Mediastinal lymph node staging with transesophageal echography in cancer of the lung

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Abstract
Transesophageal echography (TEE) was used prospectively to studymediastinal lymph node enlargement in 23 patients with cancer of the lung.The findings were validated blindly by comparison with computed tomography(CT, n = 23) and pathological N classification after curative surgery (n =9). Lymph nodes larger than 1 cm were defined as pathologically enlarged.In the upper mediastinum, 22% (8 vs 36), in the lower mediastinum includingthe subaortic region 112% (37 vs 33) and in the hilar region 67% (6 vs 9)of enlarged lymph nodes diagnosed by CT were detected by TEE. Apathological study in 9 patients demonstrated true positive findings in 2vs 1, true negatives in 4 vs 5, false positives in 3 vs 2 and falsenegatives in 0 vs 1 comparing TEE with CT. From these preliminary data, weconclude that TEE, although still experimental, is equal or superior to CTin detecting enlarged nodes in the lower mediastinum, specifically in theaortopulmonary window but clearly inferior in the upper mediastinum and thehilar region. Additional information on central tumors and infiltration ofthe heart or great vessels can be clarified. In addition, data onhemodynamics and cardiac status can be obtained. TEE seems to be apromising tool in the preoperative staging of lung cancer.

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