title: Combined endoscopic ultrasonography and endobronchial ultrasound-fine-needle aspiration for evaluation of mediastinal lymph nodes.
abstract: OBJECTIVE
  Endoscopic ultrasonography (EUS) and endobronchial ultrasound-fine-needle aspiration (EBUS-FNA), is an accurate technique for evaluation of mediastinal lymph nodes (MLN) and stadification of lung cancer. The aims of the study are to evaluate the feasibility and the efficacy of the combined technique compared with mediastinoscopy for the diagnosis of MLN.
  
  
  METHODS
  All patients with suspected malignant MLN and/or lung lesion identified by positron emission tomography-computed tomography underwent combined EUS-EBUS-FNA. The combined procedure was performed in outpatients under general anesthesia for EUS and sedation by intravenous midazolam for EBUS when performed separately, using linear-array echoendoscopes. The MLN were punctured during the EUS and EBUS-FNA procedures with a 22 gauge needle.
  
  
  RESULTS
  Thirty-four patients underwent consecutively EUS and EBUS-FNA between September 2011 and November 2013 (8 women, 26 men, mean age of 65.9 year, range: 51-83). Combined EUS-EBUS-FNA was performed in a single time procedure in 26 patients (mean time 50 min) and in two different times in eight patients (mean delay 3 days). Twenty-five malignant and 9 inflammatory lesions were diagnosed. Mediastinoscopy was performed in nine patients and confirmed in eight patients the initial combined EUS-EBUS-FNA diagnosis. The diagnosis was obtained in 91.2% with EUS-FNA, 70.6% with EBUS-FNA and 97% when combined procedure was performed. The overall sensitivity, specificity, positive and negative predictive values of EUS-EBUS-FNA for diagnosing malignancy were 96.5%, 100%, 100% and 90% respectively. No complications related to the procedure were observed.
  
  
  CONCLUSIONS
  Combined EUS-EBUS-FNA represents an accurate technique in the diagnosis of MLN, can be done in a single time procedure and has the advantage of being less invasive than mediastinoscopy.
authors.affiliation: Department of Gastroenterology, Digestive Endoscopy Unit, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Badaoui
authors.affiliation: Department of Pneumology, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Dahlqvist
authors.affiliation: Department of Gastroenterology, Digestive Endoscopy Unit, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Jf
authors.initials: J
authors.lastname: Rahier
authors.affiliation: Department of Pathology, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Weynand
authors.affiliation: Department of Pneumology, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Ocak
authors.affiliation: Department of Gastroenterology, Digestive Endoscopy Unit, St-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Ph
authors.initials: P
authors.lastname: Deprez
authors.affiliation: Department of Vascular and Thoracic Surgery, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Eucher
authors.affiliation: Department of Pneumology, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Duplaquet