Transaortic endoscopic ultrasound-guided fine needle aspiration in the diagnosis of lung cancers and mediastinal lymph nodes

Abstract

Background:Obtaining a tissue diagnosis from a lung tumor or a mediastinal lymph node located lateral to aorta (para-aortal) is a diagnostic challenge. Invasive surgical procedures such as mediastinotomy, thoracotomy, or video-assisted thoracic surgery are required for the diagnosis of these lesions. Lymph nodes on the “far side” of major blood vessels can be visualized by endoscopic ultrasound (EUS); however, fine needle aspiration (FNA) is avoided due to concern for bleeding complications.Objectives:To evaluate the feasibility, yield, and safety of EUS-guided transaortic FNA of lung tumors and para-aortic lymph nodes.Methods:A retrospective case series of 12 consecutive patients with suspected lung cancer or tuberculosis who underwent transaortic fine needle aspiration cytology during a study period of 7 years. In all cases, the para-aortal lesion was the only site suspicious for malignancy/tuberculosis (other lesion/lymph node if present were negative). Seven patients had left-sided lung mass (mean size 30 mm). Four patients had enlarged para-aortic lymph node (mean size 18 mm, range 8–22 mm). All aspirates were obtained under real-time US-guided FNA using a 22/25-gauge needle. A single real-time FNA of the lung mass or lymph node was performed.Results:The final diagnosis was known in 11 patients (seven lung carcinoma, three tuberculosis, and one thymolipoma). EUS-FNA established diagnosis in 9 of 12 patients (75%). One aspirate revealed reactive nodal tissue, and one demonstrated nonrepresentative material. One procedure was abandoned due to complication.Conclusions:This case series demonstrates the feasibility and probable safety of single EUS-guided transaortic aspiration in para-aortic lesions. The diagnostic yield is 75%.