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Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma

Kurt Tournoy UGent, Sjaak Burgers, Jouke Annema, Frank Vermassen UGent, Marleen Praet UGent, Marianne Smits, Houke Klomp, Jan Van Meerbeeck UGent and Paul Baas (2008) CLINICAL CANCER RESEARCH. 14(19). p.6259-6263
abstract
Purpose: Surgical resection as part of a multimodality approach in malignant pleural mesothelioma (MPM) has a high morbidity and mortality. Because mediastinal lymph node (MLN) metastases are a negative prognostic factor, preoperative staging is of paramount importance. Transesophageal endoscopic ultrasound with real-time guided fine needle aspiration (EUS-FNA) enables accurate MLN staging in lung cancer. Experimental Design: The feasibility and yield of EUS-FNA in MLN staging were prospectively analyzed in patients with presumed early-stage MPM considered for multimodality therapy. MLN reference pathology was defined by either pathologic staging or the formal demonstration of malignant cells by either EUS-FNA or mediastinoscopy. Results: Thirty-two consecutive patients (81% males; median age, 61 years) with proven MPM underwent EUS-FNA. In 11 (34%) patients, a negative EUS-FNA or mediastinoscopy was not confirmed by surgical MLN dissection because of clinical deterioration or disease progression. In 21 (66%) patients, a formal pathology of the MLN was obtained and staging with EUS-FNA was positive in 4 (19%). Mediastinoscopy did not result in a greater yield of MLN metastasis as compared with EUS-FNA. Thoracotomy with complete lymph node dissection was done in 17 (81%). The overall prevalence of MLN metastasis was 24%, and the sensitivity of EUS-FNA was 80% (95% confidence interval, 28-99%) with a specificity of 100% (95% confidence interval, 79-100%). One patient had esophageal perforation related to EUS-FNA. Conclusions: EUS-FNA is feasible and sensitive for MLN staging in patients with MPM who are candidate for multimodality treatment. These data warrant further evaluation.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
ULTRASONOGRAPHY, TOMOGRAPHY, EUS-FNA, PHASE-III, EUROPEAN-ORGANIZATION, LUNG-CANCER, CERVICAL MEDIASTINOSCOPY, CISPLATIN, DIAGNOSIS, ACCURACY
journal title
CLINICAL CANCER RESEARCH
Clin. Cancer Res.
volume
14
issue
19
pages
6259 - 6263
publisher
AMER ASSOC CANCER RESEARCH
place of publication
USA, Philadelphia
Web of Science type
Article
Web of Science id
000260142500040
JCR category
ONCOLOGY
JCR impact factor
6.488 (2008)
JCR rank
16/141 (2008)
JCR quartile
1 (2008)
ISSN
1078-0432
DOI
10.1158/1078-0432.CCR-07-5283
language
English
UGent publication?
yes
classification
A1
id
527114
handle
http://hdl.handle.net/1854/LU-527114
date created
2009-03-20 15:34:56
date last changed
2009-03-25 13:47:50
@article{527114,
  abstract     = {Purpose: Surgical resection as part of a multimodality approach in malignant pleural mesothelioma (MPM) has a high morbidity and mortality. Because mediastinal lymph node (MLN) metastases are a negative prognostic factor, preoperative staging is of paramount importance. Transesophageal endoscopic ultrasound with real-time guided fine needle aspiration (EUS-FNA) enables accurate MLN staging in lung cancer.
Experimental Design: The feasibility and yield of EUS-FNA in MLN staging were prospectively analyzed in patients with presumed early-stage MPM considered for multimodality therapy. MLN reference pathology was defined by either pathologic staging or the formal demonstration of malignant cells by either EUS-FNA or mediastinoscopy.

Results: Thirty-two consecutive patients (81\% males; median age, 61 years) with proven MPM underwent EUS-FNA. In 11 (34\%) patients, a negative EUS-FNA or mediastinoscopy was not confirmed by surgical MLN dissection because of clinical deterioration or disease progression. In 21 (66\%) patients, a formal pathology of the MLN was obtained and staging with EUS-FNA was positive in 4 (19\%). Mediastinoscopy did not result in a greater yield of MLN metastasis as compared with EUS-FNA. Thoracotomy with complete lymph node dissection was done in 17 (81\%). The overall prevalence of MLN metastasis was 24\%, and the sensitivity of EUS-FNA was 80\% (95\% confidence interval, 28-99\%) with a specificity of 100\% (95\% confidence interval, 79-100\%). One patient had esophageal perforation related to EUS-FNA.

Conclusions: EUS-FNA is feasible and sensitive for MLN staging in patients with MPM who are candidate for multimodality treatment. These data warrant further evaluation.},
  author       = {Tournoy, Kurt and Burgers, Sjaak and Annema, Jouke and Vermassen, Frank and Praet, Marleen and Smits, Marianne and Klomp, Houke and Van Meerbeeck, Jan and Baas, Paul},
  issn         = {1078-0432},
  journal      = {CLINICAL CANCER RESEARCH},
  keyword      = {ULTRASONOGRAPHY,TOMOGRAPHY,EUS-FNA,PHASE-III,EUROPEAN-ORGANIZATION,LUNG-CANCER,CERVICAL MEDIASTINOSCOPY,CISPLATIN,DIAGNOSIS,ACCURACY},
  language     = {eng},
  number       = {19},
  pages        = {6259--6263},
  publisher    = {AMER ASSOC CANCER RESEARCH},
  title        = {Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma},
  url          = {http://dx.doi.org/10.1158/1078-0432.CCR-07-5283},
  volume       = {14},
  year         = {2008},
}

Chicago
Tournoy, Kurt, Sjaak Burgers, Jouke Annema, Frank Vermassen, Marleen Praet, Marianne Smits, Houke Klomp, Jan Van Meerbeeck, and Paul Baas. 2008. “Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma.” Clinical Cancer Research 14 (19): 6259–6263.
APA
Tournoy, K., Burgers, S., Annema, J., Vermassen, F., Praet, M., Smits, M., Klomp, H., et al. (2008). Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma. CLINICAL CANCER RESEARCH, 14(19), 6259–6263.
Vancouver
1.
Tournoy K, Burgers S, Annema J, Vermassen F, Praet M, Smits M, et al. Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma. CLINICAL CANCER RESEARCH. USA, Philadelphia: AMER ASSOC CANCER RESEARCH; 2008;14(19):6259–63.
MLA
Tournoy, Kurt, Sjaak Burgers, Jouke Annema, et al. “Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma.” CLINICAL CANCER RESEARCH 14.19 (2008): 6259–6263. Print.