Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma
- M P Kennedy1,
- C A Jimenez1,
- J F Bruzzi2,
- A D Mhatre1,
- X Lei3,
- F J Giles4,
- T Fanning5,
- R C Morice1,
- G A Eapen1
- 1Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- 2Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- 3Department of Statistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- 4Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- 5Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Dr G A Eapen, MD Anderson Cancer Center, Department of Pulmonary Medicine, Unit 403, 1515 Holcombe Boulevard, Houston, Texas 77030, USA;
- Received 11 May 2007
- Accepted 12 October 2007
- Published Online First 26 October 2007
Background: The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of lymphoma in patients with mediastinal lymphadenopathy is not well defined.
Methods: A retrospective review was performed of all patients with mediastinal lymphadenopathy referred for EBUS-TBNA between August 2005 and December 2006 in whom lymphoma was suspected based on prior history or clinical presentation. Mediastinal biopsy specimens were taken using a linear array ultrasonic bronchoscope (Olympus XBF-UC 160F) and a 22-gauge cytology needle (NA-202C Olympus) with on-site cytopathological support. The EBUS-TBNA result was compared with a reference standard of pathological tissue diagnosis or a composite of ⩾6 months of clinical follow-up with radiographic imaging.
Results: Of 236 patients who underwent EBUS-TBNA, 25 were eligible for inclusion. Indications for EBUS-TBNA were suspected mediastinal recurrence of lymphoma (n = 13) and mediastinal lymphadenopathy of unknown cause (n = 12). Adequate lymph node sampling was accomplished in 24/25 patients (96%); there were no complications. EBUS-TBNA identified lymphoma in 10 patients and benign disease in 14 patients. There was one false negative EBUS-TBNA for lymphoma (lymphoma prevalence 11/25 (44%)). Follow-up over a median of 10.5 months (range 1–19) confirmed stable or regressive lymphadenopathy in all 14 patients without a lymphoma diagnosis, consistent with a benign diagnosis. Overall, EBUS-TBNA had a sensitivity of 90.9%, specificity of 100%, positive predictive value of 100% and negative predictive value of 92.9% for the diagnosis of lymphoma.
Conclusions: EBUS-TBNA is an accurate, safe and useful tool in the investigation of suspected lymphoma with isolated mediastinal adenopathy, and may diminish the need for more invasive procedures such as mediastinoscopy.
Competing interests: None.