnosis of neoplastic involvement by EBUS-TBNA implied a worse prognosis in terms of overall survival (p < 0.02)and cancer-specific survival (p < 0.001). In patients with EM and abnormal MLN, EBUS-TBNA has a high diagnostic yield. However, the NPV decrease in patients with head and neck tumors. Neoplastic MLN detected by EBUS-TBNA has prognostic implications in these patients.

The lungs were on fire: a pilot study of 18F-FDG PET/CT in idiopathic-inflammatory-myopathy-related interstitial lung disease

BackgroundInterstitial lung disease (ILD) and its rapid progression (RP) are the main contributors to unfavourable outcomes of patients with idiopathic inflammatory myopathy (IIM). This study aimed to identify the clinical value of PET/CT scans in IIM-ILD patients and to construct a predictive model for RP-ILD.MethodsAdult IIM-ILD patients who were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU), from 1 January 2017 to 31 December 2020 were reviewed. PET/CT scans and other characteristics of patients who met the inclusion and exclusion criteria were collected and analysed.ResultsA total of 61 IIM-ILD patients were enrolled in this study. Twenty-one patients (34.4%) developed RP-ILD, and 24 patients (39.3%) died during follow-up. After false discovery rate (FDR) correction, the percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.014), bilateral lung mean standard uptake value (SUVmean, P = 0.014) and abnormal mediastinal lymph node (P = 0.045) were significantly different between the RP-ILD and non-RP-ILD groups. The subsequent univariate and multivariate logistic regression analyses verified our findings. A “DLM” model was established by including the above three values to predict RP-ILD with a cut-off value of ≥ 2 and an area under the curve (AUC) of 0.905. Higher bilateral lung SUVmean (P = 0.019) and spleen SUVmean (P = 0.011) were observed in IIM-ILD patients who died within 3 months, and a moderate correlation was recognized between the two values.ConclusionsElevated bilateral lung SUVmean, abnormal mediastinal lymph nodes and decreased DLCO% were significantly associated with RP-ILD in IIM-ILD patients. The “DLM” model was valuable in predicting RP-ILD and requires further validation.

A Unique Diagnosis of Metastatic Prostate Adenocarcinoma

Prostate adenocarcinoma is the most common non-skin cancer that affects men in the United States. Although its prevalence is high with 1/6 men being diagnosed with prostate cancer in their lives, the prognosis is often promising with only 1/36 men dying from prostate cancer. The prognosis of this cancer, like many, is based on the presence or absence of metastases. Gastroenterologists rarely encounter this malignancy as the primary is located in a genitourinary organ and the most common sites of metastasis are bone and lung, as well as local lymph nodes. However, there are rare cases when new or recurrent diagnoses of metastatic prostate cancer can be established via fine needle aspiration (FNA) of abnormal mediastinal lymph nodes under endoscopic ultrasound (EUS). An 80 year old man had a previous history of prostate adenocarcinoma that had been treated with radiation and adjuvant androgen deprivation therapy. About 18 months after completing treatment, steadily uptrending prostate serum antigen values prompted a PET scan. This showed increased uptake in multiple retroperitoneal lymph nodes, prompting a concern for metastasis. In addition, there were multiple mediastinal lymph nodes with increased uptake. Given the rare occurrence of mediastinal lymph node metastases in prostate malignancy, there was significant concern for a second malignancy. The patient underwent EUS to further evaluate (see image 1) and an FNA showed pathology consistent with prostate adenocarcinoma (see images 2 and 3). EUS FNA is a commonly used modality for concerning lymph nodes or masses noted on PET scans or other types of imaging. Similarly, prostate cancer is a common diagnosis, especially in elderly men. However, EUS FNA is very rarely used to confirm a diagnosis of metastatic prostate cancer. This case is unique because it highlights the potential for prostate adenocarcinoma to metastasize outside of its common sites of bone, lung, liver and retroperitoneal lymph nodes. It also illustrates the associated utility of EUS FNA. Case reports have described this method of diagnosis in only a select few cases. It is far more common for lymph node involvement above the diaphragm to be associated with lung, esophageal or head/neck cancers. Recognizing and sampling concerning mediastinal lymph nodes is vital to ensure that the correct primary malignancy is identified and appropriate chemotherapy or radiation regiments can be determined.2140_A Figure 1. EUS image showing an enlarged mediastinal lymph node (circled in red) prior to FNA.2140_B Figure 2. Papanicolaou stain showing a cohesive cluster of pleomorphic malignant cells (x200)2140_C Figure 3. Prostate specific antigen (PSA) immunohistochemical stain showing positive staining in the malignant cells, consistent with metastatic prostate adenocarcinoma (x200).

Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer diagnosis and staging in 179 patients

BackgroundLinear endobronchial ultrasound-guided transbronchial needle aspiration (eBUStBNA) is an important minimally invasive procedure for non-small cell lung cancer (NScLc) staging. It is also a valid method for diagnosing extraluminal lesions adjacent to the tracheobronchial tree. Aimto evaluate our eBUS-tBNA performance regarding diagnostic yield, safety and learning curve for lung cancer diagnosis and staging. Material and methodsAll patients undergoing eBUS-tBNA for lung cancer diagnosis or staging were included. they were divided into three different groups: paratracheal and parabronchial masses sent for diagnosis (Group 1); peripheral lung lesions with abnormal mediastinal lymph nodes sent for diagnosis and staging (Group 2); NScLc patients sent for mediastinal staging (Group 3). the learning curve was assessed for yield, accuracy, procedure time, size and number of lesions punctured per patient ResultsA total of 179 patients were included and 372 lesions were punctured. the overall yield and accuracy were 88% and 92.7%, respectively. In Group 1, eBUS-tBNA was performed in 48 patients and sensitivity was 86.1% and accuracy was 87.5%. For the 87 patients included in Group 2, yield was 86.7%, accuracy was 93.1% and cancer prevalence was 51.7%. the diagnostic yield and accuracy in Group 3 was 95% and 97.7% respectively. eBUS-tBNA practice led to an increase number of sites punctured per patient in a shorter time, without complications. ConclusioneBUS-tBNA is an effective method for diagnosing and staging lung cancer patients. the procedure is clearly safe. Handling and performance improves with the number of procedures executed.

Punção aspirativa transbrônquica guiada por ecoendoscopia brônquica no diagnóstico e estadiamento de cancro do pulmão em 179 doentes

BackgroundLinear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an important minimally invasive procedure for non-small cell lung cancer (NSCLC) staging. It is also a valid method for diagnosing extraluminal lesions adjacent to the tracheobronchial tree. AimTo evaluate our EBUS-TBNA performance regarding diagnostic yield, safety and learning curve for lung cancer diagnosis and staging. Material and methodsAll patients undergoing EBUS-TBNA for lung cancer diagnosis or staging were included. They were divided into three different groups: paratracheal and parabronchial masses sent for diagnosis (Group 1); peripheral lung lesions with abnormal mediastinal lymph nodes sent for diagnosis and staging (Group 2); NSCLC patients sent for mediastinal staging (Group 3). The learning curve was assessed for yield, accuracy, procedure time, size and number of lesions punctured per patient. ResultsA total of 179 patients were included and 372 lesions were punctured. The overall yield and accuracy were 88% and 92.7%, respectively. In Group 1, EBUS-TBNA was performed in 48 patients and sensitivity was 86.1% and accuracy was 87.5%. For the 87 patients included in Group 2, yield was 86.7%, accuracy was 93.1% and cancer prevalence was 51.7%. The diagnostic yield and accuracy in Group 3 was 95% and 97.7% respectively. EBUS-TBNA practice led to an increase number of sites punctured per patient in a shorter time, without complications. ConclusionEBUS-TBNA is an effective method for diagnosing and staging lung cancer patients. The procedure is clearly safe. Handling and performance improves with the number of procedures executed.

Endobronchial Ultrasound as a Diagnostic Tool in Patients With Mediastinal Lymphadenopathy

The diagnostic yield and accuracy of new approaches to diagnose cancer should focus on comparison with established surgical techniques. Our objective was to evaluate the diagnostic performance of endobronchial ultrasound (EBUS) to detect cancer in patients with radiographically abnormal mediastinal lymph nodes. The medical records of patients who underwent EBUS and had abnormal mediastinal lymph nodes (short-axis >1 cm and [or] positron emission topography-positive) over a 25 month period at the University of Pittsburgh were reviewed. Demographic and clinical data, cytology, and pathology results were entered in a database and analyzed. A total of 172 patients [male to female = 1.8:1; median age, 67 years (range, 20 to 90]) were included. The diagnostic yield of EBUS cytology was 79.7% (137 of 172). Pathologic testing was available in 68% (117 of 172) and 82% (96 of 117) had a diagnostic EBUS. The diagnostic accuracy of EBUS was 91.7%. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were 88.1% (95% confidence interval [CI], 77.3 to 94.3), 100% (95% CI, 85.9 to 100), 100% (95% CI, 92.4 to 100), and 80.6% (95% CI, 63.4 to 91.2), respectively. In 67 patients who had a suspected or biopsy-proven primary lung cancer, diagnostic yield was 86.6% and accuracy was 94.8%. In this subgroup the sensitivity, specificity, PPV, and NPV were 93% (95% CI, 76.5 to 98.9), 100% (95% CI, 69.9 to 100), 100% (95% CI, 85 to 100), and 83.3% (95% CI, 56.2 to 97.5). Diagnostic performance data support the clinical usefulness of EBUS in the evaluation of patients with a radiographically abnormal mediastinum. It should be considered complementary to mediastinoscopy rather than substitutive.

