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The role of convex probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of malignant mediastinal and hilar lymph nodes.

Caglayan B, Salepci B, Dogusoy I, Fidan A, Sener Comert S, Kiral N, Yavuzer D, Sarac G - Iran J Radiol (2012)

Bottom Line: Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears.No major complications were seen.As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.

ABSTRACT

Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling.

Objectives: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy.

Patients and methods: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis.

Results: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen.

Conclusion: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of patients enrolled in the study
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fig531: Flow diagram of patients enrolled in the study

Mentions: Among 120 cases, the EBUS-guided TBNA specimens of five cases did not contain a sufficient number of lymphocytes and thus were considered as insufficient. Malignant cells were seen in 82 of the remaining 115 cases and these were considered as true positive. Unnecessary mediastinoscopy was prevented in these cases by EBUS-TBNA. Although there was sufficient material in 33 cases, no malignant cells were observed. In these 38 cases, more invasive procedures were performed for definitive diagnosis or the patients were followed up for the mediastinal LNs for at least six months. Definite diagnosis was determined as malignant in 10 of 38 cases with negative EBUS-guided TBNA and the final diagnosis was established by invasive procedures in nine of theses 10 cases. In one case, LN disappeared with chemotherapy during follow-up. Of the 28 cases (true negatives), in which no malignancy was detected by means of invasive interventions, diagnoses of reactive adenitis, tuberculosis and sarcoidosis were established in 25, two and one case, respectively (Figure 3), (Table 2). Based on the above-mentioned results in 120 cases, the sensitivity, diagnostic accuracy and negative predictive value (NPV) of CP-EBUS-guided TBNA in the diagnosis of malignant hilar or mediastinal LNs were 89.1%, 91.6% and 73.6%, respectively. When assessed according to LN stations, the stations in which aspiration was most commonly performed in our study were 7, 4R and 11L, respectively. The relation between the short axis diameter of the LN and the sensitivity of EBUS-guided TBNA was investigated; 64 LNs had less than 1 cm short axis diameter and 100 LNs had more than 1 cm short axis diameter and the sensitivities were 86% and 95%, respectively. The relation between the short axis diameter of the LN and the sensitivity of EBUS-guided TBNA was significant (P = 0.043). While the sensitivity of EBUS-guided TBNA was 85.4% in 62 cases with aspirations performed once and twice, it was 98.2% in 58 with aspirations performed thrice or more. The relation between the sensitivity and number of aspirations was significant (P = 0.017). In 65 of the 99 lung cancer cases, EBUS was performed for staging purposes. Ten cases were down-staged and one case was up-staged by EBUS-guided TBNA when compared with PET and PET-CT findings (Table 3). No major complication was observed in our study. The only complication was hemorrhage, which was detected in five patients.


The role of convex probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of malignant mediastinal and hilar lymph nodes.

Caglayan B, Salepci B, Dogusoy I, Fidan A, Sener Comert S, Kiral N, Yavuzer D, Sarac G - Iran J Radiol (2012)

Flow diagram of patients enrolled in the study
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569549&req=5

fig531: Flow diagram of patients enrolled in the study
Mentions: Among 120 cases, the EBUS-guided TBNA specimens of five cases did not contain a sufficient number of lymphocytes and thus were considered as insufficient. Malignant cells were seen in 82 of the remaining 115 cases and these were considered as true positive. Unnecessary mediastinoscopy was prevented in these cases by EBUS-TBNA. Although there was sufficient material in 33 cases, no malignant cells were observed. In these 38 cases, more invasive procedures were performed for definitive diagnosis or the patients were followed up for the mediastinal LNs for at least six months. Definite diagnosis was determined as malignant in 10 of 38 cases with negative EBUS-guided TBNA and the final diagnosis was established by invasive procedures in nine of theses 10 cases. In one case, LN disappeared with chemotherapy during follow-up. Of the 28 cases (true negatives), in which no malignancy was detected by means of invasive interventions, diagnoses of reactive adenitis, tuberculosis and sarcoidosis were established in 25, two and one case, respectively (Figure 3), (Table 2). Based on the above-mentioned results in 120 cases, the sensitivity, diagnostic accuracy and negative predictive value (NPV) of CP-EBUS-guided TBNA in the diagnosis of malignant hilar or mediastinal LNs were 89.1%, 91.6% and 73.6%, respectively. When assessed according to LN stations, the stations in which aspiration was most commonly performed in our study were 7, 4R and 11L, respectively. The relation between the short axis diameter of the LN and the sensitivity of EBUS-guided TBNA was investigated; 64 LNs had less than 1 cm short axis diameter and 100 LNs had more than 1 cm short axis diameter and the sensitivities were 86% and 95%, respectively. The relation between the short axis diameter of the LN and the sensitivity of EBUS-guided TBNA was significant (P = 0.043). While the sensitivity of EBUS-guided TBNA was 85.4% in 62 cases with aspirations performed once and twice, it was 98.2% in 58 with aspirations performed thrice or more. The relation between the sensitivity and number of aspirations was significant (P = 0.017). In 65 of the 99 lung cancer cases, EBUS was performed for staging purposes. Ten cases were down-staged and one case was up-staged by EBUS-guided TBNA when compared with PET and PET-CT findings (Table 3). No major complication was observed in our study. The only complication was hemorrhage, which was detected in five patients.

Bottom Line: Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears.No major complications were seen.As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.

ABSTRACT

Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling.

Objectives: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy.

Patients and methods: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis.

Results: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen.

Conclusion: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

No MeSH data available.


Related in: MedlinePlus