Endobronchial ultrasound and lymphoproliferative disorders: a retrospective study.
BACKGROUND
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to have excellent diagnostic performance for mediastinal staging of lung cancer. The utility of EBUS-TBNA for the diagnosis of lymphoproliferative disorders involving the mediastinum or hila, or both, is unclear.


METHODS
A retrospective analysis was completed of all patients diagnosed with a lymphoproliferative disorder involving the mediastinum or hila, or both, who underwent an EBUS-TBNA within 3 months of the diagnosis.


RESULTS
Sixty-five patients with mediastinal or hilar lymph node, or both, involvement of their lymphoproliferative disorder underwent EBUS-TBNA within 3 months of their diagnosis. The initial EBUS-TBNA was nondiagnostic in 34 (52%), 11 were subsequently diagnosed by mediastinoscopy, and the remaining 23 were diagnosed by biopsy of a distant site, with involvement of the mediastinum or hilum assumed from preestablished radiographic criteria. A EBUS-TBNA specimen in 31 patients (48%) was interpreted as consistent with or suspicious for a lymphoproliferative disorder. The overall sensitivity of EBUS-TBNA for establishing a definitive diagnosis was 25 of 65 (38%). The sensitivity was lower for new patients, at 7 of 32 (22%), and better for patients with recurrence, at 18 of 33 (55%).


CONCLUSIONS
Contrary to previous studies, our findings suggest that EBUS-TBNA does not provide sufficient diagnostic material for accurate lymphoproliferative disorder subtyping in a significant number of patients and performs especially poorly when evaluating new patients. Mediastinoscopy should still be considered as the initial diagnostic procedure of choice when the clinical suspicion for a lymphoproliferative disorder is high, unless the patient is being evaluated for a recurrence of prior disorder.
Division of Pulmonary and Critical Care Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Seher
S
Iqbal
Zachary S
ZS
DePew
Paul J
PJ
Kurtin
Anne-Marie G
AM
Sykes
Geoffrey B
GB
Johnson
Eric S
ES
Edell
Thomas M
TM
Habermann
Fabien
F
Maldonado
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008232:Lymphoproliferative Disorders / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies