Role of EUS-FNA in Evaluating Mediastinal Lymphadenopathy

Abstract

Purpose: Endoscopic ultrasound along with fine needle aspiration is a useful imaging modality and is being used to assess mediastinal mass lesions. This is particularly useful in staging lung and other gastrointestinal malignancies along with evaluating unexplained mediastinal lymphadenopathy. The aim of the study was to evaluate diagnostic utility of EUS-FNA in patients with mediastinal lymphadenopathy at our center. Methods: EUS database at our center from April 2002 to February 2006 was retrospectively reviewed. Patients in whom the primary indication for performing EUS was evaluation of mediastinal lesion as seen on CT scan were selected for this study. Results: 56 patients were identified and reviewed. Adequate cytology sample was obtained in all patients who underwent EUS-FNA, with a mean number of four passes. Nodal stations sampled included left paratracheal, subcarinal and aortopulmonary window. Indications for EUS included mediastinal adenopathy of uncertain cause (21 patients) and lung cancer staging (21 patients). Other malignancies with mediastinal LAP included: gastrointestinal 2, breast 2, melanoma 4, head and neck 4 and lymphoma in 2 patients. EUS confirmed presence of mediastinal mass lesion in 54 patients, 2 patients did not have mediastinal LAP as reported on CT scan. EUS-FNA revealed malignancy in 34% (18/53), atypical cells 5% (3/53), granulomas 7% (4/53) and benign tissue in another 34% (18/53). Benign paraesophageal spindle cell neoplasm and actinomycosis was found in one patient each. Pericardial cyst was seen in one patient and confirmed on surgery. There were no complications reported with the procedure. Conclusions: EUS-FNA appears to be a safe and effective modality for evaluating malignant and mediastinal adenopathy of uncertain origin. It has a significant role, especially in staging lung cancer and hence influencing treatment decisions.