Utility of Positron Emission Tomography Compared With Mediastinoscopy for Delineating Involved Lymph Nodes in Stage III Lung Cancer: Insights for Radiotherapy Planning From a Surgical Cohort

Mediastinoscopy is routinely carried out on the majority of nonmetastatic, non-small-cell lung cancer (NSCLC) patients in our institution. We used the results of mediastinoscopy from a Stage III NSCLC cohort to assess the reliability of positron emission tomography (PET) scans at identifying involved mediastinal lymph nodes (MLN) when used during radiotherapy planning. Mediastinoscopy was the gold standard. Characteristics of PET were calculated for nodal sensitivity. To compare the impact on contouring, theoretical nodal targets (NTs) containing involved MLNs were generated using PET and mediastinoscopy. We determined whether the NT derived from PET (NT-P) was equivalent to, greater than, or less than that seen with the mediastinoscopy (NT-M). Data for 122 patients with Stage III NSCLC, treated between 2000 and 2004, were analyzed. After exclusions, 87 patients with Stage III disease by mediastinoscopy were analyzed. Overall PET sensitivity was 61% and positive predictive value was 94%. Of the 87 patients, 33 (38%) had no abnormal MLN findings by PET. Of 36 Stage IIIA cancer patients, 18 (50%) had NT-P equivalent to NT-M, 10 (28%) had smaller NT-Ps, and 8 (22%) had larger NT-Ps compared with NT-Ms. Of 18 Stage IIIB cancer patients, NTs were equivalent in 6 (34%); in 1 patient (5%) NT-P was larger than the corresponding NT-M, and in 11 (61%) smaller than the corresponding NT-M. In this study PET had modest sensitivity to detect MLN involvement and underestimated the extent of involved nodes for target definition. The role of PET in mediastinal contouring needs to be evaluated prospectively and ideally correlated with a pathology standard.

Cost Efficacy of Endoscopic Ultrasound and Endobronchial Ultrasound with Fine Needle Aspiration (EUS-FNA+EBUS-FNA) Versus Mediastinoscopy for the Staging of Patients with Non Small Cell Lung Cancer (NSCLC) and Abnormal Mediastinal Lymph Nodes By Non-Invasive Imaging

Background: Currently endoscopic ultrasound with fine needle aspiration (EUS-FNA) complements Mediastinoscopy (MED) in staging of patients with NSCLC who have enlarged or abnormal appearing mediastinal lymph nodes on non-invasive imaging such as CT scan. Endobronchial ulstrasound with fine needle aspiration (EBUS-FNA) is an emerging technology that can access lymph node stations traditionally accessible only by surgical intervention. The use of combined EUS-FNA + EBUS-FNA has been shown to be feasible and reaches 95% sensitivity with specificity near 100%. The cost-benefit ratio of this procedure, which can be done on the same day under conscious sedation with discharge after standard recovery time, has not been compared to MED, which requires general anesthesia and operating room time. Aim: Compare the cost-effectiveness of combined EUS-FNA + EBUS-FNA versus MED for lymph node staging in patients with NSCLC and abnormal mediastinal lymph nodes on non-invasive imaging. Methods: A decision-analytic model was used to compare the cost-effectiveness of EUS-FNA + EBUS-FNA versus MED in a hypothetical population of 100 patients with NSCLC and suspicious mediastinal lymphadenopathy by non-invasive imaging. Probability estimates were derived from the literature: probability of node positive = 70%, sensitivity and specifity of EUS-FNA + EBUS-FNA = 95% and 99%, sensitivity and specifity of mediastinoscopy = 92% and 99%. Estimated costs of the two testing strategies were obtained from median US medical care fees. The primary outcome measured was cost per correct diagnosis. Results: The cost per correct diagnosis was $1999 for EUS-FNA + EBUS-FNA and $9189 for MED. In the sensitivity analysis, EUS-FNA + EBUS-FNA remained the dominant diagnostic strategy even when EUS and EBUS were performed on separate days (resulting in additional costs), or if the sensitivity of MED increased 99%. Conclusion: EUS-FNA + EBUS-FNA is more cost-effective than MED for staging patients with NSCLC and abnormal mediastinal lymph nodes on non-invasive imaging; EUS-FNA + EBUS-FNA should be the diagnostic modality of choice for this purpose.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Non-small Cell Lung Cancer Staging: A Systematic Review and Metaanalysis

