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Endoscopy 2006; 38: 77-80
DOI: 10.1055/s-2006-946661
Invited papers
Mediastinal EUS
© Georg Thieme Verlag KG Stuttgart · New York

Lung cancer patients with small nodes on CT - what's the next step?

J. T. Annema1 , K. F. Rabe1
  • 1Division of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Publication Date:
26 June 2006 (online)

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Lung cancer patients with small nodes-background

The management of patients with non-small cell lung cancer (NSCLC) without signs of mediastinal involvement (nodes < 1 cm short axis) at chest-computed tomography (CT) is subject of debate. Regarding the high prevalence of lung cancer and the fact that operable lung cancer patients often present with small nodes, the issue under investigation is very relevant. To date, these patients will rarely be referred for thoracotomy directly without further staging, as small nodes contain mediastinal metastases in around 18 % (range 15 %-37 %) of patients [1] and it is generally accepted that patients with locally advanced disease are preferable treated with multi modality treatment versus surgery alone [2] [3]. For mediastinal staging, in addition to the well established surgical procedures mediastinoscopy-/tomy and thoracoscopy [4], novel methods have become clinically available such as Positron Emission Tomography (PET) and ultrasound- guided needle aspiration methods from both the esophagus (transesophageal ultrasound guided fine needle aspiration: EUS-FNA) and bronchi (endobronchial ultrasound guided transbronchial needle aspiration: EBUS-TBNA). Each of the staging methods has specific advantages and limitations and therefore various staging strategies are possible to accomplish accurate mediastinal staging. In this paper we will focus on patients with NSCLC and small nodes at chest CT and provide arguments for several different staging strategies for this large subset of patients.

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Jouke Annema, MD, PhD

Department of Pulmonology C3 P

Albinusdreef 2

PO box 9600

2300 RC Leiden

Leiden University Medical Center

Leiden

The Netherlands

Phone: 0031-71-5262950

Fax: 0031-71-5266927

Email: j.t.annema@lumc.nl

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