EUS-FNA As a “First and Single Test“ For The Diagnosis and Staging of Lung Cancer – Prospective Comparison of EUS, CT scan and PET scan

Background: Multiple tests are required for the management of lung cancer. We evaluated EUS-FNA as a single test for the diagnosis and staging of lung cancer.

Methods: Consecutive subject with CT findings of newly detected lung mass were prospectively enrolled for EUS.

Result: Between March 2004 and July 2005, 157 patients were enrolled in the study. CT scan, EUS and PET scan were performed in 157, 157, and 106 cases, respectively. 113 subjects were diagnosed with lung cancer (NSCLC-95; SCLC-18). Of 113 cases, EUS was performed as a first test for diagnosis in 93 (82%) cases. EUS-FNA established tissue diagnosis in 70% cases. The accuracy of the EUS-FNA, CT scan and PET scan for the detection of metastases to the MLN was 86%, 78%, and 81%, respectively. Distant metastasis to liver, adrenal gland and celiac axis was detected in 32 of the 113 cases. There was no significant difference in the sensitivity of the EUS-FNA, CT scan and PET scan for the detection of distant metastases. The specificity and accuracy of the EUS-FNA for the detection of the distant metastases was significantly higher than the CT scan. Of 44 cases with resectable NSCLC on CT scan, EUS-FNA avoided thoracotomy in 14% cases.

Conclusion: EUS-FNA has high diagnostic yield and is highly accurate for detection of metastases to mediastinum and distant sites (liver, adrenal gland and celiac axis). EUS-FNA detects occult metastases to lymph nodes at the celiac axis and thus avoids thoracotomy. We recommend EUS-FNA as a first test after CT for the evaluation of the suspected lung cancer.

Accuracy	EUS% (95CI)	CT% (95CI)	PET% (95CI)
Media. met	86 (71–95)	78 (62–90)	81 (64–93)
Celiac met	100 (97–100	95 (89–98)	95 (88–99)
Liver met	98 (94–100)	93 (87–97)	93 (85–97)
Adre. met	99 (95–100)	94 (88–98)	97 (90–99)
Dist. met	97 (93–100)	89 (81–94)	97 (90–99)