Endoscopy 2011; 43 - A79
DOI: 10.1055/s-0031-1292150

Novel application of catheter probe EUS for mediastinal lymph node

Nishimura Makoto 1, Shono Takashi 1, Ochiai Yasutoshi 1, Nakao Masamitsu 1, Togawa Osamu 1, Ishikawa Keiko 1, Arai Shin 1, Kita Hiroto 1
  • 1Saitama Medical University International Medical, Japan

Background:

Accurate evaluation of mediastinal lymphadenopathy of esophageal cancer or lung cancer is important for determining the appropriate therapy. Radial type endoscopic ultrasound (radial-EUS), computed tomography (CT), and positron emission tomography (PET) scanning are widely used, but there are no data regarding the use of catheter probe EUS for evaluation of mediastinal lymph node.

Objective:

This study investigated the role of catheter probe EUS for mediastinal lymph node.

Design:

Single center, case series

Methods:

A total of 20 patients (15 males, 5 females, mean age 65.9 years) with esophageal cancer and lung cancer were retrospectively reviewed. All patients had undergone EGD followed by catheter probe 20MHz EUS, CT, and PET for evaluation of mediastinal lymph node. Standard EGD was performed first under conscious sedation. Then, a 20MHz catheter probe EUS was inserted via the channel of the standard endoscope without water filling and used to examine the mediastinal region to evaluate lymph nodes. During the catheter probe EUS examination, all intraesophageal air was aspirated continuously in order to visualize the mediastinum.

Results:

The detection rate for mediastinal lymph nodes was 85% for catheter probe EUS, 45% for CT, and 60% for PET. Among patients demonstrating mediastinal lymphadenopathy on catheter probe EUS, 5 of 17 cases underwent surgery, and 4 of these 5 cases demonstrated mediastinal lymph node metastasis pathologically. Two cases underwent EUS-FNA for mediastinal lymphadenopathy for pathological evaluation, which demonstrated one case of bronchogenic cyst and one case of adenocarcinoma. In patients who did not demonstrate mediastinal lymphadenopathy on catheter probe EUS, 1 of 3 cases underwent surgery, and pathology was negative for mediastinal lymph node metastasis.

Conclusion:

In esophageal cancer and lung cancer patients, catheter probe EUS is superior to CT and PET/CT for detection of mediastinal lymphadenopathy. In this study, the mediastinum was well visualized in all cases without difficulty, suggesting that catheter probe EUS following standard EGD is feasible and useful.

Our study suggests that standard EGD followed by catheter probe EUS is useful, convenient, and could replace radial-EUS. This is a novel application of catheter probe EUS for evaluation of mediastinal lymph nodes.