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 biopsies were taken using a linear array ultrasonic bronchoscope (Olympus XBF-UC 160F) and a 22 gauge cytology needle (NA-202C Olympus ltd.) with on-site cytopathologic support. The EBUS-TBNA result was compared to a reference standard of pathological tissue diagnosis or a composite of > 6 month's clinical follow-up with radiographic imaging.
Results: Of 236 patients who underwent EBUS-TBNA, 25 patients 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 1 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.
- Endobronchial Ultrasound