title: Combined transbronchial needle aspiration and (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography for diagnosing enlarged mediastinal lymph nodes.
abstract: BACKGROUND
  To demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography ((99m)Tc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy.
  
  
  METHODS
  Sixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and (99m)Tc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA.
  
  
  RESULTS
  Eighty three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of (99m)Tc-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and (99m)Tc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%.
  
  
  CONCLUSIONS
  (99m)Tc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy.
authors.affiliation: Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.affiliation: Departamento de Radiología, Unidad de Medicina Nuclear, Segunda Universidad de Nápoles, Nápoles, Italia.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Rambaldi
authors.affiliation: Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicidomini
authors.affiliation: Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia.
authors.forename: Umberto
authors.initials: U
authors.lastname: di Serio
authors.affiliation: Departamento de Salud Pública, Sección de Anatomía Patológica, Segunda Universidad de Nápoles, Nápoles, Italia.
authors.forename: Marina
authors.initials: M
authors.lastname: Accardo
authors.affiliation: Departamento de Radiología, Unidad de Radiología, Segunda Universidad de Nápoles, Nápoles, Italia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rotondo
authors.affiliation: Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia. Electronic address: mario.santini@unina2.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: Adenopatía; Aspiración por punción transbronquial; Lymph adenopathy; Single photon emission chest tomography; Technetium-99m hexakis-2-methoxyisobutyl isonitrile; Tecnecio-99m hexakis-2-metoxi-isobutil-isonitrilo; Tomografía de emisión fotónica única torácica; Transbronchial needle aspiration