Impact of EUS-guided FNA of enlarged mediastinal lymph nodes on subsequent thoracic surgery rates.
BACKGROUND
A histopathologic diagnosis of metastasis in enlarged mediastinal lymph nodes usually results in non-surgical management. Cytologic specimens obtained by EUS-guided FNA can be used to detect malignancy in posterior mediastinal lymph nodes. The purpose of this study was to determine the rate of thoracic surgery after EUS-guided FNA of enlarged mediastinal lymph nodes.


METHODS
A prospective observational study of patients with enlarged posterior mediastinal lymphadenopathy who were referred for EUS-guided FNA. All patients were candidates for mediastinoscopy. Patients were followed for 12 months to determine the subsequent rate of mediastinoscopy or thoracotomy and the diagnostic accuracy of EUS-guided FNA.


RESULTS
Evaluation of cytologic specimens obtained by EUS-guided FNA revealed malignancy in 23 of 59 (39%) patients. The overall rate of surgery was 22% (13/59): 95% CI[0.12, 0.35]. The surgery rate for patients with a positive cytologic result was 4% (1/23) compared with 33% (12/36) for those with a negative result (p=0.009). Of patients with CT findings of a peripheral lung mass plus mediastinal lymphadenopathy, 22 of 26 (42%) underwent surgery after EUS-guided FNA, compared with two of 33 (6%) of those with mediastinal lymphadenopathy alone (p=0.0009). For cytologic evaluation of specimens obtained by EUS-guided FNA, the overall sensitivity, specificity, and accuracy for the diagnosis of malignant lymphadenopathy were 96%, 100%, and 98%, respectively.


CONCLUSIONS
Few patients who undergo EUS-guided FNA of enlarged posterior mediastinal lymph nodes require subsequent thoracic surgery.
Division of Gastroenterology, University of California-San Diego, School of Medicine, UCSD Thornton Gastroenterology, 9320 Campus Point Drive, La Jolla, CA 92037, USA.
Thomas J
TJ
Savides
Anthony
A
Perricone
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery; D018288:Carcinoma, Small Cell / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008223:Lymphoma / Q000473:pathology / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013908:Thoracotomy / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed