The combination of endoscopic ultrasound and mediastinoscopy for preoperative staging of non-small cell lung cancer is more accurate than mediastinoscopy alone, according to a study published in the Journal of the American Medical Association (JAMA).

Non-small cell lung cancer (NSCLC) that has spread to lymph nodes or the mediastinum (the area between the lungs) is generally not surgically removable. However, it can be difficult to determine before surgery whether or not cancer has spread. Current approaches to evaluating the extent of disease before surgery include computed tomography (CT), positron emission tomography (PET) scans, and mediastinoscopy. During a mediastinoscopy, a surgeon inserts a mediastinoscope (lighted tube) through a small incision in the neck while a patient is under general anesthesia. This mediastinoscope allows the surgeon to examine the center of the chest and nearby lymph nodes and remove a tissue sample. Each of these approaches has limitations, and as a result, it is discovered during surgery that up to 40 percent of patients who undergo major surgery to remove apparently localized NSCLC have inoperable cancer because of lymph node spread or nearby invasion.

Endoscopic ultrasound may complement other staging approaches and improve the accuracy of preoperative staging. In endoscopic ultrasound, an ultrasound device is placed down the patient’s throat. This allows doctors to view the center of the chest and guides them as they collect tissue samples from suspicious-looking areas.

In order to determine whether the combination of endoscopic ultrasound and mediastinoscopy is better at accurately identifying operable cancers than mediastinoscopy alone, researchers in The Netherlands evaluated 100 patients with NSCLC that appeared, based on CT scan, to be confined to the lung. Patients had both endoscopic ultrasound with tissue sampling of suspicious areas, as well as mediastinoscopy. With the combination of the two approaches, 36% of patients were found to have cancer that had spread beyond the lung. These results were higher than results of either approach alone: Endoscopic ultrasound found cancer spread in 28% of patients, and mediastinoscopy found cancer spread in 20% of patients. These findings conclude that, in this patient population, adding endoscopic ultrasound to mediastinoscopy would prevent unnecessary further surgery in 16% of patients.

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The researchers conclude that adding endoscopic ultrasound to mediastinoscopy improves preoperative staging and will likely help avoid unnecessary surgeries as patients with inoperable disease are identified more accurately.

Reference: Annema JT, Versteegh MI, Veselic M et al. Endoscopic Ultrasound Added to Mediastinoscopy for Preoperative Staging of Patients with Lung Cancer. JAMA. 2005;294:931-936.

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