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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2571v1 chest.06-2571v2 132/3/916    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sawhney, M. S. Articles by Kelly, R. F. Search for Related Content PubMed PubMed Citation Articles by Sawhney, M. S. Articles by Kelly, R. F.

Impact of Pre-Operative Endoscopic Ultrasound on Non-Small Cell Lung Cancer Staging

Section of Gastroenterology [MSS, DBN], and Center for Epidemiological and Clinical Research [MSS, FAL], Minneapolis VA Medical Center; Department of Medicine, [MSS, YB, DBN, FAL] and Section of Cardio-thoracic Surgery, University of Minnesota [AMH, RFK]

msawhney{at}bidmc.harvard.edu

Abstract

AimTo determine if the addition of pre-operative EUS to non-small cell lung cancer staging can reduce the proportion of patients in whom malignant mediastinal-lymph-nodes [inoperable disease] are discovered at surgery.

MethodsAll patients with lung cancer who underwent a mediastinoscopy or thoracotomy for cancer diagnosis, staging, or treatment from 1999 to 2005 were identified. Patients that had undergone pre-operative EUS were designated as the EUS group. The control group was composed of similar patients who had not undergone pre-operative EUS, and were frequency-matched to those in the EUS group in a 3:1 ratio by pre-operative cancer stage. The proportion of patients in whom malignant mediastinal-lymph-nodes were diagnosed at surgery was the primary outcome.

ResultsForty-four patients, with average age 67.8years met criteria for EUS group, and 132 patients, with average age 67.4years, were selected as controls. Overall, in the EUS group, 3/44 patients [6.8%] were found to have malignant mediastinal-lymph-nodes at surgery, compared with 41/132 patients [31.1%] in the control group [p=0.003]. In patients undergoing thoracotomy for cancer resection, 3% in the EUS group, compared with 20% in the control group were found to have malignant mediastinal-lymph-nodes at surgery [p=0.01]. There was also a trend towards lower yield of mediastinoscopy done for cancer diagnosis or staging in the EUS group [p=0.08].

ConclusionsPre-operative EUS in lung cancer patients may reduce unnecessary surgery at which advanced inoperable disease is discovered.