EUS-FNA in the Pre-Operative Evaluation of Patients With Lung Cancer

Inclusion Criteria: * patients with histological or cytological proof of non small cell lung cancer (NSCLC) or with a high clinical suspicion for lung cancer (but without pathologically confirmed diagnosis from the bronchoscopy or CT guided transthoracal biopsies) in whom the next step is normally a diagnostic or therapeutic surgical intervention * no distant metastases after routine clinical work up (PET is optional, not mandatory) * provision of a written informed consent * recent CT-scan of the thorax (\<28 days before randomization date) * age 18 years or older * clinically fit for surgery Exclusion Criteria: * proof of small cell lung cancer (SCLC) with CWU (bronchoscopy or CT guided transthoracal punction) * stage IV NSCLC * patients with a solitary pulmonary nodule (thus without enlarged mediastinal lymph nodes on CT and without mediastinal PET hot spots) : these do not require further mediastinal investigation * former therapy (chemotherapy or radiotherapy or surgery) for lung cancer * other concomitant malignancies * reasons for which the patient is unable to swallow the EUS-instrument (e.g. zenker diverticulum, unexplained esophageal stenosis) * uncorrected coagulopathy