Non small cell lung cancer ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

On endobronchial ultrasound (EBUS) and endoscopic ultrasound, characteristic findings of non-small cell lung cancer include enlarged lymph nodes and local invasion to adjacent bronchial structures and mediastinum. Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.

Ultrasound

Endobronchial ultrasound is a first-line diagnostic modality for mediastinal staging.[1][2]

  • Endobronchial and endoscopic esophageal ultrasound are mainly used to identify mediastinal metastasis.
  • On ultrasound (endobronchial/endoscopic esophageal ultrasound), characteristic findings of non-small cell lung cancer include:
  • Indications for the endobronchial ultrasound:
    • Evaluation of lymph nodes and other structures in the mediastinum
    • Mediastinal invasion staging
    • Determination of management strategy
    • Real-time evaluation of structures

The table below summarizes the advantages and disadvantages of both ultrasound modalities, for the diagnostic assessment of non-small cell lung cancer.

Procedure Advantages Disadvantages
Endobronchial ultrasound (EBUS)
  • Direct visualization of lymph node stations.
  • Complements endoscopic ultrasound: covers lymph node stations 2R and 4R which are difficult to access by endoscopic ultrasound
  • Lower false-negative rate than with blind transbronchial fine needle aspiration and fewer complications
  • More invasive than endoscopic ultrasound, few practitioners, but rapidly growing in popularity
Endoscopic ultrasound (EUS)
  • Least invasive modality
  • Uses the esophagus to access mediastinal lymph nodes
  • Excellent for staging lymph nodes
  • Useful for station 2L and 4L, L adrenal, celiac lymph node
  • Cannot reliably access right sided paratracheal lymph node stations 2 R and 4R
  • Accurate discrimination of primary hilar tumors and involved lymph nodes is important

References

  1. Kinsey CM, Arenberg DA (2014). "Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging". Am. J. Respir. Crit. Care Med. 189 (6): 640–9. doi:10.1164/rccm.201311-2007CI. PMID 24484269.
  2. Tests for non-small cell lung cancer. American Cancer Society. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-diagnosis Accessed on February 25, 2016


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