First endoscopic procedure for diagnosis and staging ofmediastinal lymphadenopathy

Abstract

AIM:To compare a first diagnostic procedure of trans bronchial needle aspiration (TBNA) with selection of endoscopic ultrasoundguided fineneedle aspiration (EUSFNA) or TBNA for mediastinal lymphadenopathy. METHODS:Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography (CT), who required cytopathological diagnosis, were recruited. The first 34 underwent a sequential approach in which TBNA was performed first, followed by EUS FNA if TBNA was unrevealing. The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings. RESULTS:The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%. In the selective approach, the diagnostic yield of the first procedure was 71%. There was no significant difference in the overall diagnostic yield, but there were significantly fewer combined procedures with the selective approach. CONCLUSION:Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.

Endoscopic mediastinal staging of lung cancer

“…While the result of combining two ultrasound-guided endoscopic procedures may supercede that of the surgical standard, a single appropriately selected endoscopic procedure that is diagnostic for mediastinal metastases may well be all that is required. 18 In the event that both endoscopic routes allow equal access to a suspicious lymph node station, the issue becomes that of selecting the procedure of choice. Though EUS-FNA may offer better patient tolerance with less coughing as compared to EBUS-TBNA, it has limited access to some of the lymph nodes that are commonly involved in lung cancer.…”

“…Finally, targeting the mediastinum first in the setting of suspected lung cancer may lead to simultaneous diagnosis and mediastinal staging of non-small cell lung cancer with a single procedure. 12,18,19 This may be more cost-effective than performing biopsy of the lung mass, followed by mediastinal staging in a sequential manner, especially when the likelihood of mediastinal metastases is high (See Fig. 1).…”

Granulomatous mediastinal adenopathy: can endoscopic ultrasound-guided fine-needle aspiration differentiate between tuberculosis and sarcoidosis?

“…EUS is able to detect pathological mediastinal lymph nodes and obtain tissue for diagnosis using FNA, with a sensitivity of more than 90 % (range 88 % -96 %) and a specificity approaching 100 % [11 -14]. There is some evidence that EUS -FNA can also be used to diagnose sarcoidosis [15 -19] but little is known about the role of EUS -FNA in tuberculosis [20,21]. We therefore identified a need for a prospective study, including a large number of patients of the ethnic subgroups most affected by these two diseases, to determine the accuracy and utility of EUS -FNA in diagnosing these diseases and differentiating between them.…”

Endoscopic ultrasound-guided fine-needle aspiration can differentiate between tuberculosis and sarcoidosis

“…As a prospective study, the design of this investigation was rigorous and the conclusion should be credible. There are some reports of the use of endoscopic ultrasonography-guided fine-needle aspiration (EUS -FNA) in the differential diagnosis of mediastinal lymphadenopathy but most are retrospective studies [2,3]. We have also performed mediastinal lymph node puncture and believe that EUS -FNA is a safe, minimally invasive, and effective diagnostic method.…”