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. 2013 Aug;17(2):237-41.
doi: 10.1093/icvts/ivt166. Epub 2013 Apr 24.

Transoesophageal endoscopic ultrasound-guided fine-needle aspiration of pleural effusion for the staging of non-small cell lung cancer

Filippo Lococo  1 , Alfredo Cesario, Fabia Attili, Marco Chiappetta, Giovanni Leuzzi, Guido Costamagna, Pierluigi Granone, Alberto Larghi
Affiliations

Transoesophageal endoscopic ultrasound-guided fine-needle aspiration of pleural effusion for the staging of non-small cell lung cancer

Filippo Lococo et al. Interact Cardiovasc Thorac Surg. 2013 Aug.

Abstract

Objectives: The efficacy of endoscopic ultrasound (EUS) for evaluating mediastinal adenopathy in lung cancer is nowadays proven. However, its accuracy for detection of malignant pleural effusion per se has not been yet investigated. Herein we report our experience with EUS for detecting pleural effusion during the staging procedure of non-small cell lung cancer (NSCLC) patients.

Methods: Between January 2009 and December 2011, we performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) on 92 selected NSCLC patients to evaluate the T and N factors and to acquire bioptic material and when this was detected, to sample the pleural effusion.

Results: In 10 patients (8 males and 2 females, mean age 66.9±9.2 years) a pleural effusion was detected and sampled. In 7 out of the 10 cases, the cytological examination of the fluid obtained by EUS-FNA tested positive for malignant cells, thereby upgrading the case to Stage IV, irrespective of T and N statuses. In 3 cases the cytology on the EUS-FNA material was proven to be negative for malignancy thereby allowing patients to be treated with curative intent without further delay.

Conclusions: EUS-FNA of the pleural fluid is a safe and simple procedure. Our data, albeit stemming from a limited study population, show that it can be efficient in selected NSCLC cases for obtaining useful material and information with significant impact on the staging and, therefore, on the planning of the optimum therapeutic strategy.

Keywords: EUS-FNA; NSCLC; Pleural effusion.

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Figures

Figure 1:
Figure 1:
CT-scan findings: a moderate right PE, associated with large and necrotic mediastinal lymph nodes, was detected and EUS-FNA indicated.
Figure 2:
Figure 2:
EUS findings: the right PE was easily sampled with a 22-gauge needle, without complications.
Figure 3:
Figure 3:
Cytological findings: the examination of the pleural fluid demonstrated the presence of malignant neoplastic cells (see arrow).
See this image and copyright information in PMC

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