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J Thorac Cardiovasc Surg 1998;116:559
© 1998 Mosby, Inc.

GENERAL THORACIC SURGERY

Commentary

Charleston, SC

	Introduction

Top Introduction

 
The article by Hünerbein and associates describes the potential usefulness of endoscopic ultrasonography (EUS) with needle biopsy for the evaluation of mediastinal structures adjacent to the esophagus. Their experience mirrors my experience at the Medical University of South Carolina (MUSC). Although EUS is not yet a common procedure in many centers in the United States, I anticipate that its utility will increase as physicians recognize the clinical relevance and very minimally invasive nature of the procedure. EUS with biopsy does require gastroenterologists trained in the technique and close cooperation with the thoracic surgeons.

At MUSC, my colleagues and I have used EUS and fine needle aspiration (FNA) to evaluate more than 140 patients with a lung mass and mediastinal adenopathy. The radiographically designated abnormal lymph nodes in both the aortopulmonary window and the subcarinal region are now preferentially evaluated by EUS/FNA. In the period from June 1994 to September 1997, 82 patients with a lung mass and mediastinal adenopathy underwent EUS/FNA. The sensitivity for the diagnosis of malignancy was 88% and the specificity was 100%. More than 30 patients with abnormal mediastinal adenopathy without a dominant pulmonary mass have also been evaluated by EUS/FNA. Similar to the findings of Hünerbein and colleagues, a variety of disease processes have been diagnosed, including sarcoidosis, histoplasmosis, lymphoma, and small cell lung cancer.

Our experience has been confined to aspiration cytology. The development of a specialized needle that is capable of giving a core biopsy for histologic evaluation may be particularly helpful in cases of lymphoma and granulomatous disease. Like the authors, we have observed no complications from EUS/FNA.

As a diagnostic and staging tool, EUS/FNA is meant to be a complementary procedure to cervical mediastinoscopy and thoracoscopy. In our hands, EUS/FNA is less invasive and more cost effective when applied to the correct situation. In my opinion, other reports will soon verify the results in the present article as surgeons become familiar with the potential usefulness of EUS-guided needle biopsy.

This article has been cited by other articles:

				A. Fritscher-Ravens, N. Soehendra, L. Schirrow, P. V. J. Sriram, A. Meyer, H.-P. Hauber, and A. Pforte Role of Transesophageal Endosonography-Guided Fine-Needle Aspiration in the Diagnosis of Lung Cancer Chest, February 1, 2000; 117(2): 339 - 345. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carolyn E. Reed Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Reed, C. E. Search for Related Content PubMed Articles by Reed, C. E.