The role of EUS for evaluation of mediastinal adenopathy

Jacobson, Brian C.; Hirota, William K.; Goldstein, Jay L.; Leighton, Jonathan A.; Mallery, J. Shawn; Waring, J.Patrick; Baron, Todd H.; Faigel, Douglas O.

doi:10.1016/s0016-5107(03)01996-5

Cited by 18 publications

(9 citation statements)

References 26 publications

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“…Endoscopic ultrasound (EUS)-guided fine-needle aspiration has been reported as an endoscopic option to evaluate the mediastinum [9][10][11][12]. Unfortunately, it does not allow for airway inspection during the procedure.…”

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confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Herth

Ernst²,

Eberhardt³

et al. 2006

Eur Respir J

281

161

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes f1 cm in diameter.NSCLC patients with CT scans showing no enlarged lymph nodes (no node .1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results.In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred.In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.

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mentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Herth

Ernst²,

Eberhardt³

et al. 2006

Eur Respir J

281

161

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“…Although EUS features of malignant LNs are reported to be the hypoechoic homogeneous structure, distinct margins, round shape, and size larger than 1 cm, most authors agree that these features may be less reliable [3][4][5][6][7], as in this study of Hall et al [1]. Recently, Sawhney et al [2] found that the absence of a central intranodal blood vessel by color Doppler EUS was a strong and independent predictor of malignant LNs.…”

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confidence: 65%

“…Recently, Sawhney et al [2] found that the absence of a central intranodal blood vessel by color Doppler EUS was a strong and independent predictor of malignant LNs. Color Doppler EUS [2], contrast-enhanced EUS [8], EUS-FNA [3,4], and EUS elastography [6] can be superior to conventional EUS in predicting malignant LNs, but these special methods are not available in all hospitals.…”

Section: To the Editormentioning

confidence: 99%

Larger Short-Axis Length of Lymph Nodes: Another Predictor for Malignant Involvement

et al. 2009

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We read with interest the article by Hall et al. [1] on the presence of lymph node (LN) vasculature, a new endoscopic ultrasound (EUS) criterion for benign nodes. Because normal LNs have prominent, centrally-located blood vessels, which become obliterated by tumor infiltration, the presence of a central intranodal blood vessel has been noted in benign LNs [2]. They therefore evaluated the presence of intranodal vasculature in 67 mediastinal LNs by color Doppler EUS. Based on fine-needle aspiration results, 29/52 (55.8%) LNs without intranodal vasculature were malignant, and 15/15 (100%) LNs with intranodal vasculature were benign. Although they concluded that the presence of intranodal vasculature by color Doppler EUS was associated with benign LNs, we believe that another simple EUS feature might predict malignant LNs.EUS is highly suited to detect and assess LNs in patients with various malignancies [2,3]. Although EUS features of malignant LNs are reported to be the hypoechoic homogeneous structure, distinct margins, round shape, and size larger than 1 cm, most authors agree that these features may be less reliable [3][4][5][6][7], as in this study of Hall et al. [1]. Recently, Sawhney et al. [2] found that the absence of a central intranodal blood vessel by color Doppler EUS was a strong and independent predictor of malignant LNs. Color Doppler EUS [2], contrast-enhanced EUS [8], EUS-FNA [3, 4], and EUS elastography [6] can be superior to conventional EUS in predicting malignant LNs, but these special methods are not available in all hospitals. Although Hall et al. [1] and others [6 -8] demonstrated that the size (long-axis length) and round contour (longaxis/short-axis length ratio) of LNs were not associated with malignant LNs, the short-axis length of LNs itself has not been highlighted. We analyzed 1,359 dissected LNs of resected gastric cancers, and disclosed that the short-axis length of LNs was more closely related to malignant LNs than the long-axis length and round contour (long-axis/ short-axis length ratio) of LNs [9, 10]. On EUS, LNs with a larger short-axis length are also more likely to be malignant [2,3,5]. If the larger short-axis length of LNs predicts nodal malignancy, this simple feature would be valuable. References 1. Hall JD, Kahaleh M, White GE, Talreja J, Northup PG, Shami VM. Presence of lymph node vasculature: a new EUS criterion for benign nodes? Dig Dis Sci.

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“…[8] There have been several reports documenting that EUS-FNA is also useful to evaluate ML of unknown cause. [9–15] In some of these cases, lung cancer was suspected based upon imaging but no diagnosis had yet been made. In addition, some patients had a history of prior malignancy.…”

Section: Discussionmentioning

confidence: 99%

Predictors of malignancy in EUS-guided FNA for mediastinal lymphadenopathy in patients without history of lung cancer

et al. 2011

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BACKGROUND:Mediastinal lymphadenopathy (ML) poses a great diagnostic challenge.OBJECTIVE:To investigate the predictors of malignancy in endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of ML in patients without known lung cancer.DESIGN:Retrospective study.SETTING:Tertiary referral center.METHODS:One hundred eight patients without known lung cancer who underwent EUS guided-FNA for ML between 2000 and 2007. All subjects underwent EUS-guided FNA. Data was collected on patients′ demographics, and lymph node (LN) characteristics. Diagnosis of LN malignancy was based on FNA findings and clinical follow-up.RESULTS:One hundred eight patients were analyzed; 58 (54%) were men and 87 (79%) were Caucasian. Mean age was 55 years. Prior malignancy was present in 48 (43%) patients. A total of 126 FNA samples from 126 distinct LNs were performed. Twenty-five (20%) LNs were positive for malignancy. Mean short and long-axis for LNs were 13 and 29 mms respectively. Round shape and sharp borders were found in 29 (15%) and 25 (22%) LNs, correspondingly. Independent predictors of a malignant FNA were: Prior cancer (OR 13.10; 95% CI 2.7-63.32; P = 0.001), short axis (OR 1.10; 95% CI 1.00-1.22; P = 0.041) and sharp LN borders (OR 5.47; 95% CI 1.01-29.51; P = 0.048). Age, race, gender, long axis, round shape were not associated with cancer in our cohort.LIMITATIONS:Retrospective design and lack of surgical gold standard.CONCLUSIONS:Increased risk of malignancy was associated with prior history of cancer, larger LN short axis and presence of LN sharp borders. These predictors may help guide endoscopists perform FNA in malignant LNs, increasing the overall efficiency of EUS-FNA for ML.

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The role of EUS for evaluation of mediastinal adenopathy

Cited by 18 publications

References 26 publications

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Larger Short-Axis Length of Lymph Nodes: Another Predictor for Malignant Involvement

Predictors of malignancy in EUS-guided FNA for mediastinal lymphadenopathy in patients without history of lung cancer

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