Feasibility Study on the Contribution of Guided Puncture With Echoendoscopy

Main objective :

Assess the performance (in terms of sensitivity) of guided punction by echoendoscopy in the characterization of hypermetabolic mediastinal lymph nodes in PET, in a context of New cancer or cancer recurrence.

Conduct of the study :

When a patient has had a PET scan showing a hypermetabolic or mediastinal lymph nodes in the lower, middle or posterior, his case is presented in a multidisciplinary meeting (PCR # 1), with definition of diagnostic strategy:

Approved indication is achieve a biopsy surgically to have a histological documentation of mediastinal lymph nodes with obvious impact on treatment decisions.

We distinguish two groups of patients based on the feasibility of the surgical procedure:

• Group A biopsy is surgically feasible
• Group B: biopsy by surgery can not be performed (against medical contraindications or anesthetics) at that moment, definition of therapeutic strategy that was decided in the absence of histological documentation:

• Surgery outset
• Chemotherapy or other oncological treatment
• Supports non-oncological if benign disease suspected
• No treatment.

EUS is performed by oesophageal for two patient groups for the two groups of patients (within a maximum period of six weeks after the PET scan), under general anesthesia and endoscopic control.

According the pathological findings, the therapeutic strategy is defined in a second PCR (PCR # 2), to assess the impact of the puncture:

• Surgery outset
• Chemotherapy or other oncological treatment
• Supports non-oncological when benign pathology documented
• No treatment
• Selecting another surgical diagnostic procedure (non-contributory income).

A patient monitoring will be conducted for 12 months. The clinical and radiological data carried over the standard of care of the patient will be collected. Achieving a thoracoabdominopelvic scanner (TAP) at 1 year to characterize the evolution of the disease marks the end of the study for the patient.

For the patients who have had a negative biopsy, monitoring will involve a scanner TAP 6 month and 12 month then consultation with the oncologist.

Inclusion criteria

• Any patients who have had PET showing one or more hypermetabolic lymphadenopathy in middle mediastinum and/or lower and/or posterior, and requiring diagnostic certainty for support.
• PET scans performed in these particulars :

• Pre-treatment assessment of thoracic or extra-thoracic malignancies (patients without a history of cancer).
• Evaluation of response to treatment referred to oncological.
• Suspicion of relapse in patients with a personal history of thoracic or extra-thoracic malignancies.
• PET, the result is positive :

• For above-centimeter lymph node short axis: greater result than or equal to the background hepatic noise.
• For sub-centimeter lymph node small axis : greater result than the background hepatic noise
• Patient with indication of diagnostic procedure surgically (whether realized or not)
• Lymph node(s) available(s) puncture by EUS esophageal, so for a technically feasible for esophageal puncture (without vascular recusants structures)
• Age ≥ 18 years.
• PET scan performed within 6 weeks before EUS
• Platelets ≥ 70 000/mm3; TP ≥ 60%.
• Patient of childbearing age with negative pregnancy test and / or a contraception.
• Patient gave informed consent signed.
• Patient affiliated to a social security scheme.

Exclusion criteria

• Contra-indication (s) Director (s) to achieve a EUS.
• Balance adverse anesthetic (not allowing a general anesthetic).
• Esophageal stenosis.
• Coagulation disorders.
• Pregnant or lactating women.
• Unable to undergo medical monitoring test for geographical, social or psychological reasons.
• Private patient freedom and major subject of a measure of legal protection or unable to consent.