Extrathoracic Malignancies Research Articles

Transesophageal endoscopic ultrasound-guided fine-needle aspiration for the mediastinal staging of extrathoracic tumors: a new perspective

BackgroundSeveral extrathoracic tumors metastasize to the mediastinum. Mediastinoscopy is the standard method to obtain tissue proof of mediastinal spread, but drawbacks are its invasiveness, requirement for general anesthesia and costs. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is indicated in lung cancer staging guidelines as a minimally invasive alternative for surgical staging. The diagnostic values in patients with suspected mediastinal metastases and various (previous) extrathoracic malignancies were assessed. Patients and methodsConsecutive patients with suspected mediastinal metastases (on computed tomography or positron emission tomography) and an (previous) extrathoracic malignancy underwent EUS-FNA. ResultsSeventy-five patients with current (n = 14) or previously diagnosed (n = 61) extrathoracic malignancies were evaluated. EUS-FNA detected mediastinal malignancies in 43 patients (57%) [metastases of extrathoracic tumors, n = 36 (48%); second malignancy (lung cancer), n = 7 (9%)]. Mediastinal metastases were found at subsequent surgical staging in seven patients or during follow-up (one patient). In seven patients, an alternative diagnosis was established. Sensitivity, specificity, accuracy and negative predictive value of EUS-FNA for mediastinal staging were 86%, 100%, 91% and 72%, respectively. ConclusionEUS-FNA is a minimally invasive mediastinal staging method for patients with extrathoracic malignancies to confirm nodal metastatic spread and therefore may qualify as an alternative for surgical staging.

Adénopathies médiastinales malignes isolées

Mediastinal adenopathies without pulmonary disease may be benign, lymphomatous or the metastases from intra- or extrathoracic malignancy or more rarely metastases with unknown primary site. We observed 507 patients with isolated mediastinal adenopathies: benign, lymphomatous and metastatic disease represented 41.4% (210/507), 26.8% (136/507), 31.8% (161/507) of them, respectively. Management of the latter was the most challenging. Surgery was generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes in 84% of patients (135/161). However, radical surgery consisting in lymphadenectomy proved effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed long-term good results in such cases, which also was demonstrated by case reports in the literature. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.

Endobronchial ultrasound‐guided transbronchial needle aspiration cytology: a state of the art review

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe and cost-effective technique that allows sampling of mediastinal lymph nodes and peribronchial lesions including pulmonary and mediastinal lesions. Its major indications are the nodal staging of non-small cell carcinomas of the lung, their restaging after chemotherapy and/or radiation, the diagnosis of sarcoidosis and of metastases from extrathoracic malignancies, and the diagnosis of mediastinal lymphadenopathy and masses of unknown aetiology. From our experience at the University of Minnesota and a comprehensive review of the literature, we discuss technical aspects of the procedure, its advantages and limitations in comparison with other methods of sampling mediastinal lymph nodes, focusing on the role of the cytopathologist in ensuring the effectiveness of the procedure. An algorithmic approach to the cytological diagnosis, starting with the determination of the adequacy of the sample, is also presented.

Vėžinio pleurito gydymas

Pacientams, sergantiems įvairios lokalizacijos piktybiniais navikais, gali pasireikšti vėžinis pleuritas. Išgyvenimo mediana po vėžinio pleurito diagnozės nustatymo yra 4 mėnesiai. Krūties, plaučių, virškinamojo trakto, kiaušidžių navikai, limfoma – dažniausios piktybinės ligos, pasireiškiančios ir vėžiniu pleuritu. Vėžinio pleurito gydymas tebėra paliatyvus – jo apimtis ir metodas priklauso nuo paciento būklės, ligos prognozės, skysčio pleuroje kaupimosi greičio, gydytojų patirties bei gydymo metodų (kaip antai: toracentezės, protarpinio drenavimo ilgalaikiu pleuros kateteriu, pleurodezės, torkoskopijos, pleuroperitoninio nuosrūvio) prieinamumo.

Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope

Although endoscopic ultrasound-guided fine needle aspiration can be helpful when combined with bronchoscopic procedures, endoscopic ultrasound-guided fine needle aspiration is not available as a conjunctive procedure with bronchoscopy at many institutions. This study evaluated the feasibility and the additional role of transoesophageal fine needle aspiration using a convex probe ultrasonic bronchoscope (EUS-B-FNA). We analysed 84 patients who underwent EUS-B-FNA between Oct 2007 and May 2008. Bronchoscopy and/or endobronchial ultrasound-guided transbronchial needle aspiration was performed on 83 patients prior to EUS-B-FNA. EUS-B-FNA was performed on 89 lesions (1.7 aspirations/lesion) including three lung masses and 86 lymph nodes (nodal stations 1, 3P, 4L, 5, 7, 8, 9 and 10L) without complication. Sample adequacy was 95.4% for each aspiration and 100% for each lesion. Of the 89 lesions, 39 malignant lesions were confirmed by EUS-B-FNA. EUS-B-FNA provided additional diagnostic gain to bronchoscopic procedures in 16 patients (19.0%): 3 lung cancers were upstaged, 11 lung cancers were pathologically confirmed, and 2 patients were diagnosed with mediastinal metastasis from an extrathoracic malignancy. This gain was obtained by the sampling of inaccessible (n = 4) or difficult lesions by endobronchial ultrasound-guided transbronchial needle aspiration (n = 2) or when bronchoscopy was difficult due to dyspnoea, cough, brain metastasis or other conditions (n = 10). EUS-B-FNA is a technically feasible and safe procedure, which may be an alternative to endoscopic ultrasound-guided fine needle aspiration as a procedure that complements bronchoscopy. Additional diagnostic yield can be obtained by combining EUS-B-FNA with bronchoscopic procedures.

Invited Commentary

The question posed by Riquet and colleagues [1Riquet M. Berna P. Brian E. et al.Intrathoracic lymph node metastases from extrathoracic carcinoma: the place for surgery.Ann Thorac Surg. 2009; 88: 200-205Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar] and the basis for this article was the role of surgical intervention in patients with isolated, intrathoracic hilar/mediastinal lymph node metastases from extrathoracic malignancies. Of 565 such patients reviewed, 37 had a history of extrathoracic malignancies, and 11 were excluded when a biopsy specimen showed unrelated pathology. Of the remaining 26 patients, operations were done for diagnostic purposes in 15 patients who had breast, prostate, kidney, and laryngeal cancers, and melanoma. That left 11 patients with six different extrathoracic primaries who underwent lymphadenectomy as a curative procedure. Multiple stations were removed in 5 patients and single stations in 6, with genitourinary tract lesions accounting for the most cases. The authors correctly point out that the mechanism of spread of disease into the thorax from extrathoracic tumors is poorly understood for the most part, except for pelvic and renal lesions. Their 5-year survival rate was 41.6%, but 6 of the 11 died after an average of 21.6 months. This difference could be explained by selection bias, because the resected patients had more limited disease. In fact, the only long-term survivors, at 134 and 110 months, were 2 patients with testicular cancers, both of which were noted to have “evolved into mature tissue” after resection. The patient with breast cancer survived for 61 months, but it is quite possible that the same outcome could have been obtained with chemotherapy. Perhaps the major concern with this article is that the authors compared 11 patients who met criteria and who had resectable disease with 15 patients who did not, which is not a valid comparison. They concluded that, “these metastatic lesions may be isolated and that resection can be done safely with benefits to selected patients.” It is not possible to make a strong case for surgical intervention because the authors have not established that patients with resectable disease could not have had the same survival without an operation by using other forms of adjuvant therapy. To begin with, the number for the entire group is too small. The authors cover the literature well for these rare lesions, but unfortunately, the information provided here cannot be generalized over a broad spectrum of extrathoracic lesions. Not enough patients were included, and the successful cases reported are largely anecdotal, or even worse, if one considers the skew imposed by the 2 patients with testicular cancer. Therefore, the original intent of elucidating the role of surgical intervention in these patients, unfortunately, remains unanswered. Surgeons should exercise extreme caution when recommending a surgical procedure and decide each case on its merits. Intrathoracic Lymph Node Metastases From Extrathoracic Carcinoma: The Place for SurgeryThe Annals of Thoracic SurgeryVol. 88Issue 1PreviewIntrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their prognosis poorly known. We reviewed the place of surgical intervention in their management. Full-Text PDF

F-18 FDG PET/CT Findings in A Case of Multifocal Nodular Lymphoid Hyperplasia of the Lung

Pulmonary nodular lymphoid hyperplasia is a rare benign disease with polyclonal lymphoid proliferation. We describe a 67-year-old man with atypical manifestation of this disease with bilateral multifocal lesions including subcentimeter nodules and infiltrate, which showed only faint F-18 FDG uptake on PET/CT scan and spontaneous regression. Before obtaining histopathologic confirmation, the differential diagnosis of the multifocal lesions included metastases or malignant lymphoma, because of the history of extrathoracic malignancy, elevated serum interleukin-2 receptor, and temporal growing of the lesions. Histopathologic confirmation appears indispensable for the definitive diagnosis of pulmonary nodular lymphoid hyperplasia, as multifocal small lesions of malignancy, including mucosa-associated lymphoid tissue lymphoma and benign diseases such as plasmacytoma and inflammatory pseudotumor can also show only faint FDG uptake, with overlapping clinical and radiologic features.

Recent Advances in the Diagnosis and Management of Malignant Pleural Effusions

Malignant pleural effusions (MPEs) are an important complication for patients with intrathoracic and extrathoracic malignancies. Median survival after diagnosis of an MPE is 4 months. Patients can present with an MPE as a complication of far-advanced cancer or as the initial manifestation of an underlying malignancy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, gastrointestinal tract, and ovaries. However, almost all tumor types have been reported to cause MPEs. New imaging modalities assist the evaluation of patients with a suspected MPE; however, positive cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Even in the presence of known malignancy, up to 50% of pleural effusions are benign, underscoring the importance of a firm diagnosis to guide therapy. Rapidly evolving interventional and histopathologic techniques have improved the diagnostic yield of standard cytology and biopsy. Management of an MPE remains palliative; it is critical that the appropriate management approach is chosen on the basis of available expertise and the patient's clinical status. This review summarizes the pathogenesis, diagnosis, and management of MPE. Studies in the English language were identified by searching the MEDLINE database (1980-2007) using the search terms pleura, pleural, malignant, pleurodesis, and thoracoscopy.

Multifocal T4 non-small cell lung cancer: a subset with improved prognosis☆

T4-disease for non-small cell lung cancer (NSCLC) includes different conditions: mediastinal invasion, neoplastic pleural cytology, and multifocal disease in the same lobe; regarding the last category, no strict criteria allow to differentiate satellite nodules from synchronous multiple primary tumours. Retrospective study of 56 patients who underwent a complete resection from 1985 to 2006 of a NSCLC graded pT4N0 due to multifocal disease. A small nodule (<1cm) closed to the primary tumour, in a same pulmonary segment with an identical histology was considered as a satellite nodule (pT4sn). Multiple tumours, sized more than 1cm, with an identical histology, located in the same lobe but in different segment were considered as synchronous cancers (pT4sc). There were 44 males and 12 females: 35 patients were graded T4sn and 21 patients T4sc. The median age was 62.5 years. The two groups were similar for sex, age, tobacco consumption, ASA score, NYHA, Charlson's index, spirometric parameters, cardiovascular comorbidity and history of previous extra-thoracic malignancies. All had a complete anatomic resection with mediastinal lymphadenectomy. Thirty-day mortality rate was 3.6%. Overall 5-year and 10-year survival rates were 48.2% and 29.9%, respectively. There was a non-significant trend for a worse survival in T4sn group patients when compared to that of T4sc group patients: 42.9% vs 52.3% at 5 years, and 25% vs 34.9% at 10 years (p=0.62). Multifocal T4 stage IIIB disease is a heterogeneous category where overall prognosis is far better than those of other T4 subgroups. Survival rates associated with pT4sn and pT4sc look roughly similar because of the small size of the subgroups usually submitted to comparison in most series. In the present experience, respective survival figures diverge, suggesting different biological behaviours.

Percutaneous radiofrequency ablation of lung tumours: Results in first 100 consecutive patients

7714 Background: Treatment modalities for patients with primary and secondary lung malignancies who are not surgical candidates are limited. Radiofrequency ablation is a minimally invasive, lung sparing therapeutic alternative that may provide local disease control for these patients. The study reported our experience with first 100 consecutive patients who underwent radiofrequency ablation of their lung tumours. Methods: From November 2000 to December 2006, the clinical and treatment-related information regarding the 100 consecutive patients (58 males, mean age of 65 years) with 240 lung tumours treated by radiofrequency ablation were collected prospectively. Radiofrequency ablation was performed percutaneously under CT guidance with local anaethesiologic assistance and conscious sedation using a RITA Starbust XL electrode. The patients were hospitalized overnight and followed at one week, one month and then every three months with CT to evaluate treatment outcome and complications. Results: Five patients had primary lung carcinoma while the remaining patients had pulmonary metastases from extra-thoracic malignancies, with colorectal cancer being the most common primary site (68%), followed by renal cell carcinoma (8%) and uterine leiomyosarcoma (5%). The mean number of pulmonary lesions ablated was 2.4 per patient; the mean size of lesion ablated was 2.2 cm in diameter. Fifteen patients had second-time RFA; 4 patients underwent third- or fourth-time RFA for pulmonary recurrence. There was no post-procedural mortality and the overall morbidity rate was 42%. The most common complication was pneumothorax, which occurred in of 31% of procedures (n=39/127) with 20 (16%) requiring chest tube placement. After a median follow-up of 24 months (range 1 to 70 months), 72% of RFA treated lesions did not progress. The overall median disease-free interval was 13 months, with 1-, 3- and 5- year disease-free survival of 55%, 22% and 7% respectively. The overall median survival was 34 months with 1-, 3- and 5-year- survival of 85%, 49% and 33% respectively. Conclusions: Percutaneous radiofrequency ablation is an emerging therapy with promising results when surgical resection of pulmonary malignancy cannot be performed. No significant financial relationships to disclose.

Malignant mesothelioma following thoracic radiotherapy for lung cancer

As the number of long-term cancer survivors increases, secondary malignancies are becoming a greater clinical issue. Although some of these malignancies may be related to common environmental exposures, a significant number are considered to be therapy-related. Pleural malignant mesothelioma is a neoplasm that may be related to asbestos exposure or radiation exposure. Previous reports of pleural mesothelioma as a second malignancy have tended to follow radiotherapy for extra-thoracic malignancies such as Hodgkin's disease, breast cancer and Wilms' tumor. We report the case of a 66-year-old woman with no prior asbestos exposure who developed pleural mesothelioma 17 years after pneumonectomy and adjuvant radiation therapy for non-small cell lung cancer. Opacification of the lung field from prior therapy made determination of the diagnosis more challenging. Secondary malignancies such as mesothelioma should be considered in patients who develop unexplained symptoms even long after treatment of a primary tumor.

Development of Pulmonary Arteriovenous Communications within Pulmonary Metastases After Chemotherapy

The development of acquired pulmonary arteriovenous communications within pulmonary metastases from an extrathoracic malignancy is a rare phenomenon, but it has potentially serious clinical consequences for the patient. We describe two such patients, both of whom developed intrametastatic pulmonary arteriovenous communications after chemotherapy of the pulmonary metastases, and one of whom required coil embolization for control of symptoms related to the right-to-left shunt. In both cases, computed tomographic angiography was useful for the detection and pre-therapeutic evaluation of the arteriovenous malformations.

A Case of Multiple Endobronchial Metastases from Prostatic Carcinoma

The lung is the most common site for the metastasis of extrapul monary malignant tumors. However, endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are the breast, renal and colorectal carcin omas. Lung metastasis from prostate cancer is often encountered but EBM is rare. We report a 74-year old man with e ndobronchial metastases from prostatic carcinoma presented with cough. The diagnosis of prostatic cancer and the endobronchial metastasis were confirmed by immunohistological staining with the prostate specific antigen. Hormonal therapy (lutenizing hormone releasing hormone agonist) was applied to this patient. (Tuberc Respir Dis 2006; 61: 162-166)Key words: Multiple endobronchial metastases, Prostatic cancerAddress for correspondence : Ju-Ock Kim, M.D.Department of Internal Medicine, Chungnam National University Hospital.Chung Gu Dae-Sa Dong 640. Taejeon.Phone : 042-220-7158 Fax : 042-257-5753 E-mail : jokim@cnu.ac.krReceived : Apr. 24. 2006Accepted : Jun. 30. 2006

Endobronchial Metastases from Extrathoracic Malignancies

Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient.

Two-Year Survival After Multiple Bilateral Lung Metastasectomies for Cranial Meningioma

The lung represents a common site of metastases from extrathoracic malignancies, and several studies have strengthened the evidence that complete resection of pulmonary metastases is a useful therapeutic treatment for prolonged survival in selected patients. However, fewer data are available in the literature regarding the role of lung metastasectomy in rare malignancy. We present a case of extensive bilateral lung metastases due to recurrent cranial meningioma, which was successfully treated by aggressive, staged metastasectomies.

Differential diagnoses of solitary pulmonary nodules in patients with an extrathoracic malignant tumor: CT and pathologic correlations

To determine the possibility of definitive diagnosis for solitary pulmonary nodules in patients with a primary extrathoracic malignant neoplasm (ETM-SPN), and to further evaluate the value of CT for differential diagnosis in ETM-SPN by a multivariate retrospective study. Eighty-three patients with pathologically and clinically proven ETM-SPN with a diameter smaller than 3 cm were included in this study. The pathological characteristics of the SPN were correlated with those of the extrathoracic neoplasm, with the patient’s age, gender, smoking history, disease -free time interval between the diagnosis of the extrathoracic malignancy and that of the lung lesion. In all 83 cases, CT scans were reviewed to confirm the solitary nature, size, and nodular morphology of the lung lesion. Of all 83 cases, the mean age was (57.43±15.34) years. There were 51 males and 32 females, with the ratio of 1.59:1. The lesions included solitary metastasis in 43 cases, pulmonary malignant lesions in 33, and benign lesions in seven. Between the primary lung cancers and solitary metastasis groups, there was no significant difference in the gender ratio (1.20:1 vs 2.31:1, x2=0.0209,P>0.05), but there was a significant difference between the mean age (62.48 ±11.96 years vs 54.10±16.49 years,t =3.34,P 0.05). Of 81 cases who were followed-up, the mean time of the disease-free interval between extrapulmonary malignancy diagnosis and pulmonary lesion differentiation was 39.73 ±6.29 months (range 0∼300 months, median 20.00 months), whereas those in the primary lung cancer group and metastatic group were 65.62 ±13.45 months and 22.83 ±4.19 months respectively. This difference was significant between the two groups (Wilcoxon rank sum test,U=2.796,P 0.05), without showing a statistically significant relevance between the pathologic patterns of extrapulmonary malignancy and characteristics of the lung nodules. Of all the 83 cases, the mean diameters were (2.77 ±.25) cm, whereas the diameters of 33 cases of primary lung cancer and 43 cases of a solitary metastatic lesion were (2.86±1.18) cm and (2.62±1.31) cm, respectively. There was no association between the two groups (t=1.29,P>0.05). There was a statistically significant association between primary lung cancer and the metastatic group with spiculate and smooth edges of the lung lesion (Ξ2=8.562,P 0.05). The likelihood of a primary lung cancer versus a metastasis of ETM-SPN smaller than 3 cm mainly depends on the patient’s age, free interval between the two tumors and CT morphological characteristics of the lung lesion. This study showed there was no significant relevancy to factors such as gender, smoking history, pathological patterns of the extrapulmonary neoplasm or whether there has hilar or mediastinal adenopathy.

