ORIGINAL ARTICLE

Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management

S S Larsen¹, M Krasnik¹, P Vilmann², G K Jacobsen³, J H Pedersen¹, P Faurschou⁴, K Folke⁵

¹ Department of CardioThoracic Surgery, Gentofte University Hospital, DK-2900 Hellerup, Copenhagen, Denmark
² Department of Surgical Gastroenterology, Gentofte University Hospital
³ Department of Pathology, Gentofte University Hospital
⁴ Department of Pulmonology, Gentofte University Hospital
⁵ Department of Radiology, Gentofte University Hospital

Correspondence to:
Correspondence to:
Dr M Krasnik, Department of CardioThoracic Surgery, Gentofte University Hospital, DK-2900 Hellerup, Copenhagen, Denmark;
Mkrasnik{at}thorax.dk

Background: A study was undertaken to evaluate the clinical impact of endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) in patients with mediastinal masses suspected of malignancy.

Methods: From April 1993 to December 1999, 84 patients were referred for EUS-FNA. In all patients CT scanning had shown a lesion of the mediastinum suspected of malignancy located adjacent to the oesophagus. In order to evaluate the clinical impact of EUS-FNA, the history of each patient up to referral for EUS-FNA was reviewed. A board of thoracic specialists was asked to decide the further course of the patient if EUS-FNA had not been available, and this diagnostic strategy was compared with the actual clinical course after EUS-FNA.

Results: For the 79 patients in whom sufficient verification was obtained, EUS-FNA had a sensitivity of 92%, specificity of 100%, PPV of 100%, NPV of 80%, and an accuracy of 94% for cancer of the mediastinum. In 18 of 37 patients (49%) a thoracotomy/thoracoscopy was avoided as a result of EUS-FNA, and in 28 of 41 patients (68%) a mediastinoscopy was avoided. The direct result of the cytological diagnosis obtained by EUS-FNA was that a final diagnosis of small cell lung cancer was made in eight patients resulting in referral for chemotherapy, and in another three patients with benign disease specific treatment could be initiated (sarcoidosis, mediastinal abscess, and leiomyoma of the oesophagus).

Conclusions: EUS-FNA is a safe and sensitive minimally invasive method for evaluating patients with a solid lesion of the mediastinum suspected by CT scanning. EUS-FNA has a significant impact on patient management and should be considered for diagnosing the spread of cancer to the mediastinum in patients with lung cancer considered for surgery, as well as for the primary diagnosis of solid lesions located in the mediastinum adjacent to the oesophagus.

Keywords: endoscopic ultrasound; fine needle aspiration; mediastinum; lung cancer

Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging; EUS, endoscopic ultrasonography; EUS-FNA, endoscopic ultrasound guided fine needle aspiration biopsy; PPV, positive predictive value; NPV, negative predictive value; TNM, tumour, node, metastases staging; SCLC, small cell lung cancer; NSCLC, non-small cell lung cancer

