Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients

Fritscher-Ravens, Annette; Bobrowski, Christoph; Pforte, A; Topalidis, Theodoros; Krause, Christina; Jaeckle, Stefan; Thonke, Frank; Soehendra, Nib

doi:10.1111/j.1572-0241.2000.02243.x

Cited by 162 publications

(53 citation statements)

References 43 publications

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“…Also, in contrast to other studies, there were relatively few patients (three out of 52) with a prior history of cancer. In the study by FRITSCHER-RAVENS et al [12], approximately one third of patients (52 out of 153) examined by EUS had a previous diagnosis of cancer. The same study found EUS-FNA to be more accurate when used in patients with a previous diagnosis of cancer compared to patients without (sensitivity 97% with cancer versus 88% without cancer).…”

Section: Discussionmentioning

confidence: 99%

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Caddy

Conron²,

Wright³

et al. 2005

Eur Respir J

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Optimal management of nonsmall cell lung cancer (NSCLC) depends on tissue diagnosis and accurate staging. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is minimally invasive and provides cytological confirmation of malignant mediastinal disease. The aim was to assess the accuracy of EUS-FNA in cases of enlarged mediastinal lymphadenopathy (LN) of unknown aetiology and in the staging of NSCLC.A total of 52 consecutive patients with stage I-IIIb NSCLC or enlarged mediastinal LN of unknown aetiology underwent EUS-FNA. Negative results were confirmed with a surgical procedure: mediastinoscopy, video-assisted thoracic surgery (VATS) or lobectomy with systematic mediastinal lymph node dissection.In total, 34 patients had EUS-FNA performed for diagnosis, whilst the remaining 18 had EUS-FNA for staging. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (95% confidence interval) were 93% (77-99), 100% (78-100), 100% (87-100), 88% (63-99) and 95% (84-99), respectively. When EUS-FNA was used in patients with NSCLC, the sensitivity, specificity, PPV, NPV and accuracy were 92% (73-99), 100% (69-100), 100% (85-100), 83% (51-98) and 94% (80-99), respectively. For mediastinal LN of unknown aetiology, no malignant disease was missed.Endoscopic ultrasound-guided fine-needle aspiration is an accurate tool for assessing mediastinal lymph node involvement in nonsmall cell lung cancer and in the diagnosis of unexplained mediastinal lymphadenopathy. Endoscopic ultrasound-guided fine-needle aspiration is a minimally invasive procedure that can be used as an adjunct or alternative to mediastinoscopy.

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Section: Discussionmentioning

confidence: 99%

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Caddy

Conron²,

Wright³

et al. 2005

Eur Respir J

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“…Sonographic signs of benignancy are a hyperechoic core (fat), central calcification (old granulomatous disease), ill-defined edges and an elongated oval shape [67]. Regarding lymph node staging, it has been demonstrated that ultrasound features are not as accurate as aspirates [3] and therefore aspirates are needed.…”

Section: Transoesophageal Ultrasound-guided Fine Needle Aspirationmentioning

confidence: 99%

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions

Herth

Rabe²,

Gasparini³

et al. 2006

Eur Respir J

138

103

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A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging as well as the assessment of mediastinal masses. Transbronchial needle aspiration (TBNA) is a safe procedure that is performed during routine bronchoscopy. Provided mediastinal metastases are confirmed, TBNA has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of realtime needle visualisation. The introduction of echo-endoscopes has overcome this problem.Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures.It is expected that implementation of minimally invasive endoscopic methods of endobronchial ultrasound-guided transbronchial needle aspiration and transoesophageal ultrasound-guided fine needle aspiration will reduce the need for surgical staging of lung cancer significantly.

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“…35 Consecutive FNA and appropriate follow-up Savides et al [100] 2000 54 Consecutive FNA and appropriate follow-up Fritscher-Ravens et al [103] 2000 153 Consecutive FNA and appropriate follow-up Vazquez-Sequeiros et al [105] 2001 37 Consecutive Surgery Wallace et al [91] 2001 43 Consecutive FNA and appropriate follow-up Wiersema et al [85] 2001 82 Prospective Surgery Chhieng et al [96] 2001 103 Consecutive Surgery Devereaux et al [22] 2002 49 Consecutive Surgery Catalano et al [92] 2002 62 Consecutive Surgery Schwartz et al [66] 2002 188 Consecutive Surgery Arima et al [95] 2003 58 Consecutive Surgery Pellise et al [23] 2004 11 Consecutive Surgery Kramer et al [86] 2004 81 Prospective Surgery Walsh et al [97] 2005 27 Consecutive Surgery or appropriate follow-up Tournoy et al [88] 2005 67 Prospective Surgery Khoo et al [93] 2006 20 Prospective Surgery Beek et al [87] 2006 43 Prospective Surgery Figure 2A and B, respectively. EUS without FNA had a pooled specificity of 84.6% (95% CI: 83.2-85.9) and with FNA was 96.4% (95% CI: 95.3-97.4).…”

Section: Confirmatory Proceduresmentioning

confidence: 99%

Endoscopic ultrasound: It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

Puli¹,

Reddy²,

Bechtold³

et al. 2008

WJG

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AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights.RESULTS: Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI: 82.9-86.4) to 88.0% (95% CI: 85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI: 95.3-97.4). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

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Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients

Cited by 162 publications

References 43 publications

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions

Endoscopic ultrasound: It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

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