Introduction EUS-FNA allows access to the posterior mediastinum and tissue acquisition under real-time ultrasound guidance through the oesophageal wall. There is ample evidence for effectiveness of EUS-FNA in staging lung cancer but data on its utility in the diagnostic work up of sarcoidosis is limited. The aim of this study was to report our experience of mediastinal EUS-FNA as a whole and its diagnostic yield in sarcoidosis in particular.
Methods The study included all patients who underwent mediastinal EUS-FNA in our institution from January 2008 to December 2011. Data on patient demographics, mediastinal lesion characteristics and EUS-FNA details were collected from endoscopy reports. Cytology reports and microbiology culture results were analysed. Final clinical diagnoses made during the follow-up were obtained from medical records. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mediastinal EUS-FNA for individual diagnoses.
Results 195 patients (n=195, males 65%, mean age 58.6) underwent mediastinal EUS-FNA during the study period. Mean size of the lesions was 15.82 mm (range 3.9–43) in short axis and 28.23 mm (range 8–60) in long axis. Sub-carinal lymph nodes (LN) were the commonest (145/195, 70.3%) target lesions. Mean number of needle pass was 3.18 (range 1–6) and 22G (53.5%) was the commonest needle used. There were no procedure related complications or deaths. Of the 195 patients, FNAs were positive for malignancy in 61 (61/195, 31.2%), sarcoidosis in 40 (20.5%) and tuberculosis (TB) in 15 (7.6%) patients. Of the 64 (31.7%) cases where FNA was reported normal, 42 (65.6%) were accurate and 22 (34.3%) were inaccurate (final diagnosis: 8 cancer, 9 sarcoidosis and 5 TB). In 4 (2%) patients, FNA showed other diagnoses (3 anthracotic LNs, 1 sinus histiocytosis). Abstract PWE-221 table 1 Overall and condition specific results of mediastinal EUS-FNA.
Conclusion Our large series on mediastinal EUS-FNA shows that it is an important and useful tool for the assessment of mediastinal lymphadenopathy of unknown aetiology and has overall high sensitivity (≈80%) and high specificity (≈94%). For sarcoidosis in particular, sensitivity (≈83%) and specificity (≈99%) of EUS-FNA is comparable to those for cancer.
Competing interests None declared.