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Szlubowski, A., Kuzdzal, J., Kolodziej, M., Soja, J., Pankowski, J., Obrochta, A., Kopinski, P., Zielinski, M. (2009). Endobronchial ultrasound-guided needle aspiration in the non-small cell lung cancer staging. Eur. J. Cardiothorac. Surg. 35: 332-336 [Abstract] [Full Text]  
• Lennon, A. M., Penman, I. D. (2007). Endoscopic ultrasound in cancer staging. Br Med Bull 0: ldm033v1-18 [Abstract] [Full Text]  
• Sawhney, M. S., Bakman, Y., Holmstrom, A. M., Nelson, D. B., Lederle, F. A., Kelly, R. F. (2007). Impact of Preoperative Endoscopic Ultrasound on Non-small Cell Lung Cancer Staging. Chest 132: 916-921 [Abstract] [Full Text]  
• Detterbeck, F. C., Jantz, M. A., Wallace, M., Vansteenkiste, J., Silvestri, G. A. (2007). Invasive Mediastinal Staging of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest 132: 202S-220S [Abstract] [Full Text]  
• Patel, N. M., Pohlman, A., Husain, A., Noth, I., Hall, J. B., Kress, J. P. (2007). Conventional Transbronchial Needle Aspiration Decreases the Rate of Surgical Sampling of Intrathoracic Lymphadenopathy. Chest 131: 773-778 [Abstract] [Full Text]  
• Micames, C. G., McCrory, D. C., Pavey, D. A., Jowell, P. S., Gress, F. G. (2007). Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Non-small Cell Lung Cancer Staging: A Systematic Review and Metaanalysis. Chest 131: 539-548 [Abstract] [Full Text]  
• Herth, F. J. F., Rabe, K. F., Gasparini, S., Annema, J. T. (2006). Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions. Eur Respir J 28: 1264-1275 [Abstract] [Full Text]  
• Lemaire, A., Nikolic, I., Petersen, T., Haney, J. C., Toloza, E. M., Harpole, D. H. Jr, D'Amico, T. A., Burfeind, W. R. (2006). Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate.. Ann. Thorac. Surg. 82: 1185-1190 [Abstract] [Full Text]  
• Cerfolio, R. J., Bryant, A. S., Ojha, B. (2006). Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: A prospective study. J. Thorac. Cardiovasc. Surg. 131: 1229-1235 [Abstract] [Full Text]  
• Annema, J. T., Versteegh, M. I., Veselic, M., Voigt, P., Rabe, K. F. (2005). Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis and Staging of Lung Cancer and Its Impact on Surgical Staging. JCO 23: 8357-8361 [Abstract] [Full Text]  
• Annema, J. T., Versteegh, M. I., Veselic, M., Welker, L., Mauad, T., Sont, J. K., Willems, L. N. A., Rabe, K. F. (2005). Endoscopic Ultrasound Added to Mediastinoscopy for Preoperative Staging of Patients With Lung Cancer. JAMA 294: 931-936 [Abstract] [Full Text]  
• Choplin, R. H., Conces, D. J. Jr, Teague, S. D. (2005). Invited Commentary. RadioGraphics 25: 786-788 [Full Text]  
• Annema, J. T., Veselic, M., Rabe, K. F. (2005). Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Eur Respir J 25: 405-409 [Abstract] [Full Text]  
• LeBlanc, J. K., Devereaux, B. M., Imperiale, T. F., Kesler, K., DeWitt, J. M., Cummings, O., Ciaccia, D., Sherman, S., Mathur, P., Conces, D., Brooks, J., Chriswell, M., Einhorn, L., Collins, E. (2005). Endoscopic Ultrasound in Non-Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography. Am. J. Respir. Crit. Care Med. 171: 177-182 [Abstract] [Full Text]  
• Yasufuku, K., Chiyo, M., Sekine, Y., Chhajed, P. N., Shibuya, K., Iizasa, T., Fujisawa, T. (2004). Real-time Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes. Chest 126: 122-128 [Abstract] [Full Text]  
• Krasnik, M, Vilmann, P, Larsen, S S, Jacobsen, G K (2003). Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax 58: 1083-1086 [Abstract] [Full Text]  
• Manhire, A, Charig, M, Clelland, C, Gleeson, F, Miller, R, Moss, H, Pointon, K, Richardson, C, Sawicka, E (2003). Guidelines for radiologically guided lung biopsy. Thorax 58: 920-936 [Full Text]  
• Spiro, S. G., Porter, J. C. (2002). Lung Cancer--Where Are We Today?: Current Advances in Staging and Nonsurgical Treatment. Am. J. Respir. Crit. Care Med. 166: 1166-1196 [Abstract] [Full Text]  
• Penman, I, Fergusson, R J (2002). Endoscopic ultrasound: a useful tool to assess the mediastinum in patients with lung cancer?. Thorax 57: 95-96 [Full Text]