title: Usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing sarcoidosis from recurrent cancer in patients with lymphadenopathy after surgery.
abstract: OBJECTIVE
  Endobronchial ultrasound-guided transbronchial needle aspiration is a new minimally invasive test for investigating mediastinal and hilar lymphadenopathy. It is sometimes difficult to distinguish between a recurrent malignant lymph node and lymphadenopathy due to sarcoidosis in patients who develop lymphadenopathy after surgery for a malignant tumor.
  
  
  METHODS
  Between December 2009 and October 2012, we performed endobronchial ultrasound-guided transbronchial needle aspiration in 13 selected patients with a suspected recurrence in the mediastinum and/or hilum of the lung after surgical resection of a malignant tumor. We examined their medical records to obtain information on the diagnosis, the sizes of lymph nodes, the number of needle passes and other complications.
  
  
  RESULTS
  Definitive diagnoses were made using endobronchial ultrasound-guided transbronchial needle aspiration in 10 patients (three lung adenocarcinomas, one prostate carcinoma, one renal cell carcinoma, one neuroendocrine tumor and four sarcoidosis). Pathological specimens showing non-caseating granulomas led to the diagnosis of sarcoidosis in four patients; their previous malignancies had been papillary adenocarcinoma of the thyroid, carcinoma of the gingiva, thymoma and bladder cancer, but no recurrences were observed. The median of the longest diameter in 15 lymph nodes was 22 mm (range 13-35), and the median number of needle passes was two times (range 1-5) without severe complications.
  
  
  CONCLUSIONS
  Endobronchial ultrasound-guided transbronchial needle aspiration might be useful in differentiating between benign lymphadenopathy, including sarcoidosis, and cancer recurrence in patients with mediastinal or hilar lymphadenopathy after surgical resection of a malignant tumor.
authors.affiliation: *Department of General Internal Medicine 4, Kawasaki Medical School, 2-1-80 Nakasange, Okayama, 700-8505, Japan. ntakigaw@gmail.com.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Minami
authors.forename: Nagio
authors.initials: N
authors.lastname: Takigawa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hayakawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Mizuta
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kudo
authors.forename: Kozi
authors.initials: K
authors.lastname: Uchida
authors.forename: Eiki
authors.initials: E
authors.lastname: Ichihara
authors.forename: Akiko
authors.initials: A
authors.lastname: Sato
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hotta
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tabata
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kiura
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000209:etiology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018358:Neuroendocrine Tumors / Q000556:secondary; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology; D017565:Sarcoidosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: endobronchial ultrasound-guided transbronchial needle aspiration, sarcoidosis, mediastinal and hilar lymphadenopathy, lymph node metastasis