Image-guided fine needle aspirate strategies for staging of lung cancer

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18 Scopus citations


Image-guided transthoracic, bronchoscopic, and endoscopic ultrasound fine needle aspiration (FNA) greatly facilitates lung cancer staging by having the potential to precisely biopsy lung lesions and virtually all medi-astinal lymph node stations. Imaging modalities alone, including chest x-ray, computed tomography (CT), magnetic resonance imaging, and positron emission tomography identify lesions suspicious for cancer but cannot make a tissue diagnosis. We describe an algorithm for the diagnosis and tumor-node-metastasis staging of lung cancer that uses procedures with the least invasiveness and cost with the highest diagnostic yields. For the anterior mediastinum, fluoroscopic-, ultrasound-, or CT-guided transthoracic FNA (which has a greater yield than bronchoscopy and is less invasive than mediastinoscopy) should be the primary technique for lymph node sampling. In the middle mediastinum, CT-guided transthoracic FNA is preferred for all nodal stations except subcarinal. Endoscopic ultrasound-guided FNA (EUS-FNA), which enables real-time biopsies within 5 cm of the esophagus, is preferred for sampling subcarinal and posterior mediastinal nodes because the yield is similar to CT-guided transthoracic FNA, with minimal risk of pneumothorax. The posterior mediastinum is also accessed by fluoroscopic- or CT-guided transthoracic FNA or video-assisted thoracic surgery. Sampling of the aorticopulmonary window depends on lymph node size; if the nodes are large enough to displace the aortic arch and pulmonary vein, then EUS-FNA is attempted, and if the nodes are not sufficiently enlarged, CT-guided transthoracic FNA should be performed prior to thoracoscopy or thoracotomy.

Original languageEnglish
Pages (from-to)101-110
Number of pages10
JournalClinical Lung Cancer
Issue number2
StatePublished - 2000

Bibliographical note

Funding Information:
This work is supported in part by the Constance Marcili Schafer Endowed Research Fund for Respiratory Diseases.


  • Fine needle aspiration
  • Lung cancer
  • Mediastinal lymph nodes
  • Thoracotomy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research


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