EUS-guided FNA for the diagnosis of advanced lung cancer

Background: A majority of patients with lung cancer are incurable but are symptomatic and may benefit from palliative therapy Currently available diagnostic methods are either too risky or unsuccessful in obtaining a tissue diagnosis in up to 30% of patients. Objective: To evaluate the role of EUS-guided FNA in obtaining a tissue diagnosis in patients with advanced lung cancer. Design: Prospective, uncontrolled. Setting: Veterans Administration Medical Center. Subjects and Methods: Patients with suspected lung cancer who were not candidates for curative therapy were prospectively identified. CT scans were reviewed, and patients with lesions considered suitable for sampling by EUS were enrolled. Outcomes were analyzed by a final tissue diagnosis or by serial imaging. Results: Sixty-nine patients met inclusion criteria, of which 3 refused participation. The remaining 66 patients constituted the study population. EUS was technically successful in 95% of patients. A final diagnosis was based on tissue in 63 of 66 patients, serial imaging in 1 of 66 patients, and was unavailable in 2 of 66 patients. A lung mass was sampled in 21 patients, and a metastatic lesion was sampled in 45 patients. EUS made a correct diagnosis in 55 of 64 patients (86%, 95% confidence interval [CI] 77%-93%), including 24% that had undergone a failed prior attempt at diagnosis. The sensitivity of EUS was 86%, and the specificity was 100%. Sampling a metastasis was more likely to yield a correct diagnosis than sampling a lung mass (P =.02). Two self-limited complications were noted during the study. Conclusions: EUS was an accurate and a safe method for obtaining a tissue diagnosis in patients with advanced incurable lung cancer.