title: Malignant mediastinal lymphadenopathy detected by staging EUS in patients with pancreaticobiliary cancer.
abstract: BACKGROUND
  In patients with pancreatic cancer, the presence of malignant mediastinal lymphadenopathy (MML) would preclude definitive resection. A recent study suggested routine evaluation for mediastinal lymph-node metastases in all patients being evaluated for pancreaticobiliary masses. In our practice, we routinely assess for mediastinal lymph-node metastases in all patients undergoing EUS for pancreaticobiliary cancer.
  
  
  METHODS
  We retrospectively evaluated the presence of MML by EUS-guided FNA (EUS-FNA) in 160 consecutive patients with a definite diagnosis of pancreaticobiliary cancer (pancreatic and periampullary cancers) who underwent EUS-FNA by a single operator from 2000 to 2004. Lymph nodes that were round and hypoechoic with sharp margins were considered suspicious and were sampled by FNA.
  
  
  RESULTS
  Of the 160 patients included in this study, 78 had peripancreatic lymph nodes (49%: 95% CI[41%, 58%]), 25 had celiac lymph nodes (16%: 95% CI[10%, 22%]), and 14 patients had mediastinal lymph nodes (9%: 95% CI[4%, 13%]) that were suspicious for malignancy by morphologic criteria. In 8 of 14 patients with suspicious mediastinal lymph nodes, FNA documented MML in 5%: 95% CI[2%, 8%]. Only one of these 8 patients with MML had other sites of documented distant metastases by CT and/or positron emission tomography scans. However, 7 of 8 patients had locally advanced cancers.
  
  
  CONCLUSIONS
  MML is detected by staging EUS-FNA in 5% of patients with pancreaticobiliary cancer. Because of its important implications, endosonographers should routinely assess for MML in patients who undergo staging EUS for pancreaticobiliary malignancy.
authors.affiliation: Division of Gastroenterology and Hepatology and Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Banke
authors.initials: B
authors.lastname: Agarwal
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Gogia
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Linus
authors.initials: L
authors.lastname: Ho
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology; D044963:Biopsy, Fine-Needle / Q000379:methods; D003138:Common Bile Duct Neoplasms / Q000473:pathology; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000556:secondary; D010190:Pancreatic Neoplasms / Q000473:pathology*; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional