Guideline
Role of EUS for the evaluation of mediastinal adenopathy

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EUS

Radial EUS performed within the esophagus provides an image of the mediastinum similar to an axial view on a CT scan. FNA cannot be performed with the radial EUS endoscope. The linear EUS endoscope produces an approximately 180-degree image relative to the endoscope tip and allows FNA. EUS can identify lymph nodes in the posterior and inferior mediastinum. Stations 8 and 9 are accessible, as are posterior nodes at station 7 (Fig. 1). If enlarged, station 5 nodes may be accessible.4, 5, 6, 7

Obtaining tissue from mediastinal adenopathy

CT and PET scans can detect abnormal mediastinal lymphadenopathy, but are usually inadequate for diagnosis and locoregional staging of malignancy.10, 11, 12, 13, 14, 15, 16 Thus, tissue sampling is often required.13 Mediastinal tissue can be obtained by needle techniques or surgical biopsy. Needle techniques include transthoracic needle aspirate (TTNA), transbronchial needle aspirate (TBNA), EBUS-FNA , EUS-FNA, and EUS needle core biopsy. Surgical biopsy techniques include cervical

Lung cancer

Lung cancer is the most frequent cause of cancer death in the United States46 and in the world.47 Staging and treatment of lung cancer are determined by radiologic imaging and tissue diagnosis. The American Joint Committee on Cancer stages nodal metastases with lung cancer anatomically.48

A CT scan of the chest with imaging of the liver and adrenal glands should be performed in patients with suspected or known lung cancer who may undergo treatment.12 Mediastinal lymph nodes with a short-axis

Recommendations

  • 1

    In patients with known or suspected potentially resectable lung cancer whose imaging reveals mediastinal adenopathy, we suggest that EUS-FNA be performed in patients with paraesophageal, posterior, and inferior mediastinal adenopathy, if the expertise if available. ⊕⊕○○ Similarly, we suggest that EBUS-FNA be performed in patients with paratracheal mediastinal adenopathy if this information adds to the staging of the lung cancer. ⊕⊕○○ EUS-FNA and EBUS-FNA have been shown to be safe, and

Disclosure

The following authors disclosed financial relationships relevant to this publication: Dr Decker: consultant to Facet Biotechnology; Dr Fanelli: honoraria from Ethicon, consultant to RTI; owner/governor: New Wave Surgical Corp; Dr Jain: research support from Barrx; Dr Evans: consultant to Cook Medical. The other authors disclosed no financial relationships relevant to this publication.

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