Fabien Maldonado
Last active: 2/1/2016

Endobronchial ultrasound and lymphoproliferative disorders: a retrospective study.

Iqbal S, DePew ZS, Kurtin PJ, Sykes AM, Johnson GB, Edell ES, Habermann TM, Maldonado F
Ann Thorac Surg. 2012 94 (6): 1830-4

PMID: 23084417 · DOI:10.1016/j.athoracsur.2012.08.051

BACKGROUND - Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to have excellent diagnostic performance for mediastinal staging of lung cancer. The utility of EBUS-TBNA for the diagnosis of lymphoproliferative disorders involving the mediastinum or hila, or both, is unclear.

METHODS - A retrospective analysis was completed of all patients diagnosed with a lymphoproliferative disorder involving the mediastinum or hila, or both, who underwent an EBUS-TBNA within 3 months of the diagnosis.

RESULTS - Sixty-five patients with mediastinal or hilar lymph node, or both, involvement of their lymphoproliferative disorder underwent EBUS-TBNA within 3 months of their diagnosis. The initial EBUS-TBNA was nondiagnostic in 34 (52%), 11 were subsequently diagnosed by mediastinoscopy, and the remaining 23 were diagnosed by biopsy of a distant site, with involvement of the mediastinum or hilum assumed from preestablished radiographic criteria. A EBUS-TBNA specimen in 31 patients (48%) was interpreted as consistent with or suspicious for a lymphoproliferative disorder. The overall sensitivity of EBUS-TBNA for establishing a definitive diagnosis was 25 of 65 (38%). The sensitivity was lower for new patients, at 7 of 32 (22%), and better for patients with recurrence, at 18 of 33 (55%).

CONCLUSIONS - Contrary to previous studies, our findings suggest that EBUS-TBNA does not provide sufficient diagnostic material for accurate lymphoproliferative disorder subtyping in a significant number of patients and performs especially poorly when evaluating new patients. Mediastinoscopy should still be considered as the initial diagnostic procedure of choice when the clinical suspicion for a lymphoproliferative disorder is high, unless the patient is being evaluated for a recurrence of prior disorder.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

MeSH Terms (15)

Aged Biopsy, Fine-Needle Bronchoscopy Diagnosis, Differential Endosonography Female Humans Lymph Nodes Lymphoproliferative Disorders Male Mediastinum Middle Aged Reproducibility of Results Retrospective Studies ROC Curve

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