Elsevier

Lung Cancer

Volume 34, Supplement 2, December 2001, Pages S123-S126
Lung Cancer

The preoperative study of mediastinal lymph nodes metastasis in lung cancer by endoscopic ultrasonography (EUS) and helical computed tomography (CT)

https://doi.org/10.1016/S0169-5002(01)00353-1Get rights and content

Abstract

Objective: Accurate staging of mediastinal lymph nodes in patients with lung cancer is fundamental for their treatment and prognosis. The aim of this study was to compare the value of EUS and CT staging in patients with non-small-cell lung cancer (NSCLC) with postsurgical stage. Methods: Ninety two patients with NSCLC underwent EUS and CT for preoperative detection of metastases to the mediastinal lymph nodes. EUS examinations were done with the ultrasonic linear array scanning echoendoscope (FG 32 UA, Hitachi/Pentax), CT-Toshiba Exvision GX scanner, with 24-s spiral acquisition, pitch 1:1 (7 mm collimation, 4 mm reconstruction index), during i.v. administration of non-ionic iodinated contrast media. Results: The frequency of mediastinal involvement was 22.7%. The regions most accessible by EUS evaluation were subaortic, subcarinal and paraoesophageal lymph nodes. On a per-patient basis, EUS and CT results were: sensitivity 70.0 and 60.0%, specificity 80.6 and 72.6%, accuracy 77.2 and 68.5%. On a per-sites basis, the sensitivity of EUS evaluation was 78.8%, specificity 89.9%, accuracy 87.7%, comparing with CT—63.6, 84.0, 79.9%, respectively. When the EUS and CT images were analysed in combination, the sensitivity increased to 86.4%. Conclusion: We believe that EUS and CT should be used together for preoperative non-invasive staging of mediastinal lymph nodes in patients with NSCLC.

Introduction

Nodal status is the most important factor influencing the prognosis and plays crucial role in determining the treatment options in non-small-cell lung cancer (NSCLC). Preoperative assessment of mediastinal lymph node both clinically and radiologically is important, but the value of computed tomographic (CT) staging of bronchogenic carcinoma remains controversial [1], [2], [3].

Endoscopic ultrasonography (EUS) is a well-established diagnostic method in cardiac surgery and in investigating abnormalities in the gastrointestinal tract [4], [5]. This technique provides high-resolution images of the intestinal wall and the paraesophageal region [6]. Therefore, endoscopic ultrasonography is ideally suited for staging mediastinal nodes in patients with NSCLC.

The aim of the present study was to compare the value of EUS and helical computed tomography (CT) concerning the ability to detect the mediastinal lymph nodes metastases in patients with NSCLC at postsurgical stage.

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Material and methods

This study is based on 92 consecutive patients with NSCLC examined by the Chest Oncology Group and operated in the Department of Thoracic Surgery at the Białystok Medical Academy. All patients underwent surgical resection. EUS examinations were done with the ultrasonic linear array scanning echoendoscope (FG 32 UA, Hitachi/Pentax). The lymph nodes visualised by helical CT and EUS were classified according to the American Thoracic Society Mapping [7]. The size, shape, margin, internal structure

Results

Of the 92 non-small-cell lung cancers 49 were squamous cells, 27 adenocarcinomas, 11 large cells and 5 adenosquamous. Tumours were located on the right side in 44 (47.9%) patients and on the left side in 48 (52.1%) patients. A total number of resected mediastinal lymph nodes was 792. Of these, 180 nodes were found to be metastatic histopathologically and 612 were non-metastatic. For the non-metastatic mediastinal lymph nodes, the highest detection rates [detectability (%)=No. of detected

Discussion

The presence of mediastinal lymph node metastases in patients with carcinoma of the lung is one of the most important factor determining the prognosis which influence therapeutic decisions. Thus, the important aspect in the preoperative assessment of patients with NSCLC is the evaluation of the mediastinum for the possible presence and extent of metastatic disease [10]. This study was designed to compare the value of EUS and CT staging in patients with NSCLC at a postsurgical stage. We found

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