Unveiling mediastinal pathology: role of EUS guided fine needle aspiration in diagnosing mediastinal lesions

Authors

  • Mukundan S. Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • L. Venkatakrishnan Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  • Vishnu Abishek R. Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20183417

Keywords:

Endoscopic ultrasound, FNA, Mediastinal mass, ROSE

Abstract

Background: Mediastinal lesion is the focus of investigation in diagnosis of infective, granulomatous or neoplastic pathology of respiratory system. Metastatic mediastinal node assessment is an integral part of oncological management. EUS provides access to sampling of mediastinal mass, sub-carinal and aorto-pulmonary nodes. This study aims to assess the clinical impact, diagnostic yield and safety of EUS guided FNA for mediastinal lesions.

Methods: Retrospective analysis of prospectively collected data of 72 cases of mediastinal lesions between January 2014 and December 2017 was done. EUS-FNA was performed with a linear echoendoscope using a 22- or 25-gauge needle. Adequacy of cellularity was assessed by on site pathologist. Patient data (demographics, intervention and follow-up) were prospectively collected and introduced in a predefined computer database for later review.

Results: EUS-FNA was performed from 57 lymph nodes and 15 mediastinal masses. Adequate samples were obtained in 67 of 72 patients (93.05%). All mediastinal masses were malignant and were identified in the 3rd, 5th and 6th decade of life. Of the 57 lymph nodes, 15 were malignant, 28 had granulomatous lymphadenitis of which 16 individuals became asymptomatic after anti tubercular therapy. Sample was inadequate in 5 circumstances. No major complications were encountered with the procedure in any of the individuals.

Conclusions: EUS guided tissue diagnosis is a safe technique and our data supports the use of EUS-FNA in work-up of mediastinal lesions. It is minimally invasive, accurate and has easy access to mediastinum. It has significant impact on patient diagnosis, management and should be considered over other invasive techniques.

References

Dixit R, Shah NS, Goyal M, Patil CB, Panjabi M, Gupta RC, et al. Diagnostic evaluation of mediastinal lesions: Analysis of 144 cases. Lung India: Official Organ of Indian Chest Society. 2017;34(4):341-48.

Dimagno E, Regan P, Wilson D, Buxton J, Hattery R, Suarez J, et al. Ultrasonic endoscope. The Lancet. 1980 Mar 22;315(8169):629-31.

Jue TL, Sharaf RN, Appalaneni V, Anderson MA, Ben-Menachem T, Decker GA, et al. Role of EUS for the evaluation of mediastinal adenopathy. Gastrointestinal endoscopy. 2011;74(2):239-45.

LeBlanc JK, Ciaccia D, Al-Assi MT, McGrath K, Imperiale T, Tao LC, et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointestinal Endo. 2004;59(4):475-81. [PubMed]

Davenport R. Rapid on-site evaluation of transbronchial aspirates. Chest. 1990;98:59-61.

Shannon JJ, Bude RO, Orens JB, Becker FS, Whyte RI, Rubin JM, Quint LE, Martinez FJ. Endobronchial ultrasound-guided needle aspiration of mediastinal adenopathy. Am J Res Crit Care Med. 1996;153(4):1424-30.

Fassina A, Corradin M, Zardo D, Cappellesso R, Corbetti F, Fassan M. Role and accuracy of rapid on‐site evaluation of CT‐guided fine needle aspiration cytology of lung nodules. Cytopathol. 2011 Oct 1;22(5):306-12.

Collins BT, Murad FM, Wang JF, Bernadt CT. Rapid on-site evaluation for endoscopic ultrasound-guided fine-needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures. Cancer Cytopathol. 2013;121:518-24.

van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Annals Surg Oncol. 2006;13(1):31-5.

Erickson RA, Sayage-Rabie L, Beisnner S. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endos. 2000;51:185-190.

Schmidt RL, Witt BL, Lopez-Calderon LE, Layfield LJ. The influence of rapid onsite evaluation on the adequacy rate of fine-needle aspiration cytology: a systematic review and meta-analysis. Am J Clin Pathol. 2013 Mar 1;139(3):300-8 .

Bang JY, Magee SH, Ramesh J, Trevino JM, Varadarajulu S. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endos. 2013;45(6):445.

Devereaux BM, LeBlanc JK, Yousif E, Kesler K, Brooks J, Mathur P, et al. Clinical utility of EUS-guided fine-needle aspiration of mediastinal masses in the absence of known pulmonary malignancy. Gastrointestinal endoscopy. 2002;56(3):397-401.

Fritscher-Ravens A, Soehendra N, Sriram PV, Schirrow L, Meyer A, Hauber HP, et al. Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer. Chest. 2000 Feb 1;117(2):339-45.

Puri R, Vilmann P, Sud R, Kumar M, Taneja S, Verma K, et al. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy. Endoscopy. 2010 Jun;42(06):462-7.

Banerjee S, Shen B, Baron TH, Nelson DB, Anderson MA, Cash BD, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointestinal endoscopy. 2008;67(6):791-8.

Guarner-Argente C, Shah P, Buchner A, Ahmad NA, Kochman ML, Ginsberg GG. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointestinal endoscopy. 2011 Jul 1;74(1):81-6.

Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, et al. Complications of upper GI endoscopy. Gastrointest Endos. 2002;55:784-93.

Eloubeidi MA, Tamhane A, Lopes TL, Morgan DE, Cerfolio RJ. Cervical esophageal perforations at the time of endoscopic ultrasound: a prospective evaluation of frequency, outcomes, and patient management. Am J Gastroenterol. 2009;104(1):53.

Downloads

Published

2018-08-25

How to Cite

S., M., Venkatakrishnan, L., & R., V. A. (2018). Unveiling mediastinal pathology: role of EUS guided fine needle aspiration in diagnosing mediastinal lesions. International Journal of Research in Medical Sciences, 6(9), 2952–2957. https://doi.org/10.18203/2320-6012.ijrms20183417

Issue

Section

Original Research Articles