Background:Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a minimally invasive alternative technique for mediastinal staging of non-small cell lung cancer. A metaanalysis was performed to estimate the diagnostic accuracy of EUS-FNA for staging mediastinal lymph nodes (N2/N3 disease) in patients with lung cancer.Methods:Relevant studies were identified using Medline (1966 to November 2005), CINAHL, and citation indexing. Included studies used histology or adequate clinical follow-up (> 6 months) as the “gold standard,” and provided sufficient data for calculating sensitivity and specificity. Summary receiver operating characteristic curves metaanalysis was performed to estimate the pooled sensitivity and specificity.Results:In 18 eligible studies, EUS-FNA identified 83% of patients (95% confidence interval [CI], 78 to 87%) with positive mediastinal lymph nodes (pooled sensitivity) and 97% of patients (95% CI, 96 to 98%) with negative mediastinal lymph nodes (pooled specificity). In eight studies that were limited to patients who had abnormal mediastinal lymph nodes seen on CT scans, the sensitivity was 90% (95% CI, 84 to 94%) and the specificity was 97% (95% CI, 95 to 98%). In patients without abnormal mediastinal lymph nodes seen on CT scans (four studies), the pooled sensitivity was 58% (95% CI, 39 to 75%). Minor complications were reported in 10 cases (0.8%). There were no major complications.Conclusions:EUS-FNA is a safe modality for the invasive staging of lung cancer that is highly sensitive when used to confirm metastasis to mediastinal lymph nodes seen on CT scans. In addition, among lung cancer patients with normal mediastinal adenopathy seen on CT scans, despite lower sensitivity, it has the potential to prevent unnecessary surgery in a large proportion of cases missed by CT scanning.

Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients with Lung Cancer and Prior Negative Mediastinoscopy

Background: Abnormal mediastinal lymph nodes (LNs) sampling is required prior to surgical resection in non-small cell lung cancer (NSCLC) patients. In patients with both anterior and posterior mediastinal LNs, the initial strategy to diagnose metastasis to ipsilateral (N2) or contralateral (N3) LNs remains unknown. Objectives: Our objectives were 1) To evaluate the yield of EUS-FNA in NSCLC patients with both anterior and posterior LNs that had prior negative mediastinoscopy. 2) To assess cost implications associated with alternative initial strategies: initial mediastinoscopy versus initial EUS-FNA. Methods: NSCLC patients first underwent thoracic CT, PET scan, and mediastinoscopy and then underwent EUS-FNA of the posterior mediastinal LNs. Reference standards included: thoracotomy with complete thoracic lymphadenectomy, repeat clinical imaging and/or long term clinical follow-up. A Monte Carlo cost-analysis model evaluated the expected costs and outcomes associated with staging of a hypothetical cohort of NSCLC patients presenting with enlarged anterior and posterior mediastinal LNs. Results: There were thirty-five lung cancer patients (median age of 65 years, 80% male). Of the 35 NSCLC patients who had a prior negative mediastinoscopy, 13 patients (37.1%) (95% CI: 21.5–55.1) had malignant LNs. Lower lobe masses were more likely to have malignant LNs as compared to upper lobe masses (OR = 6.8; 95% CI: 1.2–42.7, P = 0.03). All patients with N2/N3 disease received initial chemotherapy and/or radiation. EUS-FNA yielded one false negative result and no false positives. Final diagnoses were confirmed by surgery in 16 patients (45.7%). Accuracy of EUS-FNA (98.1%; 95% CI: 89.9–100.0) was significantly higher than CT (41.5%; p < 0.001) and PET (40%; p < 0.001). Initial EUS-FNA resulted in an average costs per patient of $1,867 (SD ± 4308) while initial mediastinoscopy cost $12,900 (SD ± 4164). If initial EUS-FNA is utilized rather than initial mediastinoscopy, there would be an average cost saving of $11,033 per patient evaluated. Conclusions: In NSCLC patients with both anterior and posterior LNs, starting with EUS-FNA would obviate the need for mediastinoscopy in over one-third of patients. EUS-FNA is an outpatient procedure that is less invasive, safer and less costly than mediastinoscopy. These finding have major implications on resource utilization in NSCLC patients undergoing invasive tissue sampling for preoperative staging.

