title: Endobronchial ultrasound-guided transbronchial needle biopsy for diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancy.
abstract: Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jinkyeong
authors.initials: J
authors.lastname: Park
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Yeon-Mok
authors.initials: YM
authors.lastname: Oh
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Shim
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Chang Min
authors.initials: CM
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult