Clinical impact of EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer or mediastinal lymph nodes of unknown etiology

Ramesh Srinivasan, Manoop S. Bhutani, Nirav Thosani, Adrian Sǎftoiu, David C. Rice, Ana Maria Ioncicǎ, George A. Eapen, Parantap Gupta, Sathya Jaganmohan, Everson L.A. Artifon, Joseph B. Zwischenberger

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Introduction: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact. methods: A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology. Results: Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or nondiagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediastinal LNs in patients with known or suspected lung cancer was 82.35%, 100%, and 90% respectively. The negative predictive value was 80% and the positive predictive value was 100%. There were 20 patients with suspicious mediastinal LNs of uncertain etiology, with a definitive diagnosis being made using EGD/EUS-FNA in 95%. Conclusion: Our data supports the use of EUS-FNA in the work-up of enlarged mediastinal LNs on cross sectional imaging, thus avoiding more invasive mediastinal sampling procedures and potentially futile surgery.

Original languageEnglish
Pages (from-to)142-152
Number of pages11
JournalJournal of Gastrointestinal and Liver Diseases
Volume21
Issue number2
StatePublished - Jun 2012

Keywords

  • Endoscopic ultrasound
  • Endoscopic ultrasound fine needle aspiration
  • EUS-FNA
  • Lung cancer staging
  • Mediastinal lymph nodes
  • Non small cell lung cancer

ASJC Scopus subject areas

  • Gastroenterology

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