Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy.
OBJECTIVE
To evaluate the safety and accuracy of endoscopic ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior mediastinal regions.


METHODS
Eighty-six consecutive patients with mediastinal lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US-guided FNAB of mediastinal lymphadenopathy was performed as a component of staging non-small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results.


RESULTS
In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US-guided FNAB in distinguishing benign from malignant mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who underwent staging of NSCLC, endoscopic US-guided FNAB had superior mediastinal lymph node staging accuracy compared with endoscopic US alone (79%) and CT alone (79%) (P =.01). The results of endoscopic US-guided FNAB prompted a change to nonsurgical management in 66 (80%) of 82 patients who underwent the procedure. One minor complication, postprocedural fever that resolved with oral antibiotics, occurred (1%; 95% CI: 0%, 6%).


CONCLUSIONS
Endoscopic US-guided FNAB is accurate and safe for biopsy of mediastinal lymph nodes to stage NSCLC, establish a primary diagnosis, or examine patients with prior inconclusive biopsy results.
Wiersema
M J
MJ
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Eisenberg 8A, Rochester, MN 55905, USA. wiersema.maurits@mayo.edu
Vazquez-Sequeiros
E
E
Wiersema
L M
LM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity