Diagnostic Yield and Safety of Endoscopic Ultrasound Guided Fine Needle Aspiration of Central Mediastinal Lung Masses

Abstract

Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.

Esophageal Endosonography for the Diagnosis of Intrapulmonary Tumors: A Systematic Review and Meta-Analysis

“…VazquezSequeiros [27], 2013 "lung masses […] with the closest margin believed to be in sufficient proximity to the esophageal wall"; "lung masses were located in the vicinity of the cervical/upper esophagus (n = 19; each <1 cm from esophagus) or mid esophagus (n = 43; each <2 cm from the esophagus)" Nasir [28], 2014 "lung mass suspicious for either a primary or secondary neoplasm of the lung"; "mean distance between lesion and esophagus: 25 mm (range 0 -46)" Steinfort [29], 2016 "pulmonary parenchymal lesions […] adjacent to the esophagus on Computed Tomography of the chest" from the analysis in whom intrapulmonary tumors could not be visualized by EUS. Four studies used a suboptimal reference standard in at least some of the patients, and 2 studies excluded patients due to missing reference standard results.…”

Expanding the horizons of endoscopic ultrasound: diagnosis of non-digestive pathologies

“…In particular, we would like to mention the expanding role of EUS-FNA in the management of lung masses located close to the oesophagus, since recent data suggest a 97% diagnostic accuracy, with a low complication rate of 1.6% [8]. …”

Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

“…A recent retrospective study [63] assessed the diagnostic yield and safety of EUS-FNA of central mediastinal lung masses. In 11 out of 73 patients, the lung mass could not be visualised by EUS.…”