Journal Information
Vol. 36. Issue 8.
Pages 455-459 (September 2000)
Share
Share
Download PDF
More article options
Vol. 36. Issue 8.
Pages 455-459 (September 2000)
Full text access
Evaluación de la afectación mediastínica tumoral (factor T) en el cáncer de pulmón mediante ecografía transesofágica
Transesophageal ultrasound assessment of mediastinal tumor involvement (T factor) in lung cancer
Visits
9264
J.L. Duque Medina*,1, G. Ramos*, J.A. San Román**, A. López*, M. García-Yuste*, F. Heras*, J. Cerezal*, J.M. Matilla*
* Servicios de Cirugía Torácica. Hospital Universitario de Valladolid
** Servicios de Cardiología. Hospital Universitario de Valladolid
This item has received
Article information

La ecografía transesofágica es una técnica inicialmente empleada en la valoración de las neoplasias esofagogástricas. Su utilización en la evaluación de las neoplasias pulmonares puede ser una ayuda valiosa a la hora de considerar la posible afectación mediastínica tanto en el factor T como en el N.

Objetivo

Considerar la validez de esta exploración incruenta para determinar la posible afectación mediastínica por invasión directa del tumor (T4) como medio para conseguir una más correcta estadificación del cáncer de pulmón.

Pacientes y métodos

Dieciséis pacientes con neoplasia de pulmón confirmada histopatológicamente han sido explorados mediante ecografía transesofágica para evaluar una posible afectación mediastínica. Previamente habían sido etiquetados por tomografía computarizada como T4 (12) o dudosos T4 (4). En 15 de los 16 pacientes se evaluó la afectación del mediastino con mediastinotomía o toractomía.

Resultados

De los 16 pacientes, ocho presentaban afectación mediastínica mediante ecografía transesofágica y en el resto no. La evaluación quirúrgica del mediastino confirmó la afectación de éste en siete de los detectados por la ecografía (uno no se evaluó quirúrgicamente). De los 8 pacientes considerados como sin afectación mediastínica en siete no existía y en uno no se detectó una infiltración de la cara posterior de la arteria pulmonar derecha. La sensibilidad fue del 87,5%, la especificidad, del 100% y la exactitud del 93,3%.

Conclusión

La ecografía transesofágica es un método diagnóstico que puede aportar información adicional y complementaria a otros métodos diagnósticos.

Palabras clave:
Tomografía computarizada
Ecografía transesofágica
Afectación mediastínica tumoral (T4)

Transesophageal sonography was originally used to assess esophageal-gastric neoplasm. The technique may also be useful in the evaluation of pulmonary neoplasms for possible mediastinal involvement, with regard to both T and N factors.

Objective

To consider the validity of this minimally-invasive technique for assessing possible mediastinal involvement by direct tumoral invasion (T4) and to help obtain the most accurate staging of lung cancer.

Patients and methods

Sixteen patients with confirmed histopathological diagnoses of pulmonary neoplasm were examined by transesophageal sonography in order to evaluate possible mediastinal involvement. They had previously been classified by computed tomography as T4 (12 patients) or possible T4 (4 patients). Mediastinal involvement was also assessed by mediastinotomy or thoracotomy in 15 of the 16 patients.

Results

Transesophageal sonography revealed mediastinal involvement in eight of the 16 patients; the rest had no such involvement. Surgical exploration of the mediastinum confirmed involvement in seven of those who had been so classified by sonography (with the remaining patient not having been assessed surgically). Among the eight patients who were considered free of mediastinal involvement, there was in fact none, although we found previously undetected infiltration of the posterior surface of the right pulmonary artery in one patient. Sensitivity was 87.5%, specificity 100% and accuracy 93.3%.

Conclusion

Transesophageal ultrasound is a diagnostic tool that can provide additional information to complement other diagnostic strategies.

