The role of mediastinoscopy in the diagnosis of mediastinal lymphadenopathy

Porte, Henri; Roumilhac, Didier; Eraldi, L.; Cordonnier, Charlotte; Puech, Philippe; Wurtz, Alain

doi:10.1016/s1010-7940(97)00324-2

Cited by 93 publications

(64 citation statements)

References 11 publications

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“…Although its diagnostic yield of 82-97% [5][6][7] is high, mediastinoscopy has a morbidity of 2% [8], and requires general anesthesia, operating facilities and clinical admission in most hospital settings. Additionally, this generally young patient population ends up with scarring to the neck.…”

Section: Resultsmentioning

confidence: 99%

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Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis

Annema

Veselic²,

Rabe³

2005

European Respiratory Journal

136

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The objective of the current study was to assess the yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for the diagnosis of sarcoidosis in a large patient group.Bronchoscopy with transbronchial lung biopsy (TBLB) is nondiagnostic in 30% of patients with suspected sarcoidosis and has a risk of pneumothorax and haemoptysis. In order to obtain a diagnosis, mediastinoscopy is often performed as the next diagnostic procedure. EUS-FNA provides a nonsurgical alternative for the demonstration of noncaseating granulomas by aspirating mediastinal lymph nodes from the oesophagus.In total, 51 patients with suspected sarcoidosis stage I and II underwent EUS-FNA. Thirty-six patients (71%) previously underwent a nondiagnostic bronchoscopy. All patients were clinically followed (median 18 months) and surgical-pathological verification occurred in those patients with EUS aspirates that contained unrepresentative material.EUS-FNA demonstrated noncaseating granulomas without necrosis in 41 of 50 patients (82%) with the final diagnosis of sarcoidosis. Specific ultrasound features of clustered, well-demarcated iso-echoic lymph nodes were observed in 64% of patients with sarcoidosis. No complications occurred.Endoscopic ultrasound-guided fine-needle aspiration has a high yield in diagnosing sarcoidosis and qualifies as the next diagnostic step after a nondiagnostic bronchoscopy. The current authors expect that endoscopic ultrasound-guided fine-needle aspiration will reduce the number of mediastinoscopies for the diagnosis of sarcoidosis dramatically.

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Section: Resultsmentioning

confidence: 99%

“…Although high yields of 82-97% in demonstrating noncaseating granulomas are reported [5][6][7], mediastinoscopy is invasive, requires general anaesthesia, often clinical admission and has a morbidity of 2% [8].…”

mentioning

confidence: 99%

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis

Annema

Veselic²,

Rabe³

2005

European Respiratory Journal

136

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“…13,14) It can only sample nodal stations 1-4 and 7, cannot access hilar nodal stations and has a morbidity of 1% and mortality of 0.05% which increases with inexperienced hands. 4,15) In contrast, the EBUS-TBNA procedure is safe and minimally invasive, and does not require general anesthesia or hospitalization.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients

Çetınkaya

Özgül

Tutar

et al. 2014

ATCS

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Background: There are many causes of mediastinal and hilar lymphadenopathy, such as neoplasms, granulomatous diseases, infections and reactive hyperplasia. Nowadays, the popularity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasing in the diagnosis of mediastinal and hilar lymphadenopathy. We aimed to investigate the diagnostic value of EBUS-TBNA in patients with mediastinal and/or hilar lymphadenopathy and previously conventional TBNA-negative or inadequate results. Methods: Retrospective analysis was performed in 64 patients with previously conventional TBNA-negative or inadequate results and consequently undergoing EBUS-TBNA between July 2007 and August 2011. Results: One hundred and twenty three lymph nodes were sampled by EBUS-TBNA in 64 patients with no complications. In the 63 (98.4%) cases with adequate results, the sensitivity, diagnostic accuracy, and NPV of EBUS-TBNA per patient was 90.5%, 90.6%, and 66.6%, respectively. In a total of 122 (99.1%) adequately sampled lymph nodes, the diagnostic sensitivity, accuracy, and NPV of EBUS-TBNA per nodal station were 87.8%, 90.1%, and 65.7%, respectively. Non-small cell lung cancer (NSCLC) (n = 21, 33.3%) and sarcoidosis (n = 16, 25.3%) were the most common malignant and benign diseases in the patients with adequate samples by EBUS-TBNA. The relationships of diagnostic accuracy with the number of lymph nodes sampled, number of passes per node, or size of lymph nodes were both insignifi cant ( p >0.05). Conclusion: EBUS-TBNA is a sensitive and accurate method for the assessment of mediastinal and hilar lymph nodes in patients with conventional TBNA negative results.

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“…Mediastinoscopy is effective in assessment of the mediastinum. Porte et al have found that sensitivity of the mediastinoscopy was 97 % in 400 mediastinoscopes performed in 398 patients with undiagnosed mediastinal lesions (Porte et al, 1998). It is important to remember that non-necrotizing epithelioid cell granulomas may be related to carcinoma of the lung and other malignant disease.…”

Section: Mediastinoscopymentioning

confidence: 99%

Bronchoalveolar Lavage and Sampling in Pulmonary Sarcoidosis

Danila¹

2011

Sarcoidosis Diagnosis and Management

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The role of mediastinoscopy in the diagnosis of mediastinal lymphadenopathy

Abstract: According to the results, the few contraindications of the procedure and its low cost, we confirm that MDS is still the first choice procedure to diagnose lesions located in the axial mediastinum.

Cited by 93 publications

References 11 publications

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis

The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients

Bronchoalveolar Lavage and Sampling in Pulmonary Sarcoidosis

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