Endoscopy 2006; 39 - FR26
DOI: 10.1055/s-2006-947765

The incremental yield of endoscopic ultrasound over endobronchial ultrasound and CT for detection of extrathoracic metastases in lung cancer

J Conway 1, G Silvestri 1, C Reed 1, J Romagnuolo 1, R Hawes 1, J Ravenel 1, B Hoffman 1
  • 1Medical University of South Carolina, Charleston, US

Background: Endoscopic Ultrasound (EUS) with fine needle aspiration (FNA), is an established modality for staging of non-small cell lung cancer. EUS-FNA can also detect suspected extrathoracic metastases in the celiac area, left adrenal, and liver. Endobronchial US (EBUS) has the ability of reviewing thoracic stations not accessible by EUS but cannot review extrathoracic areas.

Aim: To describe the frequency of celiac area, left adrenal, and liver metastases in patients referred for EUS mediastinal staging of lung cancer.

Methods: The database was queried to identify lung cancer cases from 1994 to 2005. Data on the EUS, cytology results, and cross sectional imaging were collected. Binomial confidence intervals (CI) were calculated for the incremental yield of EUS in extrathoracic disease.

Results: The database identified 299 patients. Mean age was 65, 68% were male, and 82% were white. The celiac area, left adrenal, and liver were commented on in 100%, 89%, and 75% of reports, respectively. The table shows the number (percent of total) of lesions seen on CT and/or EUS and the number of malignant or atypical EUS-FNA result in the celiac area, left adrenal, and liver. Overall, 40 (13.4%) patients had suspicious celiac area, left adrenal, or liver lesions seen at EUS; only 47% of these lesions were also seen on CT. 6.7% (95% CI 4.1–10%) of all patients had confirmatory cytology by EUS-FNA. CT noted extrathoracic suspicious lesions in 6.3% of all patients, missing 5 involved celiac nodes, 3 adrenal lesions, and 3 liver lesions.

Conclusion: In a small but important proportion of patients undergoing staging for lung cancer EUS-FNA can confirm extra-thoracic metastases, many of which are missed by CT and would be missed by EBUS. Routine review of the celiac area, left adrenal, and liver is critical in EUS staging of lung cancer.

Celiac

L. Adrenal

Liver

CT_lesion

1 (0.3)

14 (4.7)

4 (1.3)

EUS_lesion

10 (3.3)

23 (7.7)

7 (2.3)

Malignant

5 (1.5)

11 (3.7)

4 (1.3)