Diagnosis Of Mediastinal Lymphadenopathy Research Articles

The value of rapid on-site evaluation during conventional and endobronchial ultrasound needle aspiration in the diagnosis of mediastinal lymphadenopathy and lung cancer

BackgroundThe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has revolutionized pulmonology by identifying cancer spread in lung cancer patients. It is now used for diagnosing sarcoidosis, tuberculosis, and lymphoma. Rapid onsite evaluation (ROSE) is a crucial tool for pathologists, assisting in sample adequacy, accuracy, and prompt decision-making. This study aimed to evaluate the efficacy of ROSE in identifying mediastinal lymphadenopathy and lung cancer during EBUS-TBNA and cTBNA.MethodsOur research was a prospective study in which we examined sixty cases that were separated into two groups of similar size. The rapid onsite evaluation group and the non-rapid onsite evaluation group were subjected to either Conventional TBNA or endobronchial ultrasound-guided transbronchial needle aspiration.ResultsThe total diagnostic yield of conventional and endobronchial ultrasound-guided transbronchial needle aspiration in both groups was 83.3% (50/60 cases). Twenty-eight cases (46.7%) were positive for malignancy, 22 cases (36.6%) were positive for benign lesions, and 10 cases (16.6%) were not conclusive. Regarding diagnostic accuracy, it was greater in the rapid onsite evaluation group than in the non-rapid onsite evaluation group (100% in the rapid onsite evaluation group vs. 66.7% in the non-ROSE group).ConclusionsRapid onsite evaluation during conventional or endobronchial ultrasound-guided transbronchial needle aspiration improves diagnostic accuracy of mediastinal lesions by excluding suspicious or nondiagnostic specimens and can reduce unnecessary punctures or eliminate the need for additional bronchoscopy procedures when reaching preliminary diagnosis.

Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

BackgroundDifferential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy.MethodsThe study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure.Resultswe found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis.ConclusionLymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Convex-probe Endobronchial Ultrasound: A Decade of Progress

Ever since the invention of the flexible bronchoscope, perhaps no other innovation in the field of interventional pulmonology has caused so much excitement the world over, as the convex probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). While it took over a decade from 1992 to 2004 for the radial EBUS to evolve into the commercial convex probe EBUS scope, another exciting decade has gone by with the technology being thoroughly researched and appraised. The current evidence suggests that EBUS-TBNA can replace mediastinoscopy as the first investigation in the mediastinal staging of lung cancer. The use of EBUS-TBNA has been extended to several other areas including the diagnosis of undefined mediastinal lymphadenopathy, evaluation of intra-parenchymal lesions and others. In fact, EBUS-TBNA is the preferred modality for accessing mediastinal lesions in contact with the airways. The procedure not only has a high diagnostic efficiency (80%-90% for most indications) but is also safe compared to alternative options, such as image-guided fine needle aspiration and mediastinoscopy in the diagnosis of mediastinal lymphadenopathy. Apart from the traditional use of EBUS to perform TBNA, the last decade has seen the evolution of its transoesophageal use, development of novel EBUS-TBNA needles to obtain better histological specimens and a smaller EBUS scope. This review summarises the developments made in this field over the years since its inception.

Efficacy of TBNA needles for EBUS during fiberoptic bronchoscopy?

Conventional transbronchial needle aspiration (cTBNA) biopsy is a diagnostic minimally invasive technique applied using fibreoptic bronchoscopy (FOB) in the evaluation of mediastinal/hilar lymph nodes. With the development of endobronchial ultrasound (EBUS) devices, transbronchial aspiration needles have been revised for use according to the EBUS guidelines. The main aim of this research was to evaluate the diagnostic success of transbronchial aspiration needles that was produced for EBUS when it was applied with FOB instead of conventional TBNA. A retrospective examination was made with the data of 35 patients applied with FOB TBNA, using needles specifically designed for EBUS and 36 patients with conventional TBNA (cTBNA group), for lung cancer staging or the diagnosis of mediastinal lymphadenopathy between November 2018 and November 2019. Seventy-two and sixty procedures performed on 71 patients were included in the study. Diagnostic efficiency for TBNA and cTBNA groups were 91.4% and 83.3%, respectively. Conventional TBNA is still acceptable when the low cost and ease of application are taken into consideration. In conclusion, improvement of current conventional TBNA needles similar to EBUS-TBNA needles for more efficient aspiration capacity could be the first stepto increasing the TBNA diagnostic yield. Nevertheless, further studies are needed to confirm our results.

Cervical mediastinoscopy in diagnosis and treatment of lung cancer

Lung cancer remains the leading cause of cancer mortality. It ranks first in the incidence of cancer in the world. According to the European Association of Oncologists, the annual incidence of lung cancer is increasing with every passing year and amounts to about 1.8 million new cases worldwide. Men have a higher prevalence of lung cancer (33.8 per 100,000) than their female counterparts (13.5 per 100,000). In most cases, it is diagnosed at an advanced stage (III — IV), which is characterised by mediastinal lymphadenopathy. Early detection of lung cancer allows seeking early treatment. Lung cancer screening is used to find a tumour and/or lung cancer metastasis, determine its location and size as well as its morphological verification.
 Objective — to define the most accurate invasive and non‑invasive methods of verification and diagnosis of mediastinal lymphadenopathy and improve diagnosis and treatment of lung cancer through the extensive use of cervical mediastinoscopy and creation of an algorithm for its optimal use.
 Materials and methods. The study included 146 patients. A wide range of clinical, laboratory, endoscopic (Endobronchial ultrasound transbronchial needle aspiration (EBUS‑TBNA), Cervical Mediastinoscopy (CM)), radiographical (Computed tomography (CT), Positron emission tomography (PET)), morphological, immunohistochemical and statistical methods were used. Statistical analysis was performed using Statistics for Windows Version 10.0 (Stat Soft Inc., USA).
 Results. The study involved 146 patients who underwent screening for mediastinal lymphadenopathy using mediastinoscopy. According to the laboratory findings, 98 patients had lung cancer. The rest of the cases were presented by other pathologies. Colorectal and stomach cancers were most commonly seen. In one case, the patient had a comorbidity, a combination of lung cancer and colorectal cancer.
 Conclusions. Mediastinoscopy is the most effective diagnostic method for mediastinal lymphadenopathy, especially in lung cancer.

Usefulness and problems of cytological examination by endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: A retrospective single-centre study.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and useful technique for sampling mediastinal lymph nodes. High sensitivity and specificity of EBUS-TBNA in staging lung cancer have been reported. However, few studies have addressed the results of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy with or without lung cancer, since various neoplastic and non-neoplastic conditions can involve the mediastinal lymph nodes. The present study analysed the results of the cytological examination of mediastinal lymphadenopathy using EBUS-TBNA in Kansai Medical University Hospital (Hirakata, Japan). A total of 41 consecutive patients with mediastinal lymphadenopathy who underwent EBUS-TBNA between January 2008 and December 2019 in Kansai Medical University Hospital were enrolled. This cohort included 29 males and 12 females. Cytological analyses demonstrated that 16/17 (94.1%) patients with metastatic carcinoma were diagnosed as having carcinoma (malignancy). The sensitivity, specificity and positive predictive value of the cytological examination in cases of carcinoma were 94.1, 100 and 100, respectively. However, only 3/11 (27.3%) patients with sarcoidosis were diagnosed by cytological examination. The present study demonstrated that EBUS-TBNA may be a useful method for detecting metastatic carcinoma in the mediastinal lymph nodes. However, the detection rate of epithelioid granuloma, which is a characteristic feature of sarcoidosis, was low in the present cohort. Hence, an improvement in the sampling technique is necessary.

Influence of technological parameters of performing transbronchial aspiration biopsy of mediastinal lymph nodes under endosonography control on its sensitivity in the diagnosis of mediastinal lymphadenopathy

<h3>ОБОСНОВАНИЕ</h3> Лимфаденопатия средостения — рентгенологический синдром, проявляющийся увеличением лимфатических узлов (ЛУ). Этиологические причины представляют собой гетерогенную группу. Одним из новых методов диагностики является трансбронхиальная аспирационная биопсия ЛУ средостения под контролем эндосонографии (EBUS-TBNA). <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Определение технологических параметров, влияющих на информативность EBUS-TBNA при верификации лимфаденопатии средостения. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В проспективное нерандомизированное исследование с февраля 2012 г. по февраль 2020 г. включены 235 пациентов в возрасте 18 лет и старше с коротким диаметром (1 см или более) как минимум одного из ЛУ групп 4R, 7 и 4L. EBUS-TBNA выполнена при помощи ультразвукового бронхоскопа и ультразвукового сканера. Пункции выполнены специальными ультразвуковыми трансбронхиальными иглами размером 22G. Для математической обработки использовался метод построения деревьев классификаций (метод CHAID). <h3>РЕЗУЛЬТАТЫ</h3> Общая чувствительность метода составила 80%. Чувствительность при пункции 1, 2 и 3 групп и более составила 65, 83 и 85% соответственно, при использовании активной аспирации — 84%. <h3>ЗАКЛЮЧЕНИЕ</h3> Факторами, которые способствуют повышению чувствительности EBUS-TBNA с целью верификации лимфаденопатии средостения, являются биопсия 2 групп ЛУ и более средостения и использование активной аспирации.

Endoscopic ultrasound-guided-fine-needle aspiration/fine-needle biopsy in diagnosis of mediastinal lymphadenopathy - A boon.

Background/Objectives:Evaluation of mediastinal lymphadenopathy (MLA) is a great diagnostic challenge considering the myriad of causes. In recent years, the role of endoscopic ultrasound (EUS) has been greatly extended in evaluation of MLA due to its safety, reliability, and accuracy. The present study details the role of EUS-guided-fine-needle aspiration/fine-needle biopsy (EUS-FNA/FNB) in MLA of unknown origin.Methods:Seventy-two patients (34 men) with MLA of unknown etiology were studied. Mediastinum was evaluated with linear echoendoscope and FNA/FNB was performed with 22-G needle and sent for cytology, histopathological, and mycobacterial growth indicator tube/GeneXpert evaluation. EUS-FNA/FNB diagnosis was based on cytology reporting by pathologists. Patients tolerated the procedure, and insertion of needle into the lesion was always successful without any complications.Results:EUS-FNA/FNB established a tissue diagnosis in 66/72 patients in first sitting, while six patients underwent repeat procedure. EUS-FNA diagnoses (after second sitting) were tuberculous lymphadenitis in 45/72 (62.5%), metastatic lymph nodes 12/72 (16.7%), reactive lymphadenopathy 6/72 (8.3%), sarcoidosis 4/72 (5.6%), and lymphoma 2/72 (2.8%), while it was nondiagnostic in 3/72 (4.1%) patients. Final diagnosis was based on combined clinical presentation, EUS-FNA/FNB result and clinicoradiological response to treatment on long-term follow-up of 6 months.Conclusion:EUS echo features along with EUS-FNA/FNB can diagnose MLA and surgical biopsy can be avoided.

The role of endobronchial ultrasound-guided transbronchial needle aspiration liquid-based cytology in the diagnosis of mediastinal lymphadenopathy.

BackgroundEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a minimally invasive, reliable technique for sampling mediastinal lymph nodes (LNs). Liquid‐based cytology (LBC) is widely used for cervical cancer screening because it provides reliable and feasible results. The present study aimed to evaluate effectiveness of the combination of EBUS‐TBNA and LBC in the diagnosis of mediastinal lymphadenopathy.MethodsA total of 602 LNs that were retrospectively analyzed were sampled in 442 patients who underwent EBUS‐TBNA between January 2014 and December 2016. The histopathological result of TBNA tissue or cell blocks was considered as the gold standard to evaluate diagnostic utility of LBC and conventional smears (CS) for the diagnosis of mediastinal lymphadenopathy.ResultsOf the 602 LNs, 265 were mediastinal LN metastases from lung cancer, four were lymphoma, and 333 were benign. The sensitivity of LBC and CS in the diagnosis of mediastinal LN metastases from lung cancer was 72.8% and 63%, respectively, and the specificity was 98.5% and 97%, respectively. The positive predictive values for LBC and CS were 97.5% and 94.4%, respectively, whereas the negative predictive values were 82.2% and 76.9%, respectively. The accuracy of LBC and CS was 88% and 83.7%, respectively. The diagnostic value of LBC was significantly higher than that of CS (P = .001).ConclusionsThe combination of EBUS‐TBNA and LBC is a highly reliable and feasible procedure that optimizes diagnostic utility for the diagnosis of lung cancer and mediastinal LN staging.

Utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and additional value of cell block in the diagnosis of mediastinal lymphadenopathy: A one year study in a tertiary care hospital in north India

Utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and additional value of cell block in the diagnosis of mediastinal lymphadenopathy: A one year study in a tertiary care hospital in north India - IJIRM- Print ISSN No: - 2581-4214 Online ISSN No:- 2581-4222 Article DOI No:- 10.18231

BRAF Mutated Tall Cell Papillary Carcinoma Lung Metastasis Following Thyroidectomy

SESSION TITLE: Metastatic and Other Primary Lung Tumors SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: BRAF Mutated Tall Cell Papillary Carcinoma is a rare tumor infrequently presented as lung metastasis. Although Papillary Carcinoma is one of the most frequent Thyroid Cancers, BRAF-Tall Cell Variant carries the worst prognosis. CASE PRESENTATION: A 65-year-old male former 12-pack year smoking history and total thyroidectomy as a child presents for evaluation of hematochezia. He has no prior history of radiation exposure or familial history of thyroid cancer. Supplemental thyroid replacement therapy was started at age 21 due to clinical hypothyroidism. Residual thyroid glandular tissue was not visible on CT scan or ultrasound studies. Abdominal and pelvic computed tomography (CT) scan demonstrated the incidental finding of a 1.2 cm non-calcified lobulated and speculated pulmonary nodule. Positron Emission Test (PET) Scan demonstrated maximum SUV uptake of 11.0 in mediastinal and pretracheal structures. Mediastinoscopy aborted after experiencing intraoperative bleeding complications. Endobronchial Ultrasound Trans-bronchial fine needle aspiration (EBUS-TB FNA) was was non-diagnostic. Exploratory thoracotomy with right middle lobe wedge resection and mediastinal lymph node dissection was performed. Surgical biopsy diagnosed a poorly differentiated tall cell papillary carcinoma, BRAF positive mutation. DISCUSSION: BRAF is a important oncoprotein responsibile for the MAPK-pathway output. Its role suppresses the expression of genes required for iodide incorporation. Due to poor iodide uptake, radioactive iodine is not useful diagnostically or therapeutically in tall cell variant disease. CONCLUSIONS: BRAF-mutated classical or tall-cell-variant papillary thyroid carcinomas have a high frequency of lymph-node metastases and recurrence after thyroidectomy. These associated carcinomas have a poor response to radioiodine therapy due to the high MAPK-pathway output, which is driven by the BRAF V600E oncoprotein. This case demonstrates the difficulty with diagnosis of mediastinal lymphadenopathy and rare presentation of tall cell variant papillary cell carcinoma as lung metastasis. Reference #1: American Cancer Society: Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer Society, 2016. Reference #2: Gimm, O., Rath, F. W. and Dralle, H. (1998), Pattern of lymph node metastases in papillary thyroid carcinoma. Br J Surg, 85: 252-254. doi:10.1046/j.1365-2168.1998.00510.x Reference #3: Xing M, Westra WH, Tufano RP, et al. BRAF mutation predicts a poorer clinical prognosis for papillary thyroid cancer. J Clin Endocrinol Metab 2005;90:6373-9. DISCLOSURE: The following authors have nothing to disclose: Brandon Hooks No Product/Research Disclosure Information

Uniportal video-assisted thoracic surgery in the diagnosis of mediastinal lymphadenopathy of unknown aetiology

Background: Recently endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been widely reported to be useful for patients with lung cancer for lymph node staging, and this tool may be the first line procedure for patients with mediastinal and hilar lymphadenopathy of unknown aetiology. However, more invasive techniques as mediastinoscopy and video-assisted thoracic surgery (VATS) are useful in well-selected patients, and surgery has a significant role in the evaluation of some areas in the mediastinum. The purpose of the current study was to investigate the clinical utility of VATS with the uni-portal approach in the diagnosis of mediastinal lymphadenopathies of unknown aetiology. Methods: Retrospective chart review of our VATS database between 2003 and 2013 (10-year experience) was performed. All mediastinal lymphadenopathies of unknown origin were included in the study and were classified and designated according to the International Staging System. Pathological diagnosis was determined in all patients and was classified into two categories: malignant lymphadenopathy and benign lymphadenopathy. Results: A total of 136 patients with mediastinal lymphadenopathy of unknown origin were identified, and the final diagnosis was available in all patients’ means of VATS surgery with uniportal technique. We no consider mediastinoscopy cases. The final diagnosis was available in all patients and was 114 malignant lymphadenopathies and 22 benign lymphadenopathies. VATS was safe (without complications) and had a sensitivity and a specificity of 100%, and it permits to study all areas of the mediastinum. Additionally, VATS surgery is accurate in the diagnosis of EBUS-TBNA negative lymphadenopathy (26 patients, 19%). Conclusions: VATS is a safe and reliable minimally invasive approach for a sampling of mediastinal and hilar lymphadenopathies, and it should be considered a second line procedure for a sampling of mediastinal tissue. However, in some areas of the mediastinum (anterior, posterior, left 5–6 lymph node stations) and in the cases where EBUS-TBNA fails, this is a winning tool for obtaining a pathological diagnosis of mediastinal disease. We also believe that for these patients are paramount a multidisciplinary approach.

Transoral endoscopic mediastinal surgery (TOEMS)—true or false hope?

Mediastinal lymphadenopathy include a variety of clinical entities including primary lung cancer, primary and metastatic mediastinal tumors, and multiple benign conditions. In the clinical practice, diagnosis of mediastinal lymphadenopathy includes imaging, endoscopic and surgical techniques.

The value of cervical mediastinoscopy in the diagnosis of mediastinal lymphadenopathy

Objective. This study retrospectively evaluated mediastinoscopic interventions performed for diagnostic purposes in cases with mediastinal lesions remained undiagnosed by other diagnostic methods. Methods. We retrospectively evaluated the medical information of 218 patientss that underwent diagnostic cervical mediastinoscopy for mediastinal lymphadenopathy apart from lung cancer staging between January 2011 and December 2015. The patients were evaluated for age, sex, distribution of sampled lymph node stations detected to have lymphadenopathy, intraoperative and postoperative mortality and morbidity, and histopathological diagnostic parameters. The gender-based distribution of the disease types diagnosed by cervical mediastinoscopy were analyzed with the Chi-Square test. Results. Two hundred and six (94.5%) of 218 patients were diagnosed by cervical mediastinoscopy. The most common diagnosis was sarcoidosis in women and bronchogenic carcinoma in men. Nineteen (8.7%) patients suffered minor complications, with pain being the most common; no major complication occurred. Conclusion. The present study shows that mediastinoscopy is still an invasive diagnostic method with high diagnostic accuracy that can be safely used with low rates of mortality and morbidity in a large proportion of patients with mediastinal lymphadenopathy of undetermined origin.

Randomized study comparing conventional needle fine needle aspiration to procore biopsy needle in patients with mediastinal lymphadenopathy and masses of unknown origin

Background and Objectives:Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is a commonly used tool in the diagnosis of mediastinal lymphadenopathy. However, less is known of the value of ProCore fine needle biopsy (FNB). This prospective, comparative study compares the outcomes of EUS-guided FNA (EUS FNA) and FNB, in patients with mediastinal lymphadenopathy and masses of unknown origin.Methods:Results were compared for cellularity and adequacy for all patients who had cytological/histological specimens taken. Patients were randomized into Group A (undergone EUS FNA only) and Group B (EUS FNA + FNB). Patients were followed up for 3 months and final diagnosis was made.Results:Sixty-one patients underwent EUS for mediastinal lymphadenopathy and had specimens taken through FNA, FNB, or both. Four patients lost to follow-up and therefore were excluded from analysis. Of the remaining 57 patients, adequacy and inadequacy of EUS FNA sample were seen in 41 (71.93%) and 16 (21.07%), respectively. Of the 29 patients undergoing both procedures, the adequacy in FNA and FNB were 20 (68.97%) and 23 (79.31%), respectively. The difference was not statistically significant (P > 0.05).Conclusions:The diagnostic sensitivity of aspirated material obtained using EUS-FNA needle and ProCore needle in mediastinal masses and lymph nodes was comparable in our study.

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy.

Context:The diagnosis of mediastinal lymphadenopathy is always a challenge. There always a need of a technique that is highly accurate as well as safe for diagnosis the same.Aims:The aim of the study is to assess the clinical usefulness and safety profile of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosing the patients with mediastinal lymphadenopathy.Settings and Design:This was an observational prospective study.Subjects and Methods:One hundred adult patients with mediastinal lymphadenopathy who underwent EBUS-TBNA with aspirate obtained from the most hypoechoic lymph node (with a 22 gauge needle) and its cytopathological analysis were included in the study. Patients were observed for postprocedure complications.Results:Out of 100, 92 cases were reported as adequate (diagnostic yield = 92%). Among these 92, there were 71 granulomatous lymphadenitis (tuberculosis [TB] = 41 [44.5%], sarcoid-like granuloma = 30 [32.2%]). Malignancy was reported in 16 (17.3%) patients, and 5 (5.43%) were reported to have reactive lymphadenopathy. There was one case each of Mycobacterium avium complex and Mycobacterium abscessus. Out of 16 cases of malignancy, six cases were adenocarcinoma, four cases of squamous cell carcinoma, and two cases of small cell carcinoma. There were three cases of Hodgkin's lymphoma and one case of non-Hodgkin's lymphoma. No major complications were noted, except fever (26), nausea (20), mild bleeding (4), bronchospasm (3), and transient intraprocedural hypoxia (2).Conclusions:EBUS-TBNA is highly accurate (diagnostic yield 92%) and safe procedure for diagnosing mediastinal lymphadenopathy. In our experience, granulomatous lymphadenitis was most common with TB as the main etiology.

Endobronchial ultrasound versus conventional transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: a meta-analysis.

Currently, whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is superior to conventional TBNA (cTBNA) in the diagnosis of mediastinal lymphadenopathy remains controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) to evaluate the diagnostic yield of EBUS-TBNA versus cTBNA in the diagnosis of mediastinal lymphadenopathy, both in benign and malignant etiologies. Computer-based retrieval was performed on PubMed and EMBASE. The quality was evaluated according to the quality assessment of diagnostic accuracy studies-2, and Meta-Disc was adopted to perform meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95 % confidence intervals (CIs) were calculated. The summary receiving operating characteristic curve as well as the areas under curve (AUC) was measured. Four studies with a total of 440 patients met the inclusion criteria. Our results showed that the pooled sensitivity was 0.90 (95 % CI 0.85–0.94) and 0.76 (95 % CI 0.68–0.82), pooled specificity was 0.75 (95 % CI 0.60–0.87) and 0.94 (95 % CI 0.86–0.98), DOR was 75.38 (95 % CI 16.38–346.97) and 108.17 (95 % CI 13.84–845.35), and AUC was 0.9339 and 0.9732 for EBUS-TBNA group and cTBNA group, respectively. Although EBUS-TBNA with a higher sensitivity performs better than cTBNA, there is lack of enough evidence regarding EBUS-TBNA being superior to cTBNA in the diagnosis of mediastinal lymphadenopathy. Considering the limitations of methodology and limited data, further robust RCTs are needed to verify the current findings and investigate the optimal choice in patients receiving TBNA.

Thoracoscopy as the Method of Choice in Diagnosis of Mediastinal Lymphadenopathy

Thoracoscopy as the Method of Choice in Diagnosis of Mediastinal Lymphadenopathy

An Atypical Etiology of Mediastinal Lymphadenopathy: Extraskeletal Ewing Sarcoma

Background: Ewing's sarcomas and peripheral primitive neuroectodermal tumors are high grade malignant neoplasms, arising from bone and soft tissues and are grouped in the Ewing family of tumors. Primary localization in the mediastinum is extremely rare and was treated in only a few case reports. Lymphatic localization has never been reported. We present a case of an extraskeletal Ewing sarcoma arising from lymphadenopathy in the hilar and anterior mediastinal regions with literature review. Case presentation: A 24 year old man was admitted to our institution for persistent cough, nocturnal diaphoresis, and weight loss of 6 kg. The chest X-ray displayed opacity of the left hilum at polycyclic contours. Chest Computed tomography scan confirmed supradiaphragmatic lymphadenopathy in the hilar and anterior mediastinal. Biopsy was performed. Histological and immunohistochemical analysis showed small and round cells tumor with positive staining for CD99 and vimentin, and negative staining of desmine, myogenine, actine muscle lisse, Proteine S-100, Chromogranine, CD56, pancytokeratin, myeloperoxidase and TTF1. Young age, morphological and immunohistological characters argued in favor of a tumor of Ewing group .We could not perform molecular cytogenetic analysis, because of the lack of technical structure. The staging was negative for any other metastatic disease or primitive bone tumor, and final diagnosis was primary localized Ewing sarcoma in mediastinal nodes. The patient received Ewing’s sarcoma chemotherapy regimen. Complete response was achieved after six courses. Radiotherapy was prescribed, and the same chemotherapy regimen was continued totaling a period of one year. The patient was well with no evidence of local relapse or metastasis three years after diagnosis. Conclusion: Extraskeletal Ewing sarcoma should be contemplated in the differential diagnosis of mediastinal lymphadenopathy. With multimodal treatment, the patients are potentially curable.

Mo1481 Role of the Combined Endobronchial and Transesophageal Approach by Using Single Ultrasound Bronchoscope for Diagnosis of Mediastinal Lymphadenopathy

Mo1481 Role of the Combined Endobronchial and Transesophageal Approach by Using Single Ultrasound Bronchoscope for Diagnosis of Mediastinal Lymphadenopathy