EUS-guided FNA immediately after unrevealing transbronchial needle aspiration in the evaluation of mediastinal lymphadenopathy: a prospective study

• Published in: Gastrointestinal endoscopy Vol. 63; no. 2; pp. 215 - 220
• Main Authors: Khoo, Kay-Leong, MBBS, MMed, Ho, Khek-Yu, MD, FRACP, Nilsson, B., CFIAC, Lim, T.K., MBBS, FRCP
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2006; Elsevier
• Subjects: Aged; Biological and medical sciences; Biopsy, Fine-Needle - methods; Bronchoscopy; Carcinoma - complications; Carcinoma - diagnostic imaging; Carcinoma - pathology; Diagnosis, Differential; Digestive system. Abdomen; Endoscopy; Endosonography; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - complications; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lymphatic Diseases - diagnostic imaging; Lymphatic Diseases - etiology; Lymphatic Diseases - pathology; Lymphoma - complications; Lymphoma - diagnostic imaging; Lymphoma - pathology; Male; Mediastinal Diseases - diagnostic imaging; Mediastinal Diseases - etiology; Mediastinal Diseases - pathology; Medical sciences; Prospective Studies; Reproducibility of Results; Sarcoidosis, Pulmonary - complications; Sarcoidosis, Pulmonary - diagnostic imaging; Sarcoidosis, Pulmonary - pathology; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - pathology; Sonography; Fine needle; Endoscopic route; Aspiration; Mediastinum; Adenopathy; Endoscopic ultrasonography; Echography; Aspiration punction
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.06.038

Background Transbronchial needle aspiration (TBNA) and EUS-guided FNA (EUS-FNA) are minimally invasive diagnostic approaches to mediastinal lymphadenopathy. Rapid on-site cytopathologic evaluation (ROSE) may facilitate the decision whether to proceed to a second procedure in the same session. The aim of this study was to determine the utility of TBNA with ROSE, combined with the option for immediate EUS-FNA in a single-session approach to mediastinal lymphadenopathy. Methods We prospectively recruited 20 patients (12 men; mean age 66.7 ± 10.2 years) with mediastinal lymphadenopathy on CT who required cytopathologic evaluation. Bronchoscopy was first performed with TBNA and ROSE. If this was unrevealing, EUS-FNA was performed immediately afterward with ROSE. All procedures were performed with the patient under local anesthesia and sedation. Results TBNA specimens were deemed adequate on-site in 13 patients, and EUS-FNA was performed in the remaining 7 patients. TBNA with ROSE was falsely negative in one patient. The diagnostic yield for TBNA and EUS-FNA alone was 65% and 86%, respectively. This single-session approach provided a yield of 90%, with no complications. The final diagnoses were 12 non-small-cell lung cancer, two small-cell lung cancer, one metastatic adenocarcinoma, two sarcoidosis, one tuberculosis, one lymphoma, and one with no definitive diagnosis. Conclusions Combining TBNA with the option for EUS-FNA immediately after unrevealing TBNA gave a yield approaching that of mediastinoscopy and, therefore, may reduce the need for invasive mediastinal sampling. This single-session endoscopic approach was safe, required only local anesthesia and sedation, was convenient, and obviated the need for patients to return for a second procedure.