Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration in the Management of Mediastinal Lymph Nodes in Patients with Suspicion of Lung Cancer: Can Surgical Procedures be Avoided?

Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) has been recently introduced in the routine evaluation of patients with mediastinal lymph nodes (LN) in the context of lung cancer. Data about the usefulness of this procedure in the management of these patients are limited. Aim: To evaluate the usefulness of EUS-guided FNA in the management of patients with mediastinal LN and suspicion of lung cancer, in terms of ability to avoid diagnostic or therapeutic surgical procedures. Methods: Patients referred to our EUS Unit for the study of mediastinal LN and with the suspicion of lung cancer, previously detected by CT scanning, were included. EUS and EUS-guided FNA were performed by two echoendoscopists using the lineal scanning Pentax FG-38UX. For puncture, 19G and 22G needles were used. All procedures were performed under conscious sedation with midazolam and meperidine. Vital signs were continuously monitored. Samples were processed for cytological and histological analysis. Further diagnostic or therapeutic surgical procedures were avoided in case of conclusive lung cancer LN metastasis, or conclusive benign nature of LN. Results: A total of 22 consecutive patients (20 male, mean age 55 years, range 41–80 years) were included. Cytological and histological analysis of the material obtained by EUS guided-FNA provided with a definite diagnosis, either benign or malignant, in 19 patients (86.4%) (13 patients with NSCLC lung cancer, 3 cases with SCL lung cancer, and one case of lymphoma; and three patients had benign LN); however, in 3 patients (13.6%) diagnosis was inconclusive. Sensitivity, specificity and overall accuracy were 84.2%, 100% and 86.4% respectively. EUS-guided FNA avoided a further surgical procedure in 22 cases (77.3%). There were no complications related to the technique. Conclusion: EUS-guided FNA is a safe and useful procedure for the evaluation of mediastinal LN in patients with suspicion of lung cancer. Inclusion of this procedure in the diagnostic workout of these patients avoids surgical procedures in up to three out of each four patients.