Surgical Management of Non-small Cell Lung Cancer With Synchronous Brain Metastases

Published series on the synchronous combined resection of brain metastases and primary non-small cell lung cancer are small and scarce. We therefore undertook a multicenter retrospective study to determine long-term survival and identify potential prognostic factors. Our series includes 103 patients who were operated on between 1985 and 1998 for the following tumors: adenocarcinomas (74); squamous cell carcinomas (20); and large cell carcinomas (9). Three patients had two brain metastases, and one patient had three metastases; the remaining patients had a single metastasis. Ninety-three patients presented with neurologic signs that regressed completely after resection in 60 patients and partially, in 26 patients. Neurosurgical resection was incomplete in six patients. Seventy-five patients received postoperative brain radiotherapy. The time interval between the brain operation and the lung resection was < 4 months. Pulmonary resection was incomplete in eight patients. The survival calculated from the date of the first operation was 56% at 1 year, 28% at 2 years, and 11% at 5 years. Univariate analysis showed a better prognosis for adenocarcinomas (p = 0.019) and a trend toward a better prognosis for patients with small pulmonary tumors (T1 vs T3, p = 0.068), N0 stage disease (N0 vs N+, p = 0.069), and complete pulmonary resection (p = 0.057). In a multivariate analysis, adenocarcinoma histology also affected the survival rate (p = 0.03). It seems legitimate to proceed with lung resection after complete resection of a single brain metastasis, at least in patients with an adenocarcinoma and a small lung tumor and without abnormal mediastinal lymph nodes seen on the CT scan or during mediastinoscopy.

Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer

Background. Esophageal endoscopic ultrasonographic (EUS) guidance fo fine-needle aspiration (FNA) of mediastinal lymph nodes has been introduced only recently. The utility of EUS/FNA in diagnosing and staging bronchogenic carcinoma is unknown. Methods. After a thoracic computed tomographic scan, 27 patients with known or suspected lung cancer underwent EUS. Accessible abnormal mediastinal lymph nodes were aspirated under EUS guidance. Patients with positive cytologic studies did not undergo further testing, whereas the remaining patients underwent mediastinal exploration. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for both chest computed tomography and EUS/FNA. Results. Twenty-two of 27 patients had mediastinal adenopathy by computed tomography scan. Sixteen patients had positive findings on EUS, 15 with positive FNA (10 non-small cell lung cancer; 5 small cell lung cancer) and 1 with T4 status. Fourteen patients with positive FNA had lymph nodes samples at level 5, level 7, or both. Of 11 patients with negative EUS/FNA, 2 had positive findings at operation (sensitivity 89%). The diagnosis of lung cancer was established in 7 patients. Conclusions. The results showed that EUS/FNA improves the accuracy of computed tomographic scan in the staging of lung cancer. By accessing lymph nodes at levels 5 and 7, EUS/FNA complements mediastinoscopy and is considered the staging modality of choice in these regions. Positive EUS/FNA can obviate the need for further invasive staging.

Endoscopic ultrasound with fine-needle aspiration in the Diagnosis and staging of lung cancer

Esophageal endoscopic ultrasonographic (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has been introduced only recently. The utility of EUS/FNA in diagnosing and staging bronchogenic carcinoma is unknown. After a thoracic computed tomographic scan, 27 patients with known or suspected lung cancer underwent EUS. Accessible abnormal mediastinal lymph nodes were aspirated under EUS guidance. Patients with positive cytologic studies did not undergo further testing, whereas the remaining patients underwent mediastinal exploration. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for both chest computed tomography and EUS/FNA: Twenty-two of 27 patients had mediastinal adenopathy by computed tomography scan. Sixteen patients had positive findings on EUS, 15 with positive FNA (10 non-small cell lung cancer; 5 small cell lung cancer) and 1 with T4 status. Fourteen patients with positive FNA had lymph nodes sampled at level 5, level 7, or both. Of 11 patients with negative EUS/FNA, 2 had positive findings at operation (sensitivity 89%). The diagnosis of lung cancer was established in 7 patients. The results showed that EUS/FNA improves the accuracy of computed tomographic scan in the staging of lung cancer. By accessing lymph nodes at levels 5 and 7, EUS/FNA complements mediastinoscopy and is considered the staging modality of choice in these regions. Positive EUS/FNA can obviate the need for further invasive staging.