Is your stage III NSCLC patient truly "downstaged" to N0? EUS helpful only if positive (J Thorac Oncol) - PulmCCM
Advertisement
Oct 022011
 

So you’ve referred your patient with stage III non-small cell lung cancer (N2 or N3 mediastinal nodes) to receive neoadjuvant chemoradiation therapy in the hopes of eliminating cancer from the mediastinal nodes, “downstaging” her to a resectable N0 status. How do you re-evaluate the lymph nodes to ensure resection may be curative?

von Bartheld et al retrospectively looked at 58 consecutive patients with N2/N3 stage III NSCLC who received neoadjuvant chemoradiation, and then underwent transesophageal ultrasound fine needle aspiration (EUS-FNA).

EUS-FNA found metastasis in 15 patients (26%). That left 43 who were negative by EUS, and 33 of them underwent mediastinoscopy, of which 58% were positive.

Take-home: EUS-FNA is a good first test in re-analyzing the mediastinal nodes after chemoradiation for stage III N2/N3 NSCLC, because if it’s positive you’re done. However, its low negative predictive value mean a negative test must be followed up with more invasive sampling.

von Bartheld et al. Transesophageal Ultrasound-Guided Fine-Needle Aspiration for the Mediastinal Restaging of Non-small Cell Lung Cancer.  J Thorac Oncol 2011;6:1510-1515.

Liked this post? Get a weekly email update (no spam, ever), and explore our library of clinical guidelines, practice updatesreview articles. and board review questions.

PulmCCM is an independent publication, not affiliated with or endorsed by any other organization, society or journal referenced on the website.

Authors: contribute your work to PulmCCM Journal or in a guest blog post.

Leave a Comment