title: Endoscopic ultrasonography-fine needle aspiration versus PET-CT in undiagnosed mediastinal and upper abdominal lymphadenopathy: a comparative clinical study.
abstract: OBJECTIVE
  The wide use of PET-CT for the staging of neoplasms has extended to enlarged lymph nodes of unknown origin. Nevertheless, upper abdominal and mediastinal nodes are accessible to endoscopic ultrasonography-fine needle aspiration (EUS-FNA), providing a cytological diagnosis, with a high diagnostic yield in previous reports. In this paper, we have compared the accuracy of both procedures in this particular setting.
  
  
  METHODS
  After the finding of a lymphadenopathy in a conventional CT, both PET-CT and EUS-FNA were performed. The endoscopist had no information about PET-CT results. FNA was performed after a systematic EUS exam, with a 25 G needle and no suction. We considered the pathologic results as the gold standard or, if not available, the patients' outcome as a surrogate marker.
  
  
  RESULTS
  A total of 54 patients were included. Common locations of nodes included subcarinal space (33.3%), porta hepatis (31.5%), upper mediastinum (15%), peripancreatic (7.4%), and other locations (12.8%). Adequate specimens were obtained in 48/54 patients (89%). The most common diagnoses based on cytology were benign/reactive (42%), epidermoid carcinoma (8.4%), lymphoma (8.4%), and ductal adenocarcinoma of pancreatic origin (6.3%). PET was positive in 67% of patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of EUS-FNA were 91.3, 100, 100, 92.5, and 95.8%, respectively. The same values for PET-CT were 75, 25, 50, 50, and 50%, respectively.
  
  
  CONCLUSIONS
  In our series, EUS-FNA has proven to be the best diagnostic procedure to accurately establish the etiology of isolated adenopathies, showing a much better diagnostic yield than PET-CT, the role of which should be re-evaluated in this setting.
authors: aEndoscopy Unit, Department of Gastroenterology and Hepatology bDepartment of Pathology, Virgen de las Nieves University Hospital, Granada, Spain.
authors: Eduardo
authors: E
authors: Redondo-Cerezo
authors: Juan G
authors: JG
authors: Martínez-Cara
authors: Javier
authors: J
authors: Esquivias
authors: Paloma
authors: P
authors: de la Torre-Rubio
authors: Cristina
authors: C
authors: González-Artacho
authors: María del Carmen
authors: Mdel C
authors: García-Marín
authors: Javier
authors: J
authors: de Teresa-Galván
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed