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Ann Thorac Med. 2012 Oct-Dec; 7(4): 210–214.
PMCID: PMC3506100
The utility of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal or hilar lymph node evaluation in extrathoracic malignancy: Benign or malignant?
Elif T. Parmaksız, Benan Caglayan, Banu Salepci, Sevda S. Comert, Nesrin Kiral, Ali Fidan, and Gulsen Sarac
Department of Pulmonary Diseses, Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
Address for correspondence: Dr. Sevda Sener Comert, Pembe kosk sok. Emek apt. No: 16 D:14 34732 Kadikoy, Istanbul, Turkey. E-mail: sevdasener2/at/yahoo.com
Received March 6, 2012; Accepted May 18, 2012.
Abstract
OBJECTIVE:
Newly arising enlarged or hypermetabolic mediastinal/hilar lymph nodes (LNs) in patients with previously diagnosed extrathoracic malignancies raise suspicion of metastasis. Relatively high proportion of these LNs is due to a benign condition. We aimed to determine frequency of malignant LNs and role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the origin of suspicious LNs in these patients.
METHODS:
Consecutive patients with a known extrathoracic malignancy and suspected hilar/mediastinal LN were included in this prospective study. Computed tomography (CT) of thorax and positron emission tomography-CT of all patients were taken. LNs with short axis >1 cm at CT of thorax and SUV ≥ 2.5 were accepted suspicious for malignancy. All patients underwent EBUS-TBNA for pathological verification of LNs. Patients with benign diagnosis either underwent invasive procedures or were followed up. The results were evaluated for frequency of malignant hilar/mediastinal LNs and sensitivity, specificity, and diagnostic values of EBUS-TBNA.
RESULTS:
A total of 48 cases with a mean age of 57.4±11.6 were included. All cases had the diagnosis of an extrathoracic malignancy. 78 LNs were aspirated with EBUS-TBNA in 48 cases (1.62 LNs/patient). The mean short axis of aspirated LNs was 1.51±0.63. Results of EBUS-TBNA revealed malignancy in 15 cases (31.2%), tuberculosis in six cases (12.5%), sarcoidosis in four cases (8.3%), and reactive adenitis in 23 cases (48%). The sensitivity, specificity, and negative predictive value of EBUS-TBNA for malignancy were 83.3%, 100%, and 90.9%, respectively. When both benign and malignant diseases were considered, sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA were 89.2%, 100%, 86.9%, and 93.7%, respectively.
CONCLUSIONS:
The ratio of benign LNs in patients with extrathoracic malignancies is relatively high. EBUS-TBNA is a safe, minimally invasive, and effective method for clarification of intrathoracic LNs.
Keywords: Endobronchial ultrasound, extrathoracic malignancy, fine needle aspiration, lymph nodes, mediastinal diseases
Articles from Annals of Thoracic Medicine are provided here courtesy of
Medknow Publications