PURPOSE: The role of trans-esophageal ultrasound-fine needle aspiration (EUS-FNA) in the diagnosis and staging of thoracic malignancies has been described extensively in recent years. Reports on its role in patients without suspected or proven lung cancer are scarce. Using our EUS database, we sorted patients with benign cytology results to assess findings, subsequent clinical management by referring physicians and outcomes.
METHODS: All patients referred to our center for endoscopic ultrasound and fine needle aspiration of enlarged lymph nodes and mediastinal masses seen on CT between January 2001 and December 2005 and with benign cytology findings were eligible. We excluded patients referred for staging/diagnosis of lung cancer. The clinical outcome following FNA results was sought by review of patients’ charts from referring institutions. In patients in whom sufficient clinical data were available, we determined whether further investigation was performed and if the diagnosis was modified thereafter.
RESULTS: One hundred and fifteen (n=115) patients were eligible. Sufficient follow-up data from referring institutions were available in 62 patients. FNA results were consistent with the following diagnoses: sarcoidosis, reactive lymph nodes, infection, silicosis, and mediastinal cyst. One case initially diagnosed as small cell lung cancer was later found at mediastinoscopy to be a false positive. There was also one possible false negative (missed mediastinal metastases from colon cancer). No EUS-FNA related complications were observed in this series. Referring clinicians tended to rely on benign EUS cytology findings as justification for simple clinical and CT surveillance. Whenever deemed necessary, mediastinoscopy was undertaken but never revealed malignancy that was not diagnosed by EUS-FNA.
CONCLUSION: In patients without suspected of proven lung cancer, mediastinal EUS-FNA is a safe and useful tool.
CLINICAL IMPLICATIONS: Where available, EUS-FNA should be considered in patients with enlarged mediastinal lymph nodes or masses not apparently caused by lung cancer.
DISCLOSURE: Bich Nguyen, None.