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Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma

(2008) CLINICAL CANCER RESEARCH. 14(19). p.6259-6263
Author
Organization
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.
Keywords
ULTRASONOGRAPHY, TOMOGRAPHY, EUS-FNA, PHASE-III, EUROPEAN-ORGANIZATION, LUNG-CANCER, CERVICAL MEDIASTINOSCOPY, CISPLATIN, DIAGNOSIS, ACCURACY

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MLA
Tournoy, Kurt, Sjaak A Burgers, Jouke T 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.
APA
Tournoy, K., Burgers, S. A., Annema, J. T., Vermassen, F., Praet, M., Smits, M., Klomp, H. M., 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.
Chicago author-date
Tournoy, Kurt, Sjaak A Burgers, Jouke T Annema, Frank Vermassen, Marleen Praet, Marianne Smits, Houke M 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.
Chicago author-date (all authors)
Tournoy, Kurt, Sjaak A Burgers, Jouke T Annema, Frank Vermassen, Marleen Praet, Marianne Smits, Houke M 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.
Vancouver
1.
Tournoy K, Burgers SA, Annema JT, 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. 2008;14(19):6259–63.
IEEE
[1]
K. Tournoy et al., “Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma,” CLINICAL CANCER RESEARCH, vol. 14, no. 19, pp. 6259–6263, 2008.
@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 A and Annema, Jouke T and Vermassen, Frank and Praet, Marleen and Smits, Marianne and Klomp, Houke M and Van Meerbeeck, Jan and Baas, Paul},
  issn         = {1078-0432},
  journal      = {CLINICAL CANCER RESEARCH},
  keywords     = {ULTRASONOGRAPHY,TOMOGRAPHY,EUS-FNA,PHASE-III,EUROPEAN-ORGANIZATION,LUNG-CANCER,CERVICAL MEDIASTINOSCOPY,CISPLATIN,DIAGNOSIS,ACCURACY},
  language     = {eng},
  number       = {19},
  pages        = {6259--6263},
  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},
}

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