Diagnosis of a malignant mesothelioma by EUS-guided FNA of a mediastinal lymph node

Kahi, Charles J.; DeWitt, John M.; Lykens, Michael; Leblanc, Julia K.; Chappo, John; McHenry, Lee; Sherman, Stuart

doi:10.1016/s0016-5107(04)02177-7

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…Indeed, the role of mini-invasive techniques (percutaneous or endoscopic procedures) in such patients is limited and remains controversial, even considering the need for "large" and "deep" specimens to achieve a definitive diagnosis. In such cases, the echoendoscopic approach (transbronchial or transesophageal) has only been attempted very rarely (3)(4)(5)(6) and is usually reserved for cases in which mediastinal lymph node involvement is detected.…”

Section: Discussionmentioning

confidence: 99%

"Dry" Pleural Mesothelioma Successfully Diagnosed on Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Aspiration (TBNA)

et al. 2014

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The acquisition of histologic material is obligatory in order to establish the diagnosis of malignant pleural mesothelioma (MPM). In particular, tissue acquisition in cases of "dry" MPM (focal pleural thickening without pleural effusion or mediastinal lymph node involvement) is usually performed via a thoracoscopic pleural biopsy. In contrast, the techniques for performing echoendoscopic (transbronchial or transesophageal) needle aspiration of pleural lesions have only rarely been reported due to the theoretical limitations of tissue acquisition in such cases. We herein report the first case of "dry" MPM successfully diagnosed via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a 73-year-old man presenting with a pleural mass in the right costovertebral recess, adjacent to the carina. The patient underwent radical resection, and a definitive pathological examination confirmed the diagnosis of epithelioid MPM.

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Section: Discussionmentioning

confidence: 99%

"Dry" Pleural Mesothelioma Successfully Diagnosed on Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Aspiration (TBNA)

et al. 2014

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“…Kahi et alreported the first case of malignant mesothelioma diagnosed by EUS-FNA in a mediastinal lymph node in an 86-year-old patient without a known primary pulmonary malignancy. 8 Gerke et alalso reported a case of primary mesothelioma diagnosed by EUS-FNA. 9 However, no surgical tissue resection follow-up was available in this patient.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic usefulness and challenges in the diagnosis of mesothelioma by endoscopic ultrasound guided fine needle aspiration

Bakdounes

Jhala

2008

Diagnostic Cytopathology

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Malignant mesothelioma is a rare neoplasm. It has been noted in the literature that fine needle aspiration (FNA) is a useful tool for the diagnosis of mesothelioma. However, the differential diagnosis may require use of a battery of immunohistochemical stains. Clinico-radiologic correlation is also crucial. Real time endoscopic ultrasound (EUS) combined with FNA has been shown to be a very sensitive technique to obtain samples from different organ sites, including mediastinal lesions. The use of EUS-FNA for the diagnosis of mesothelioma, reinforces the role of a cytopathologist as a cohesive team player along with a radiologist and a clinician during on-site assessment for the proper triage of additional specimens for ancillary studies leading to a better patient management.

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“…Therefore, without a preliminary assessment on site, our standard practice is to perform 6-7 passes from solid lesions and 3-4 passes from lymph nodes [9]. However, the total number of passes per lesion is left to the discretion of the attending.…”

Section: Methodsmentioning

confidence: 99%

Training in EUS-Guided Fine Needle Aspiration: Safety and Diagnostic Yield of Attending Supervised, Trainee-Directed FNA from the Onset of Training

Coté

Hovis

Kohlmeier

et al. 2011

Diagnostic and Therapeutic Endoscopy

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Background. The optimal time to initiate hands-on training in endoscopic ultrasound fine needle aspiration (EUS-FNA) is unclear. We studied the feasibility of initiating EUS-FNA training concurrent with EUS training. Methods. Three supervised trainees were instructed on EUS-FNA technique and allowed hands-on exposure from the onset of training. The trainee and attending each performed passes in no particular order. During trainee FNA, the attending provided verbal instruction as needed but no hands-on assistance. A blinded cytopathologist assessed the adequacy (cellularity) and diagnostic yield of individual passes. Primary outcomes compared cellularity and diagnostic yield of attending versus fellow FNA passes. Results. We analyzed 305 FNA sites, including pancreas (51.2%), mediastinal/upper abdominal lymph node (LN) (28.5%) and others (20.3%). The average proportion of fellow passes with AC was similar to attending FNA—pancreas: 70.3 versus 68.8%; LN: 79.0 versus 81.7%; others 65.5 versus 68.7%; P > 0.05); these did not change significantly during the training period. Among cases with confirmed malignancy (n = 179), the sensitivity of EUS-FNA was 78.8% (68.4% fellow-only versus 69.6% attending only). There were no EUS-FNA complications. Conclusions. When initiated at the onset of EUS training, attending-supervised, trainee-directed FNA is safe and has comparable performance characteristics to attending FNA.

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Diagnosis of a malignant mesothelioma by EUS-guided FNA of a mediastinal lymph node

Cited by 14 publications

References 13 publications

"Dry" Pleural Mesothelioma Successfully Diagnosed on Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Aspiration (TBNA)

"Dry" Pleural Mesothelioma Successfully Diagnosed on Endobronchial Ultrasound (EBUS)-guided Transbronchial Needle Aspiration (TBNA)

Diagnostic usefulness and challenges in the diagnosis of mesothelioma by endoscopic ultrasound guided fine needle aspiration

Training in EUS-Guided Fine Needle Aspiration: Safety and Diagnostic Yield of Attending Supervised, Trainee-Directed FNA from the Onset of Training

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