Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration

Abstract

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) seems to be a powerful tool to obtain cytologic specimens from mediastinal and celiac lymph nodes, enlarged left adrenal glands, and intrapulmonary tumors with mediastinal extension. The diagnostic yield of EUS-FNA and the accuracy of cytologic specimens was evaluated.

Methods: Cytologic assessment of EUS-FNA specimens was performed and specimens were classified as positive, negative, suspicious for malignancy, or unsatisfactory for diagnosis. Cytology was compared with histologic and clinical (> or = 6 months) follow-up.

Results: Cytologic specimens were collected from 155 lymph nodes, 10 left adrenal glands, and 9 intrapulmonary tumor masses. For lymph nodes, the diagnostic yield was 0.65. After exclusion of unsatisfactory specimens, sensitivity, specificity, accuracy, and positive (PPV) and negative (NPV) predictive values of cytologic specimens were 0.92, 1.00, 0.93, 1.00, and 0.63, respectively. Subgroup analysis of lymph nodes with a dimension of > or = 10 mm showed similar results. With EUS imaging only, lymph node diameter and a round or irregular shape were significant predictors of malignancy at multiple logistic regression analysis, but their clinical usefulness is very limited (PPV = 0.78 and NPV = 0.45). For left adrenal gland specimens, sensitivity and specificity were 0.89 and 1.00, respectively. From intrapulmonary masses, 8 true-positive and 1 true-negative specimens were obtained.

Conclusions: Cytologic specimens from mediastinal or celiac lymph nodes obtained with EUS-FNA were reliable and accurate. Specimens from left adrenal glands and intrapulmonary tumor masses showed promising results.