Endoscopic ultrasound (EUS) guided fine needle aspiration in mediastinal lymphadenopathy of unknown cause

M. F. Catalano, F. Gress, W. Wassef, J. Scheiman, M. Kochman, E. Alcocer, J. E. Geenen

Research output: Contribution to journalArticlepeer-review

Abstract

EUS guided fine needle aspiration (FNA) biopsy has significantly increased the diagnostic capability of endosonography with respect to gastrointestinal pathology. The application of FNA technology can also be helpful in the diagnosis of non-gastrointestinal disorders. The role of EUS guided FNA to establish the diagnosis of idiopathic mediastinal lymphadenopathy has not been previously described. AIM: To evaluate the diagnostic accuracy and impact on subsequent therapy of EUS guided FNA in mediastinal lymphadenopathy of unknown cause. METHODS: 62 patients (40 men, 22 women; age 16-91, mean 56) underwent EUS guided FNA in patients presenting with idiopathic mediastinal adenopathy at 6 tertiary referral centers. Presenting sx's included dysphagia = 26, night sweats-14, cough = 8, chest pain=10, odynophagia = 10, fever=6, weight loss = 8 and no symptoms/abnormal x-ray= 12. Final diagnosis using EUS-FNA, surgery, autopsy or long-term follow-up was available in all patients. EUS FNA was classified under 3 disease categories: 1) Benign/infectious LN; 2) Malignant pulmonary; and 3) Malignant mediastinal (lymphoma, metastatic, etc). Lymph node criteria for metastases included 4 features (Size > 1cm, round shape, sharp borders, homogeneous/hypoechoic echo pattern). RESULTS: Final diagnosis included benign/infectious LN's = 26, malignant pulmonary = 24 and malignant mediastinal LN's=12. EUS guided FNA was successful in establishing a tissue diagnosis in 56 of 62 patients (90%) for all 3 categories. EUS features suggestive of malignant lymph nodes were more frequently present in malignant pulmonary (mean 2.6) and malignant mediastinal (2.8) than benign/infectious (1.9) LN's. EUS was successful in directing subsequent work-up in 90% and therapy in 87% of patients. No complications were seen. LN DISEASE CLASSIFICATION Pt's. (No.) LN'S Imaged Range (mean) # Malignant LN Criteria (mean) EUS FNA DIAGNOSTIC EUS Dx ALTERS WORK-UP RX Benign/Infectious 26 1-4 (2.6) 1-3 (1.9) 24 (92%) 23 (89%) 24 (92%) Malignant Pulm 24 1-4 (2.4) 1-4 (2.6) 22 (92%) 21 (87%) 22 (92%) Malignant Mediast. 12 1-3 (1.9) 1-4 (2.8) 10 (83%) 12 (100%) 8 (67%) CONCLUSIONS: EUS guided FNA in patients with mediastinal lymphadenopathy is safe and assists in guiding subsequent therapy in the vast majority of cases. The emergence of transesophageal EUS guided FNA of mediastinal lymph nodes provides minimally invasive tissue sampling, obviating need for mediastinoscopy or bronchoscopy.

Original languageEnglish (US)
Pages (from-to)AB27
JournalGastrointestinal endoscopy
Volume47
Issue number4
StatePublished - 1998
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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