title: EUS-guided FNA immediately after unrevealing transbronchial needle aspiration in the evaluation of mediastinal lymphadenopathy: a prospective study.
abstract: BACKGROUND
  Transbronchial needle aspiration (TBNA) and EUS-guided FNA (EUS-FNA) are minimally invasive diagnostic approaches to mediastinal lymphadenopathy. Rapid on-site cytopathologic evaluation (ROSE) may facilitate the decision whether to proceed to a second procedure in the same session. The aim of this study was to determine the utility of TBNA with ROSE, combined with the option for immediate EUS-FNA in a single-session approach to mediastinal lymphadenopathy.
  
  
  METHODS
  We prospectively recruited 20 patients (12 men; mean age 66.7 +/- 10.2 years) with mediastinal lymphadenopathy on CT who required cytopathologic evaluation. Bronchoscopy was first performed with TBNA and ROSE. If this was unrevealing, EUS-FNA was performed immediately afterward with ROSE. All procedures were performed with the patient under local anesthesia and sedation.
  
  
  RESULTS
  TBNA specimens were deemed adequate on-site in 13 patients, and EUS-FNA was performed in the remaining 7 patients. TBNA with ROSE was falsely negative in one patient. The diagnostic yield for TBNA and EUS-FNA alone was 65% and 86%, respectively. This single-session approach provided a yield of 90%, with no complications. The final diagnoses were 12 non-small-cell lung cancer, two small-cell lung cancer, one metastatic adenocarcinoma, two sarcoidosis, one tuberculosis, one lymphoma, and one with no definitive diagnosis.
  
  
  CONCLUSIONS
  Combining TBNA with the option for EUS-FNA immediately after unrevealing TBNA gave a yield approaching that of mediastinoscopy and, therefore, may reduce the need for invasive mediastinal sampling. This single-session endoscopic approach was safe, required only local anesthesia and sedation, was convenient, and obviated the need for patients to return for a second procedure.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, National University Hospital, Singapore.
authors.forename: Kay-Leong
authors.initials: KL
authors.lastname: Khoo
authors.forename: Khek-Yu
authors.initials: KY
authors.lastname: Ho
authors.forename: B
authors.initials: B
authors.lastname: Nilsson
authors.forename: T K
authors.initials: TK
authors.lastname: Lim
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D001999:Bronchoscopy; D002277:Carcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008223:Lymphoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D017565:Sarcoidosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology