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Does Size Really Matter?

Endoscopic ultrasound (EUS) is well recognized for its ability to accurately stage primary gastrointestinal and pancreatic tumors (T-stage) and detect the presence of lymph nodes (N-stage) that may not be seen using other modalities. EUS has also recently established a role in evaluating mediastinal pathology, including lung cancer staging. Finding prominent lymph nodes in a patient with cancer is worrisome, but any inflammatory processes can give lymph nodes an abnormal appearance, particularly in the mediastinum where histoplasmosis, sarcoid, and other conditions frequently cause lymphatic enlargement. The characteristic features of malignant lymphadenopathy by EUS have long been the subject of discussion and debate. Differentiating between inflammatory and metastatic lymphadenopathy is critical, as this information directly affects therapeutic options and may exclude a patient from surgery (1,2). The prospective study presented by Chen et al., examines the association of various echo findings with malignant lymphadenopathy, compares the accuracy of echo findings alone to EUS-guided fine needle aspiration (EUS-FNA), and reconfirms the utility of this technology in cancer staging.