Accuracy of Helical CT in the Detection of Pulmonary Metastases: Is Intraoperative Palpation Still Necessary?

Background Pulmonary metastasectomy is well accepted in patients with isolated metastases from an extrathoracic malignancy. The standard approach involves careful intraoperative palpation of the lungs because more metastases are frequently found than were seen by preoperative conventional computed tomography (CT). Helical CT detects more nodules than conventional CT, raising the question of whether palpation of the lungs is still necessary if helical CT is used. Methods Retrospective review was done of medical records of patients undergoing metastasectomy with curative intent at the University of North Carolina (UNC) from 1999 to 2003. During this time at UNC, helical CT was routinely performed using a standardized technique, and all metastasectomy patients underwent manual lung palpation. The primary outcome measure of this study was whether malignant nodules (palpated, resected, and proven histologically) were reliably detected preoperatively by helical CT. Results Thirty-four patients were identified who underwent 41 cases of pulmonary metastasectomy with lung palpation. Our analysis revealed that in 22% (9/41), more malignant nodules were found intraoperatively than were detected by helical CT. Of 88 malignant intraparenchymal nodules, 69 were detected by helical CT (sensitivity 78%). Subset analyses of tumor histology, disease-free interval, the presence of a single lesion versus multiple lesions, the interval between the CT and metastasectomy, and the size of the largest lesion were unable to identify a cohort in which lung palpation was no longer needed after preoperative helical CT. Conclusions Despite the advent of helical CT, palpation of the lung is necessary if the goal is to resect all detectable disease.

Endoscopic ultrasound-guided fine-needle aspiration in patients with mediastinal abnormalities and previous extrathoracic malignancy

Endoscopic ultrasound-guided fine-needle aspiration in patients with mediastinal abnormalities and previous extrathoracic malignancy

Métastases intrathoraciques

Pulmonary metastasis are the most frequent pulmonary malignant lesions. They have a prevalence of 30 to 50% in patients with thoracic or extrathoracic malignancies, this being related with the role of vascular filter of the lung parenchyma. Primary malignancies most often concerned are pulmonary, breast, colonic, pancreatic, kidney, gastric, ENT carcinoma and melanoma. Pleural metastasis represent 95% of malignant diseases of the pleura. Pulmonary, breast, ovarian or gastric adenocarcinoma are most often concerned. Lymphoma may also involve the pleura with possible multifocal localizations and represent a differential diagnosis. Knowledge of mechanisms of drainage and migration of tumoral cells initial site explains the various patterns of lung metastasis. Computed tomography is the best imaging toll for the diagnosis and post-therapeutic follow-up of pulmonary metastasis. In this context of disseminated disease, chemotherapy increases the survival. Surgery may be proposed when disease is localized to the lung and stabilized by chemotherapy. Cases of cure have however been reported after surgery of colonic metastasis without previous chemotherapy.

Endoscopic ultrasound-guided fine-needle aspiration in patients with mediastinal abnormalities and previous extrathoracic malignancy

Enlarged mediastinal lymph nodes in patients with previous extrathoracic malignancy require pathological verification. However, surgical procedures lead to morbidity and (rarely) mortality. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a minimally invasive, outpatient procedure. We prospectively assessed its usefulness in patients with mediastinal abnormalities and previous extrathoracic malignancy. All patients underwent EUS-FNA prior to planned surgical procedures. Specimens were categorised as positive, negative, or inconclusive. Surgical procedures were cancelled after positive EUS-FNA. Twenty patients underwent EUS-FNA, being positive in eleven and providing an alternative diagnosis in one patient (a total of 60%). In 8 patients, EUS-FNA was negative or inconclusive, while surgery was positive in five and negative in three. Sensitivity and specificity of EUS-FNA were 69 and 100%, respectively. EUS-FNA is useful in the assessment of mediastinal abnormalities in patients with previous extrathoracic malignancy. Surgical diagnostic procedures were precluded in 60% of such patients.