Two minimally invasive staging methods used together may be an accurate substitute for mediastinoscopy for some lung cancer patients with suspected metastatic mediastinal lymph nodes, according to a report in JAMA (299:540-546, 2008).
"Noninvasive staging with chest CT or PET is associated with high rates of false-positive and false-negative results, respectively," said Michael B. Wallace, MD, MPH, of the Mayo Clinic, Jacksonville, Florida, and his colleagues.
The lung cancer staging guidelines of the American College of Chest Physicians recommend that patients with abnormal lymph nodes on CT or PET, or centrally located tumors without mediastinal adenopathy, undergo invasive staging, with tissue confirmation of suspected metastatic mediastinal lymph nodes.
"Mediastinoscopy or thoracoscopy has been the diagnostic standard," the authors said, but less invasive methods have emerged as potential alternatives.
These new noninvasive methods include blind transbronchial needle aspiration (TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and, most recently, endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA).
The investigators tested the three newer methods in 138 patients with known or suspected lung cancer, based on a lung or mediastinal abnormality seen on CT, and no pathologically proven extrathoracic metastases.