Clinical Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis of Mediastinal and Intra-Abdominal Lymphadenopathy

Abstract

Introduction: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has proven to be helpful in obtaining tissue samples from enlarged mediastinal and intra-abdominal lymph nodes. This is especially beneficial in the diagnosis and staging of malignancy. We retrospectively reviewed the clinical utility of this method at a tertiary care cancer hospital in Pakistan. Patients and Methods: The medical records of 183 consecutive patients referred to the gastroenterology service from August 2008 to March 2012 were reviewed in this retrospective study. The mean age of the patients at presentation was 46.7 years (range 6-87; 62% males); 119 patients had mediastinal and 64 had intra-abdominal lymphadenopathy. Major indications for referral were diagnosis of lymphadenopathy of unknown origin detected on CT scan or PET-CT, to exclude lymph node metastasis in patients with a known primary tumor and to rule out relapse of lymphoma following treatment or during follow-up. Rapid on-site evaluation (ROSE) was performed in all patients to confirm the adequacy of sampling, followed by definitive cytopathological evaluation. Results: EUS-FNA with ROSE obtained adequate tissue for cytology in 97.3% of the patients in this cohort. These results were further confirmed on final cytopathological analysis in 96.2% of patients. Two patients (1.1%) had inadequate specimens for final interpretation (97.3 vs. 96.2; p = 0.001). Clinical utility was 95% for mediastinal lymphadenopathy and 98.4% for intra-abdominal lymphadenopathy. Only 1 patient had a serious complication requiring hospitalization and this was successfully managed conservatively. Conclusion: EUS-FNA is safe and has a high clinical utility in diagnosing unexplained mediastinal and intra-abdominal lymphadenopathy.

Fine needle aspiration cytology in the diagnosis of lymph nodes: Correlation with histopathological diagnosis

“…[15][16][17][18][19] Although FNAC is an accepted technique to determine the possibility of infectious/inflammatory diseases and metastatic disease, its place in the diagnosis of lymphoproliferative disease remains controversial. [20][21][22][23] There are also studies investigating the accuracy of FNAC in the diagnosis of lymphoma. [23] The success rate of FNAC has been reported to vary between 38% and 88.8% in the identification of the correct subtype of lymphoma.…”

Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas

“…EUS- or EBUS-FNA has been demonstrated to be an accurate tool for the cytological diagnosis of deep-seated lesions of unknown origin, especially metastatic epithelial malignancies [13,21,22,23,24]. However, FNA diagnosis of deep-seated lymphoma remains controversial [6,25,26].…”

Lymph node cytopathology: Essential ancillary studies as applied to lymphoproliferative neoplasms

“…An abnormally enlarged lymph node, either superficial or deep‐seated, is a very common clinical problem in both children and adults. Cytopathologic evaluation by fine‐needle aspiration (FNA) biopsy of a clinically concerning lymph node, especially in the clinical context of an infectious/inflammatory condition or possible metastatic malignancy, has become a well‐accepted and reliable initial diagnostic technique because of its rapid turnaround time, minimally invasive nature, and low cost . However, the proper role of FNA in lymphoproliferative neoplasia diagnoses remains debatable and controversial .…”

“…Cytopathologic evaluation by fine-needle aspiration (FNA) biopsy of a clinically concerning lymph node, especially in the clinical context of an infectious/inflammatory condition or possible metastatic malignancy, has become a well-accepted and reliable initial diagnostic technique because of its rapid turnaround time, minimally invasive nature, and low cost. [1][2][3] However, the proper role of FNA in lymphoproliferative neoplasia diagnoses remains debatable and controversial. 4 No doubt, the important and often critical role of FNA diagnosis in lymphoproliferative neoplasia has become increasingly recognized with the technological advances in ancillary techniques over the past several decades.…”