Clinical impact of EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer or mediastinal lymph nodes of unknown etiology.
BACKGROUND
Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact.


METHODS
A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology.


RESULTS
Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or non-diagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediastinal LNs in patients with known or suspected lung cancer was 82.35%, 100%, and 90% respectively. The negative predictive value was 80% and the positive predictive value was 100%. There were 20 patients with suspicious mediastinal LNs of uncertain etiology, with a definitive diagnosis being made using EGD/EUS-FNA in 95%.


CONCLUSIONS
Our data supports the use of EUS-FNA in the work-up of enlarged mediastinal LNs on cross sectional imaging, thus avoiding more invasive mediastinal sampling procedures and potentially futile surgery.
Division of Gastroenterology, UTMB, Galveston, TX, USA.
Ramesh
R
Srinivasan
Manoop S
MS
Bhutani
Nirav
N
Thosani
Adrian
A
Săftoiu
David C
DC
Rice
Ana Maria
AM
Ioncică
George A
GA
Eapen
Parantap
P
Gupta
Sathya
S
Jaganmohan
Everson L A
EL
Artifon
Joseph B
JB
Zwischenberger
D044963:Biopsy, Fine-Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D019160:Endosonography / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008207:Lymphatic Metastasis; D008482:Mediastinum; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods*