Diagnostic accuracy and clinical impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in Positron Emission Tomography - Computed Tomography (PET-CT)-positive mediastinal lymphadenopathies in subjects with thoracic or extra-thoracic malignancy

• Published in: Clinics and research in hepatology and gastroenterology
• Main Authors: Bechade, Dominique, Bellera, Carine, Gauquelin, Lisa, Soubeyran, Isabelle, Mckelvie-Sebileau, Pippa, Debled, Marc, Chomy, Francois, Roubaud, Guilhem, Fonck, Marianne, Pernot, Simon, Roch, Alexandre, Cazeau, Anne-Laure
• Format: Journal Article
• Language: English
• Published: Elsevier 24.03.2022
• Subjects: Life Sciences; Santé publique et épidémiologie; Endoscopic ultrasound-guided fine-needle aspiration; Clinical impact on cancer management; Mediastinal lymphadenopathy; Positron Emission Tomography - Computed Tomography
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2022.101912

BACKGROUND: The high sensitivity of PET-CT can identify hypermetabolic mediastinal adenopathies during cancer management, but specificity is low and a biopsy is sometimes required to eliminate benign adenopathies. METHODS: This prospective diagnostic accuracy study included patients with hypermetabolic mediastinal lymphadenopathies revealed on PET-CT, during either the initial management of a cancer, treatment evaluation, or monitoring. All patients underwent EUS-FNA. Diagnose of malignancy based on cytological analysis following EUS-FNA were compared with clinical and radiological follow-up informations. Treatment strategy decided before the results of the EUS-FNA pathology reports (Multidisciplinary Team Meeting [MTM-1]) was recorded and compared to the treatment strategy decided once pathological data from EUS-FNA were available (MTM-2). MAIN FINDINGS: Between 2013 and 2018, 75 patients were included with 47 eligible and evaluable patients. The sensitivity, specificity, and positive and negative predictive values of EUS-FNA were 93%, 100%, 100% and 90%, respectively. The concordance value between the therapeutic strategies determined for MTM-1 and MTM-2 was 44.7%. There were no significant differences in the intensity of fixation on PET-CT between malignant and benign lesions. CONCLUSION: The diagnostic accuracy of the minimally invasive EUS-FNA procedure is sufficiently robust to avoid surgical diagnosis. The combination of PET-CT and EUS-FNA may alter the therapeutic strategy that would be considered after PET-CT alone. REGISTRATION: NCT01892501.