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Multicenter Study
. 2010 Sep;24(9):2260-7.
doi: 10.1007/s00464-010-0946-9. Epub 2010 Feb 23.

Performance of EUS-FNA for mediastinal lymphadenopathy: impact on patient management and costs in low-volume EUS centers

Meike M C Hirdes  1 , Matthijs P Schwartz, Kristien M A J Tytgat, Noël J Schlösser, Daisy M D S Sie-Go, Menno A Brink, Bas Oldenburg, Peter D Siersema, Frank P Vleggaar
Affiliations
Multicenter Study

Performance of EUS-FNA for mediastinal lymphadenopathy: impact on patient management and costs in low-volume EUS centers

Meike M C Hirdes et al. Surg Endosc. 2010 Sep.

Abstract

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of mediastinal lymphadenopathy has been shown to be a valuable diagnostic tool in high-volume EUS centers (≥ 50 mediastinal EUS-FNA/endoscopist/year). Our goal was to assess the diagnostic accuracy of EUS-FNA and its impact on clinical management and costs in low-volume EUS centers (<50 mediastinal EUS-FNA/endoscopist/year).

Methods: Consecutive patients referred to two Dutch endoscopy centers in the period 2002-2008 for EUS-FNA of mediastinal lymphadenopathy were reviewed. The gold standard for a cytological diagnosis was histological confirmation or clinical follow-up of more than 6 months with repeat imaging. The impact of EUS-FNA on clinical management was subdivided into a positive impact by providing (1) adequate cytology that influenced the decision to perform surgery or (2) a diagnosis of a benign inflammatory disorder, and a negative impact which was subdivided into (1) false-negative or inconclusive cytology or (2) an adequate cytological diagnosis that did not influence patient management. Costs of an alternative diagnostic work-up without EUS-FNA, as established by an expert panel, were compared to costs of the actual work-up.

Results: In total, 213 patients (71% male, median age= 61 years, range = 23-88 years) underwent EUS-FNA. Sensitivity, specificity, and negative and positive predictive values were 89%, 100%, 80%, and 100%, respectively. EUS-FNA had a positive impact on clinical management in 84% of cases by either influencing the decision to perform surgery (49%) or excluding malignant lymphadenopathy (35%), and a negative impact in 7% of cases because of inadequate (3%) or false-negative (4%) cytology. In 9% of cases, EUS-FNA was performed without an established indication. Two nonfatal perforations occurred (0.9%). Total cost reduction was €100,593, with a mean cost reduction of €472 (SD = €607) per patient.

Conclusions: Mediastinal EUS-FNA can be performed in low-volume EUS centers without compromising diagnostic accuracy. Moreover, EUS-FNA plays an important role in the management of patients with mediastinal lymphadenopathy and reduces total diagnostic costs.

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Figures

Fig. 1
Fig. 1
Flowchart of all EUS-FNA procedures for mediastinal lymphadenopathy and their reference standards
See this image and copyright information in PMC

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References

    1. Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) Chest. 2007;132:202S–220S. doi: 10.1378/chest.07-1362. - DOI - PubMed
    1. Williams DB, Sahai AV, Aabakken L, Penman ID, van Velse VA, Webb J, Wilson M, Hoffman BJ, Hawes RH. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut. 1999;44:720–726. doi: 10.1136/gut.44.5.720. - DOI - PMC - PubMed
    1. Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997;112:1087–1095. doi: 10.1016/S0016-5085(97)70164-1. - DOI - PubMed
    1. Fritscher-Ravens A, Sriram PV, Bobrowski C, Pforte A, Topalidis T, Krause C, Jaeckle S, Thonke F, Soehendra N. Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients. Am J Gastroenterol. 2000;95:2278–2284. doi: 10.1111/j.1572-0241.2000.02243.x. - DOI - PubMed
    1. Catalano MF, Nayar R, Gress F, Scheiman J, Wassef W, Rosenblatt ML, Kochman M. EUS-guided fine needle aspiration in mediastinal lymphadenopathy of unknown etiology. Gastrointest Endosc. 2002;55:863–869. doi: 10.1067/mge.2002.124637. - DOI - PubMed

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