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Ultrasonography |
1 From the Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Eisenberg 8A, Rochester, MN 55905 (M.J.W., E.V.S.); and St Vincent Hospitals, Indianapolis, Ind (M.J.W., L.M.W.). Received March 9, 2000; revision requested April 5; final revision received August 4; accepted September 12. Address correspondence to M.J.W. (e-mail: wiersema.maurits@mayo.edu).
PURPOSE: To evaluate the safety and accuracy of endoscopic ultrasonography (US)–guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior mediastinal regions.
MATERIALS AND METHODS: Eighty-six consecutive patients with mediastinal lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US–guided FNAB of mediastinal lymphadenopathy was performed as a component of staging non–small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results.
RESULTS: In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US–guided FNAB in distinguishing benign from malignant mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who underwent staging of NSCLC, endoscopic US–guided FNAB had superior mediastinal lymph node staging accuracy compared with endoscopic US alone (79%) and CT alone (79%) (P = .01). The results of endoscopic US–guided FNAB prompted a change to nonsurgical management in 66 (80%) of 82 patients who underwent the procedure. One minor complication, postprocedural fever that resolved with oral antibiotics, occurred (1%; 95% CI: 0%, 6%).
CONCLUSION: Endoscopic US–guided FNAB is accurate and safe for biopsy of mediastinal lymph nodes to stage NSCLC, establish a primary diagnosis, or examine patients with prior inconclusive biopsy results.
Index terms: Biopsies, technology, 60.126 • Lymphatic system, neoplasms, 60.3214, 60.342, 60.343 • Mediastinum, interventional procedures, 60.126 • Thorax, CT, 60.12112, 60.12115 • Thorax, neoplasms, 60.3214, 60.342, 60.343 • Thorax, US, 60.12981, 60.12984, 60.12985
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