The utility of EBUS-TBNA in mediastinal or hilar lymph node evaluation in extrapulmonary malignancy

Erer, Onur Fevzi; Anar, Ceyda; Erol, Serhat; Aktoğu, Serir

doi:10.3906/sag-1407-113

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…Evaluation of MHLE and mediastinal masses in patient with known/suspected EPMs constitutes ~10%‐16% of all indications for which patients undergo EBUS‐TBNA . Metastases are identified in only 40%‐50% of these patients, of whom 5%‐23% patients are found to harbour a second primary malignancy, most commonly in the lung .…”

Section: Discussionmentioning

confidence: 99%

“…Metastases are identified in only 40%‐50% of these patients, of whom 5%‐23% patients are found to harbour a second primary malignancy, most commonly in the lung . A significant proportion (9%‐20%) have granulomatous diseases, further characterised as TB (2%‐9%) or sarcoidosis in few studies . Each of these diagnoses requires drastically different treatments.…”

Section: Discussionmentioning

confidence: 99%

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Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

et al. 2018

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary modality for mediastinal lymph node staging in lung carcinoma. We aimed to evaluate its utility in extra-pulmonary malignancies (EPM). EBUS-TBNA aspirations (2013 done in patients with known/suspected EPMs and mediastinal lymphadenopathy/masses was performed. All archived cytology/histology material was reviewed and categorised as positive, negative and unsatisfactory. Methods: Database search of Results:The selected 139 patients included 100 patients with known EPMs, 11 patients with known lymphoma, and 28 patients with suspected EPM of unknown primary. EBUS-TBNA was adequate in 110 patients (79%), including 21 patients who yielded only reactive lymphoid tissue. Satisfactory blood clot cores were obtained in 34 patients and contributed significantly to diagnosis and ancillary testing. Metastasis was detected in 45 patients with known EPM, predominantly originating from a known primary in the breast in females (56%) and squamous cell carcinomas of head and neck in males (60%). Granulomatous lymphadenopathy was identified in 16 patients with known EPM (16%). Lymphoma relapse and granulomatous lymphadenopathy were identified in three and four patients with known lymphoma, respectively. In patients with suspected EPM of unknown primary site, malignancy was confirmed in 21 patients, predominantly representing metastatic adenocarcinomas (n = 5) and neuroendocrine neoplasms (n = 5). Immunocytochemistry was performed in 16 of these cases and aided in characterisation of primary site/type of tumour in 12 cases.Conclusion: EBUS-TBNA is efficient for screening mediastinal lymph nodes/masses for malignancy in EPMs. Procuring sufficient material for ancillary testing would improve diagnostic accuracy and reduce need for resampling. K E Y W O R D Sblood clot cores, endobronchial ultrasound-guided transbronchial needle aspiration, extrapulmonary malignancy, lymphoma, mediastinal lymphadenopathy, metastases Aruna Nambirajan and Moanaro Longchar contributed equally and should be considered co-first authors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

et al. 2018

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“…EBUS‐TBNA is a reliable method for MLN sampling 1–3 . Slides may be sufficient for the diagnosis of malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with extrathoracic malignancies (ETM), hilar, and mediastinal lymph node (MLN) enlargement raise the suspicion of metastasis. However, MLN may also be due to benign conditions like infections, or granulomatous inflammation 1–3 …”

Section: Introductionmentioning

confidence: 99%

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Importance of mediastinal granulomatous/sarcoid‐like lymphadenopathy in extrathoracic malignancies

Erol,

Kaya,

Arslan

et al. 2024

Diagnostic Cytopathology

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BackgroundIn patients with extrathoracic malignancies (ETM), granulomatous lymph adenopathy called sarcoid‐like reactions (SLR) can be seen in the regional or draining lymph nodes. We hypothesized that SLR may be a sign of imminent metastasis and investigated the clinical course and rate of recurrence in patients with ETM and granulomatous mediastinal lymphadenopathy (MLN).MethodsIn this retrospective observational study, we reviewed the medical files of patients with known ETM and who underwent EBUS‐TBNA for initial staging or detection of recurrence from 2011 to 2023. Patients with granulomatous MLN were included.ResultsForty‐one patients (29 female) enrolled in the study. Breast and colorectal carcinomas were the most common malignancies. A total of 81 lymph nodes were sampled. The final diagnosis of patients was five sarcoidosis, one tuberculosis, one second primary, one drug reaction, and 33 SLR. Among patients with SLR, in one patient lymph nodes progressed during the follow‐up and were accepted as false‐negative without confirmatory biopsy. The negative predictive value (NPV) of granulomatous MLN for metastasis was 97.05%.ConclusionGranulomatous MLN may be due to tuberculosis, drug reaction, sarcoidosis, or SLR in patients with ETM. SLR has a high NPV in patients with ETM. Follow‐up imaging rather than confirmatory biopsy is reasonable in these patients.

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The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

Korkmaz¹,

Demirbaş²,

Vatansev³

2021

Medicine

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. Material and Method: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. Results: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ± 2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ± 7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. Conclusion: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.

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The utility of EBUS-TBNA in mediastinal or hilar lymph node evaluation in extrapulmonary malignancy

Cited by 6 publications

References 28 publications

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology in patients with known or suspected extra‐pulmonary malignancies: A cytopathology‐based study

Importance of mediastinal granulomatous/sarcoid‐like lymphadenopathy in extrathoracic malignancies

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

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