PURPOSE: The purpose of this study is to report the pathologic outcome of patients with previous malignancy and mediastinal adenopathy. Endobronchial Ultrasound (EBUS)-guided biopsy can be done with minimal risk and excellent diagnostic accuracy.
METHODS: This is a single-institution, retrospective review of all patients who underwent EBUS for mediastinal adenopathy between 2008 and 2010, identified by billing and equipment codes. Descriptive statistics were used to characterize this population.
RESULTS: We identified 77 (39.3%) patients with a previous malignancy out of 196 total patients receiving EBUS. Of the patients with previous malignancy, 11 (14.3%) had only prior lung cancer, 52 (67.5%) had only one extrathoracic malignancy, and 14 (18.2%) had multiple previous malignancies. Five of the patients with multiple previous malignancies had lung cancer as one of their diagnoses. Of the 77 patients with a previous malignancy, 42 (54.5%) were diagnosed with a malignancy, 33 (42.9%) with benign pathology, and 2 (2.3%) with inadequate samples. Of the 16 patients with previous lung cancer, 8 (50.0%) were diagnosed with recurrent lung cancer. Of the 61 patients with extrathoracic malignancy, 35 (57.4%) were diagnosed with malignancy and 19 (54.3%) with a new lung malignancy. In a logistic regression model, time since previous cancer diagnosis was associated with decreased odds of lung cancer, but this was not statistically significant (OR= 0.60 95% CI(0.34, 1.07) p= 0.087). The average time between previous cancer diagnosis and presentation was 63.6 months, the median was 24 months, and the standard deviation was 84.6 months.
CONCLUSIONS: In patients with a previous malignancy, mediastinal adenopathy is nonspecific. EBUS provides evaluation of mediastinal adenopathy by discerning benign, recurrent metastasis, and new lung cancer pathology. Lung cancer is the most common diagnosis, even in the setting of a previous extrathoracic malignancy.
CLINICAL IMPLICATIONS: Surveillance CT scans of the chest following previous malignancy will often reveal mediastinal adenopathy. EBUS should be investigated as the best modality for obtaining a tissue diagnosis.
DISCLOSURE: The following authors have nothing to disclose: B. Payne Stanifer, Konstantin Dragnev, Peter Delong, Lisa Tilluckdharry, James Rigas, Anne McGowan, Piroska Kopar, William Nugent, Cherie Erkmen
No Product/Research Disclosure Information