High Sensitivity of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Lymphadenopathy Caused by Metastatic Disease: A Prospective Comparative Study

Abstract

Diagnosing unclear lymphadenopathy such as lymph node metastasis has an enormous impact on the treatment of neoplastic diseases. Therefore, the aim of treatment usually switches from cure to palliation. Numerous other diseases are accompanied by lymphadenopathy, including benign conditions such as infections and inflammatory disease. 1 Hence, sampling of the target node is often required to unveil the underlying diagnosis and to enable adequate clinical management. 2 Intrathoracic or intraabdominal lymphadenopathies are clinically challenging because the nodes are difficult to sample using non-invasive techniques. Therefore, invasive methods such as mediastinoscopy or laparotomy are needed but are associated with risks. 3 A mini-invasive method such as endosonography (EUS) is an alternative approach in such scenarios. 4 Endosonographic characteristics of malignant lymph nodes include large size, hypoechogenicity, distinct border, round shape, and high tissue stiffness on elastography. 5,6 Neverthe

Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study

“…The results of our EUS-FNA series are in line with the current literature based on studies not using ROSE [ 10 ]. On the other hand, EUS-FNB in our study showed results slightly superior to previous studies, probably due to the prevalent use of newer FNB needles in our series as compared to the large proportion of patients sampled with the reverse bevel needle in previous reports [ 19 , 20 , 23 ].…”

“…Sample adequacy analysis showed a non-significant trend in favor of EUS-FNB (96.1% versus 89.5%, p = 0.06), a result consistent with the aforementioned studies [ 19 , 20 ]. As expected, the histological core procurement rate was significantly higher with EUS-FNB (94.2% versus 51.4%; p < 0.001) and this might be of particular relevance in patients with suspected lymphoma, where adequate histological samples are needed for molecular diagnosis and subclassification, as shown in the subgroup of lymphoma patients reported in Table 4 .…”

“…A small prospective study enrolling 48 patients also did not find a significant difference between the two sampling strategies, although the diagnostic sensitivity for lymphoma was borderline superior in favor of EUS-FNB performed using the ProCore ® needle ( p = 0.06) [ 20 ].…”

“…Only a few studies enrolling both patients with mediastinal and intrabdominal lymphoadenopathy compared these two sampling strategies. However, these studies were limited by a small sample size and single-center design or poor statistical methodology [ 19 , 20 ]. Therefore, the aim of this study was to compare, through a robust propensity-matched design, the diagnostic performance of EUS-FNB in comparison to EUS-FNA in the workup of intraabdominal lymphadenopathies in a multicenter cohort of patients.…”

A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System

“…The diagnosis of malignant lymphadenopaties still relies on excisional biopsy and histological evaluation [2,3]. However, most benign lymphadenopaties may be reliably diagnosed by combining FNC microscopic features with flow cytometry (FC), immunocytochemistry (ICC), microbiological analysis, and molecular testing data [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], thus, avoiding unnecessary diagnostics surgical procedures. Moreover, cytology can be especially useful when a surgery is inadvisable or unfeasible, as in elderly patients with comorbidities or in metastatic settings.…”