Combination of tissue biopsy and fine needle aspiration cytology reduces false negativity of mediastinoscopy for non-small cell lung cancer

Abstract

Background: This study aims to compare tissue biopsy with fine needle aspiration (FNA) and investigate whether the combination reduces false negativity of mediastinoscopy. Methods: Between January 2004 and October 2005, 92 patients with non-small cell lung cancer (NSCLC) who underwent cervical video mediastinoscopy were included in this prospective study. Tissue biopsy samples and FNAs were obtained from the same lymph node and were sent for a pathologic examination. Tissue samples and FNAs were stained with Hematoxilene-Eosine. All specimens were evaluated by two histopathologists. Results: Using tissue biopsy samples, no metastasis was found in 54 patients, while 38 patients were metastatic. Forty-eight patients had no metastasis, while 44 patients were metastatic using FNA samples. The difference was statistically non-significant (p>0.05). The false negativity of the FNA and tissue biopsy were 5.4% and 12%, respectively. Subsequently, 43 patients with negative FNA and tissue biopsy underwent lung resection with thoracotomy and sistematic lymph node dissection. Following lymph node dissection, lymph node metastases were found in two cases (4.6%). As a result, false negativity of mediastinoscopy was reduced to 4.6% when two techniques were combined. There was no complication related to the technique. Conclusion: The FNA of mediastinal lymph nodes is a safe and effective method, compared to tissue biopsy and reduces the false negativity of mediastinoscopy when combined with tissue biopsy.