title: Can endoscopic ultrasound distinguish between mediastinal benign lymph nodes and those involved by sarcoidosis, lymphoma, or metastasis?
abstract: BACKGROUND
  Lymph nodes (LNs) echofeatures on endoscopic ultrasound (EUS) and concurrent fine needle aspiration (FNA) are alternatives to highly invasive approaches for etiologic diagnosis of mediastinal lymphadenopathy (MLAD).
  
  
  OBJECTIVE
  To evaluate the efficacy of LNs echofeatures and FNA via EUS to distinguish benign LNs from LNs involved by sarcoidosis, lymphoma, and metastasis in non-lung cancer patients.
  
  
  METHODS
  A retrospective review of patients who underwent EUS-FNA for MLAD was performed. Echofeatures of LNs including echogenicity, margins, shape, and LN size were recorded. Final diagnosis was made based on surgical sampling or clinical diagnosis with long-term follow-up. Only patients diagnosed as benign MLAD, sarcoidosis, lymphoma, and metastasis included. Diagnostic value of echofeatures and FNA was evaluated.
  
  
  RESULTS
  Included were 162 patients with final diagnosis of benign (68), sarcoidosis (33), lymphoma (20), and metastasis (41). The median LN along axis in the benign group [20.5 mm (6-76)] was significantly shorter than in the metastasis [28 mm (9-82)] and sarcoidosis [27 mm (17-50)] groups (p < 0.05). The median LN short axis in the benign group [11 mm (2-50)] was significantly shorter than in the metastasis [17 mm (5-44)] and lymphoma [16 mm (7-47)] groups (p < 0.05). No other echofeatures showed a discriminant value among the groups. When performing FNA, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 73.7, 100, 100, 72.2, and 84.4 %, respectively.
  
  
  CONCLUSIONS
  Although benign MLAD tend to be smaller than other etiologies, echofeatures of LNs are not reliable etiologic diagnostic approach to MLAD. Therefore, FNA is suggested when feasible. However, due to relatively low sensitivity, LNs with benign FNA results should be subjected to further work-up if they are clinically suspicious.
authors.affiliation: Division of Gastroenterology and Hepatolohgy, Department of Medicine, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Laith.Jamil@cshs.org.
authors.forename: Laith H
authors.initials: LH
authors.lastname: Jamil
authors.forename: Amir
authors.initials: A
authors.lastname: Kashani
authors.forename: Daniela
authors.initials: D
authors.lastname: Scimeca
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghabril
authors.forename: Seth A
authors.initials: SA
authors.lastname: Gross
authors.forename: Kanwar R S
authors.initials: KR
authors.lastname: Gill
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000000981:diagnostic imaging* / Q000473:pathology