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Management of non-CF bronchiectasis
P72 The Use of Endoscopic Ultrasound in the Diagnosis of Mediastinal Lymphadenopathy: A Comparison of Trucut Biopsy Versus Fine Needle Aspiration
  1. P Ramachandran,
  2. F Al-Murani,
  3. R Banka King
  1. George Hospital, Ilford, UK

Abstract

Background Endoscopic ultrasound guided fine needle aspiration is a commonly used tool in the diagnosis of mediastinal lymphadenopathy. However, less is known of the value of additional trucut biopsy. This retrospective study compares the outcomes of EUS-guided FNA and trucut biopsy, in an unselected group of patients with mediastinal lymphadenopathy of unknown origin.

Method The endoscopy database of two district general hospital sites was reviewed for all patients who had undergone endoscopic ultrasound for mediastinal lymphadenopathy. Results were reviewed for all patients who had cytological or histological specimens taken. Documentation of patient comfort levels and immediate complications was also collected.

Results 77 patients underwent EUS for mediastinal lymphadenopathy and had specimens taken via FNA, trucut or both. For 1 patient no data was available and therefore was excluded from analysis. Of the remaining 76 patients, 46 had trucut and FNA sampling, 29 FNA alone and 1 trucut alone.

Comparison of the subgroups having FNA plus trucut and FNA alone, via Fisher’s exact test, showed no statistically significant difference in the diagnostic information acquired (p=1.0000).

There was no difference in the immediate complication rates or level of patient comfort during procedure (both p=1.0000).

Trucut did provide additional information in 5 patients but this was not statistically significant. A large number of trucut specimens received were inadequate for histological analysis (20/47) compared with FNA (8/67). This was statistically significant with p=0.0001.

Conclusions EUS-guided trucut biopsy provided additional diagnostic information in some patients and is well tolerated, with no reports of immediate complications. This retrospective study performed in a single NHS hospital trust was unable to provide statistically significant data to confirm the benefits of trucut sampling however it did confirm its safety and tolerability of EUS-trucut. It may be beneficial to repeat this study in multiple centres with a larger sample size and multiple operators.

References Initial experience with EUS-guided trucut needle biopsies of perigastric organs. Wiersema et al. Gastrointestinal Endoscopy 56 (2) 2002.

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