Impact of EUS-guided FNA of enlarged mediastinal lymph nodes on subsequent thoracic surgery rates

• Published in: Gastrointestinal endoscopy 2004-09, Vol.60 (3), p.340-346
• Main Authors: Savides, Thomas J., Perricone, Anthony
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle - methods; Bronchoscopy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Small Cell - pathology; Carcinoma, Small Cell - surgery; Diagnosis, Differential; Endoscopy; Esophagoscopy - methods; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Lymphoma - pathology; Lymphoma - surgery; Male; Mediastinal Neoplasms - pathology; Mediastinal Neoplasms - surgery; Medical sciences; Middle Aged; Patient Care Team; Prospective Studies; Sensitivity and Specificity; Thoracotomy - statistics & numerical data; Tomography, X-Ray Computed
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(04)01709-2

A histopathologic diagnosis of metastasis in enlarged mediastinal lymph nodes usually results in non-surgical management. Cytologic specimens obtained by EUS-guided FNA can be used to detect malignancy in posterior mediastinal lymph nodes. The purpose of this study was to determine the rate of thoracic surgery after EUS-guided FNA of enlarged mediastinal lymph nodes. A prospective observational study of patients with enlarged posterior mediastinal lymphadenopathy who were referred for EUS-guided FNA. All patients were candidates for mediastinoscopy. Patients were followed for 12 months to determine the subsequent rate of mediastinoscopy or thoracotomy and the diagnostic accuracy of EUS-guided FNA. Evaluation of cytologic specimens obtained by EUS-guided FNA revealed malignancy in 23 of 59 (39%) patients. The overall rate of surgery was 22% (13/59): 95% CI[0.12, 0.35]. The surgery rate for patients with a positive cytologic result was 4% (1/23) compared with 33% (12/36) for those with a negative result ( p = 0.009). Of patients with CT findings of a peripheral lung mass plus mediastinal lymphadenopathy, 22 of 26 (42%) underwent surgery after EUS-guided FNA, compared with two of 33 (6%) of those with mediastinal lymphadenopathy alone ( p = 0.0009). For cytologic evaluation of specimens obtained by EUS-guided FNA, the overall sensitivity, specificity, and accuracy for the diagnosis of malignant lymphadenopathy were 96%, 100%, and 98%, respectively. Few patients who undergo EUS-guided FNA of enlarged posterior mediastinal lymph nodes require subsequent thoracic surgery.