Key words:
Computed tomography
Transesophageal ultrasound
Tumor, mediastinal involvement (T4)
Full text is only aviable in PDF
Bibliografía
[1.]
L.E. Quint, I.R. Francis, R.L. Wahl, B.H. Gross, G.M. Glazer.
Preoperative staging of non small-cell carcinoma of yhe lung: imaging methods.
AJR, 164 (1995), pp. 1349-1359
[2.]
W.R. Webb, E.A. Gatsonis, E.A. Zerhouni, R.T. Heelan, G.M. Glazer, R. Francis, et al.
CT and MR staging in non-small cell bronchogenic carcinoma: Radiology Diagnostic Oncology Group.
Radiology, 178 (1991), pp. 705-713
[3.]
E.A. Rendina, D.A. Bognolo, T.C. Mineo, G.F. Gualdi, M. Caterino, C. Di Biasi, et al.
Computed tomography for the evaluation of intrathoracic invasion by lung cancer.
J Thorac Cardiovasc Surg, 94 (1987), pp. 57-63
[4.]
T. Arita, T. Matsumoto, T. Kuramitsu, M. Kawamura, N. Matsunaga, K. Sugi, et al.
Is it posible to differentiate malignant mediastinal nodes from benign nodes by size?.
Chest, 110 (1996), pp. 1004-1008
[5.]
D. Kondo, M. Imaizumi, T. Abe, T. Naruke, K. Suemasu.
Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer.
Chest, 98 (1990), pp. 586-593
[6.]
D.J. Sugarbaker, G.M. Strauss.
Advances in surgical staging and therapy of non-small-cell lung canceer.
Semin Oncol, 20 (1993), pp. 163-172
[7.]
R.E. Dales, R.M. Stark, S. Raman.
Computed tomography to stage lung cancer.
Am Rev Respir Dis, 141 (1990), pp. 1096-1101
[8.]
T.C. McLoud, P.M. Borgouin, R.W. Greenberg, S.P. Kosiuk, P.A. Templeton, J.A. Shepard, et al.
Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node maping and sampling.
Radiology, 182 (1992), pp. 319-323
[9.]
A. Gdeedo, P. Van Schil, B. Corthouts, F. Van Mieghem, J. Van Meerbeeck, E. Van Marck.
Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging.
Eur Respir J, 10 (1997), pp. 1547-1551
[10.]
R.H. Hawes, F. Gress, A. Kesler, O.W. Cummings, D.J. Conces.
Endoscopic ultrasound versus computed tomography in the evaluation of the mediastinum in patients with non-small-cell lung cancer.
Endoscopy, 26 (1994), pp. 784-787
[11.]
N. Lee, K. Inoue, R. Yamamoto, H. Kinoshita.
Patterns of internal echoes in lymph nodes in the diagnosis of lung cancer metastasis.
World J Surg, 16 (1992), pp. 986-994
[12.]
L.S. Broderick, R.D. Tarver, D.J. Conces.
Imaging of lung cancer: old and new.
Semin Oncol, 24 (1997), pp. 411-417
[13.]
F.G. Gress, R.H. Hawes, T.J. Savides, S.O. Ikenberry, G.A. Lehman.
Endoscopic ultrasound-guided fine needle aspiration biopsy using linear array and radical scanning endosonography.
Gastrointest Endosc, 45 (1997), pp. 243-250
[14.]
P. Potepan, E. Meroni, I. Spagnoli, L. Milella, G.M. Danesini, A. Laffranchi, et al.
Non-small-cell lung cancer: detection of mediastinal lymph node metastases by endoscopic ultrasound and CT.
Eur Radiol, 6 (1996), pp. 19-24
[15.]
G.A. Silvestri, B.J. Hoffman, M.S. Bhutani, R.H. Hawes, L. Coppage, A. Sandeers-Cliette, et al.
Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.
Ann Thorac Surg, 61 (1996), pp. 1441-1446
[16.]
M.J. Wierseman, M.L. Kochman, H.M. Cramer, L.M. Wersema.
Preoperative staging of non-small cell lung cancer: Transesophageal US-guided fine-needle aspiration biopsy of mediastinal lymph nodes.
Radiology, 190 (1994), pp. 239-242
[17.]
D.L. Serna, H.E. Aryan, K.J. Chang, M. Brenner, L.M. Tran, J.C. Chen.
An early comparison between endoscopic ultrasound-guided fineneedle aspiration and mediastinoscopy for diagnosis of mediastinal malignancy.
Am Surg, 64 (1998), pp. 1014-1018
[18.]
M. Hünerbein, B.M. Ghadami, W. Haensch, P.M. Schlag.
Transesophageal biopsy of mediastinal and pulmonary tumors by means of endoscopic ultrasound guidance.
J Thorac Cardiovasc Surg, 116 (1998), pp. 554-559
[19.]
C.F. Mountain.
A new international staging system for lung cancer.
Chest, 89 (1986), pp. 225S-235S
[20.]
American Joint Committee on, Cancer,.
Manual for staging of cancer.
4.ª, Lippincott, (1992), pp. 115-122
[21.]
UICC International Union Against Cancer.
TNM classification of malignant tumours, 5.ª, pp. 91-97
[22.]
AJCC cancer staging manual, 5.ª, pp. 127-137
[23.]
Grupo de Trabajo SEPAR.
Normativa actualizada (1998) sobre diagnóstico y estadificación del carcinoma broncogénico, 34 (1998), pp. 437-452
[24.]
C.H. Chaagnaud, J.M. Bartolf, P.E. Magnan, J.M. Bereden, R. Guidicelli, P. Fuentes, et al.
Bilan pre-operatoire des cancers broncho-pulmonaires centraux.
Corrélations TDM-IRM-angiographie pulmonaire nemérisée et chirurgie. Ann Chir Chir thorac Cardio-Vasc, 44 (1990), pp. 125-128
[25.]
L. Bonomo, C. Ciccotosto, A. Guidotti, M.L. Storto.
Lung cancer staging: the role of computed tomography and magnetic resonance imaging.
Eur J Radiol, 23 (1996), pp. 35-43
[26.]
S. Lam, H.D. Becker.
Future diagnostic procedures.
Chest Surg Clin North Am, 6 (1996), pp. 363-380
[27.]
T. Tatsumura.
Preoperative and intraoperative ultrasonographic examination as an aid in lung cancer operations.
J Thorac Cardiovasc Surg, 110 (1995), pp. 606-612
[28.]
E. Meroni, P. Potepan, I. Spagnoli, P. Spinelli.
Esophageal endosonography in staging of lung tumors.
J Bronchol, 3 (1996), pp. 266-270
[29.]
G. Potoff, J.M. Curtius, K. Wasseerman, M. Junge-Hulsing, H. Schicha, H.H. Hilger.
Tranesophageal echography in staging of bronchial cancers.
Pneumologie, 48 (1992), pp. 111-117
[30.]
D.K. Rex, R.D. Tarver, M. Wieersema, K.W. O’Conner, J.C. Lappas, K. Tabatowski.
Endoscopic tranesophageal fine needle aspiration of mediastinal masses.
Gastrointest Endosc, 37 (1991), pp. 465-468
Copyright © 2000. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?