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19  Accepted Manuscript
Combined Endosonographic Mediastinal Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non-Small Cell Lung Cancer in high-risk patients
Pravachan Hegde MD , Juan Carlos Molina MD ,
Maureen Thivierge-Southidara , Ratnali Vipul Jain MD, MS ,
Akshatha Gowda MD , Pasquale Ferraro MD ,
Moishe Liberman MD, PhD
PII:
DOI:
Reference: 
To appear in: 
Seminars in Thoracic and Cardiovascular Surgery
Please cite this article as: Pravachan Hegde MD , Juan Carlos Molina MD , Maureen Thivierge-Southidara , Ratnali Vipul Jain MD, MS , Akshatha Gowda MD , Pasquale Ferraro MD , Moishe Liberman MD, PhD , Combined Endosonographic Mediastinal
Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non-Small Cell Lung Cancer in high-risk patients, Seminars in Thoracic and Cardiovascular Surgery (2019), doi: https://doi.org/10.1053/j.semtcvs.2019.07.007
This is a PDF Þle of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its Þnal form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Combined Endosonographic Mediastinal Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non-Small Cell Lung Cancer in high-risk patients.
Pravachan Hegde MD1,2, Juan Carlos Molina MD1, Maureen Thivierge-Southidara1, Ratnali Vipul Jain MD MS2, Akshatha Gowda MD2, Pasquale Ferraro MD1, Moishe Liberman MD PhD1
CETOC – CHUM Endoscopic Tracheobronchial and Oesophageal
Center, Department of Surgery, Division of Thoracic Surgery, University of Montréal, Montréal, Québec, Canada
UCSF - Fresno Medical Education Program, Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, Division of Pulmonary & Critical Care University of California San Francisco (UCSF), Fresno, CA, USA
No conflict of interest and no funding for any author Clinical Trial Registry: Not applicable Corresponding Author: Pravachan Hegde, MD
UCSF - Fresno Medical Education Program, Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, Division of Pulmonary & Critical Care
University of California San Francisco (UCSF), 2335 East Kashian Lane, Suite 260, Fresno, CA 93701, USA Email: [email protected]
ACCEPTED MANUSCRIPT
Objective (50 words max): Positron emission tomography (PET) with computed tomography
(CT) is routinely utilized to investigate lymph node (LN) metastases in non-small cell lung cancer.
However, it is less sensitive in normal-sized LNs. This study was performed in order to define the
prevalence of mediastinal LN metastases discovered on combined endosonography by endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) fine needle aspiration in patients with a radiologically normal mediastinum.
Methods (100 words max): This study consists of a retrospective, single-institution, tertiary care referral center review of a prospectively maintained database. Patients were identified from a
cohort between January 2009 and December 2014. One hundred and sixty-one patients with biopsy
proven, non-small cell lung cancer were identified in whom both the pre-endosonography CT and
PET- CT were negative for mediastinal LN metastases. Combined endosonography (EBUS + EUS
– FNA) was performed in all patients. Z test was used for statistical analysis. A p-value of <0.05 was considered statistically significant.
Results (150 words max): A total of 161 consecutive patients were included. Patients were staged if they had central tumor, tumor size > 3cm, N1 lymph node involvement on PET– CT/CT, or if there was low SUV (< 2.5) in the primary tumor. A total of 416 lymph nodes were biopsied in the 161 patients using combined endosonography; 147 with EBUS and 269 with EUS. Mean and median number of lymph nodes biopsied per patient using combined EBUS/EUS was 2.5 and 3, respectively (mean and median EBUS: 0.91 and 2.5; mean and median EUS 1.6 and 3). Endosonographic staging upstaged 13% of patients with radiologically