Comparison of Accuracy of the Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasonography for Detection of the Metastases at Celiac Axis Lymph Nodes in Lung Carcinoma: A Prospective Study Pankaj Singh, Rahul Gupta, Yashodeep Jadhav, Rama M. Reddy, Phalguni Mukhopadhyay, Rajnikanth S. Shah, Chetan Jinadatha, John C. Lasiter, Ashish Sharma, Richard A. Erickson Background: Previous studies using CT scan for staging Non-small cell lung cancer (NSCLC) have not reported celiac axis (CA) as a site for distant metastases. Detection of metastases to CA is critical since these patients are considered nonresectable. EUS is considered superior to CT scan for detection of CA lymphadenopathy. Aim: To determine the incidence of metastases to lymph nodes at CA in patients with lung carcinoma using EUS-FNA. Methods: Consecutive subjects with CT findings of newly detected lung mass were prospectively enrolled for EUS-FNA. FNA was performed whenever lymph node could be identified irrespective of the endosonographic features. Primary outcome was to determine the sensitivity of the EUS-FNA, CTscan and PETscan for detection of the metastases to lymph nodes at celiac axis. Gold standard for the diagnosis of metastases was cytologically positive malignant cells. Results: 53 consecutive cases of lung carcinoma were identified that underwent EUS evaluation of the celiac axis. EUS identified lymph nodes at CA in 11 of the 53 cases. EUS-FNA was performed in all the 11 cases. EUS-FNA cytologically confirmed malignancy in 9 of the 11 cases. CT scan and PET scan missed celiac lymphadenopathy in 4 of 9 cases and 2 of 5 cases, respectively. EUS influenced the management in 4 of the 9 cases. In two patients EUS avoided surgery by detection of the metastases at CA that were missed by CT scan and PET scan. In one patient with lung carcinoma and past history of lymphoma, EUS-FNA confirmed the enlarged lymph node to be metastastic lung carcinoma and not the recurrence of lymphoma and in one case immunocytochemisty of the cytology showed that celiac metastases is from non-lung primary. Conclusion: CA is an important site for distant metastasis in NSCLC. EUS-FNA detects metastasis at CA that is missed by both CT and PET scan. Of all the diagnostic tests, EUS-FNA is the only test that cytologically confirms the metastases and influences the management.