Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration

Abstract

BACKGROUND Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) seems to be a powerful tool to obtain cytologic specimens from mediastinal and celiac lymph nodes, enlarged left adrenal glands, and intrapulmonary tumors with mediastinal extension. The diagnostic yield of EUS‐FNA and the accuracy of cytologic specimens was evaluated. METHODS Cytologic assessment of EUS‐FNA specimens was performed and specimens were classified as positive, negative, suspicious for malignancy, or unsatisfactory for diagnosis. Cytology was compared with histologic and clinical (≥6 months) follow‐up. RESULTS Cytologic specimens were collected from 155 lymph nodes, 10 left adrenal glands, and 9 intrapulmonary tumor masses. For lymph nodes, the diagnostic yield was 0.65. After exclusion of unsatisfactory specimens, sensitivity, specificity, accuracy, and positive (PPV) and negative (NPV) predictive values of cytologic specimens were 0.92, 1.00, 0.93, 1.00, and 0.63, respectively. Subgroup analysis of lymph nodes with a dimension of ≥10 mm showed similar results. With EUS imaging only, lymph node diameter and a round or irregular shape were significant predictors of malignancy at multiple logistic regression analysis, but their clinical usefulness is very limited (PPV = 0.78 and NPV = 0.45). For left adrenal gland specimens, sensitivity and specificity were 0.89 and 1.00, respectively. From intrapulmonary masses, 8 true‐positive and 1 true‐negative specimens were obtained. CONCLUSIONS Cytologic specimens from mediastinal or celiac lymph nodes obtained with EUS‐FNA were reliable and accurate. Specimens from left adrenal glands and intrapulmonary tumor masses showed promising results. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.

Endobronchial ultrasound-guided transbronchial needle aspiration biopsy is useful evaluating mediastinal lymphadenopathy in a cancer center

“…[7] Another study suggested a lymph node aspirate would be insufficient if one of the smears did not contain an area with numerous small lymphocytes or follicle center cells. [18] At the time of this study, we did not have well-defined criteria for sampling adequacy, but in general, we required lymphoid cells that were loosely associated or in aggregates. A consensus on adequacy criteria for these specimens will help improve the false-negative rates.…”

Thymomas: Review of Current Clinical Practice

“…They evaluated the procedure as superior in comparison with FNA, as surgical diagnostic procedures can be reduced, and the repetition of unsuccessful FNA is avoided. For the same reason, endoscopic ultrasound-guided FNA has become increasingly useful in obtaining cytologic specimens from mediastinal lesions [43, 44]. Larghi and colleagues [44] implemented an altered endoscopic ultrasound-guided FNA technique in a pilot study of 27 patients using continuous high, negative pressure suction for core tissue acquisition, and they compared this technique to standard endoscopic ultrasound-guided FNA.…”

Utility of Fine Needle Aspiration Cytology in Mediastinal Lesions

“…Transesophageal and transbronchial ultrasound-guided aspirations are being used with a high degree of sensitivity and specificity. 6 However, in the present study all of the aspirations were percutaneous aspirations. Diagnostic yield in the present study (80.7%) is comparable to the study conducted by Shabb et al 8 Significantly, it is also comparable to the study by Sklair-Levy et al 14 on core biopsies.…”

“…Diagnostic accuracy ranges from 77% to 100% in various studies. [1][2][3][4][5][6] With the advent of computed tomography (CT) and endoscopic ultrasonography (US), FNAC has proved its role even in primary mediastinal lesions. 7,8 Addition of ancillary techniques such as immunocytochemistry, flow cytometry and electron microscopy helps increase diagnostic accuracy.…”