Mediastinal lymphadenopathy in patients with or without previous malignancy

EUS-FNA-based differential cytodiagnosis in 153 patients

A. Fritscher-Ravens, Sreeram Parupudi, C. Bobrowski, A. Pforte, T. Topalidis, C. Krause, S. Jaeckle, F. Thonke, N. Soehendra

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. The investigation of choice is thoracic CT with a variable sensitivity and specificity requiring tissue diagnosis. We used endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for cytodiagnosis of ML in patients with and without previous malignancy. The cause, distribution of lesions, and incidence of second cancers were investigated. METHODS: Linear echoendoscopes and 22-gauge needles for cytology were used for EUS-FNA. A cytological diagnosis of malignancy was accepted, and histology or consistent follow-up of at least 9 months confirmed benign results. RESULTS: One hundred fifty-three patients underwent EUS-FNA between November 1997 and November 1999 (mean age, 60 yr; range, 13-82 yr; 105 men). Cytology was adequate in 150 patients. Final diagnosis was malignancy in 84 and benign in 66 patients (sensitivity, specificity, and diagnostic accuracy: 92%, 100%, 95%, respectively). In 101 patients without previous cancer cytology identified 48 malignant (lung, 41; extrathoracic, 7) and 51 benign lesions (inflammation, 35; various, 9; sarcoidosis, 7) (sensitivity, specificity, accuracy: 88%, 100%, 94%). Fifty-two patients had prior malignancy, mostly in extrathoracic sites. Cytology revealed recurrences in 21 patients, second cancer in 9 and benign lesions in 21 patients (inflammatory, 11; sarcoidosis, 8; tuberculosis, 1; abscess, 1) (sensitivity, specificity, accuracy: 97%, 100%, 98%). CONCLUSIONS: In patients without previous cancer malignant ML originates from the lung >80%. In those with previous malignancy recurrence of extrathoracic sites is the major cause. Benign lesions and treatable second cancers occur in a significant frequency, emphasizing the need for tissue diagnosis. EUS-FNA is a safe and minimally invasive alternative for cytodiagnosis in the mediastinum. (C) 2000 by Am. Coll. of Gastroenterology.

Original languageEnglish (US)
Pages (from-to)2278-2284
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume95
Issue number9
DOIs
StatePublished - 2000
Externally publishedYes

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Cytodiagnosis
Neoplasms
Cell Biology
Second Primary Neoplasms
Sensitivity and Specificity
Sarcoidosis
Mediastinal Neoplasms
Lymphadenopathy
Recurrence
Lung
Mediastinum
Gastroenterology
Abscess
Needles
Histology
Tuberculosis
Thorax

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Mediastinal lymphadenopathy in patients with or without previous malignancy : EUS-FNA-based differential cytodiagnosis in 153 patients. / Fritscher-Ravens, A.; Parupudi, Sreeram; Bobrowski, C.; Pforte, A.; Topalidis, T.; Krause, C.; Jaeckle, S.; Thonke, F.; Soehendra, N.

In: American Journal of Gastroenterology, Vol. 95, No. 9, 2000, p. 2278-2284.

Research output: Contribution to journalArticle

Fritscher-Ravens, A. ; Parupudi, Sreeram ; 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. In: American Journal of Gastroenterology. 2000 ; Vol. 95, No. 9. pp. 2278-2284.
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abstract = "OBJECTIVE: Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. The investigation of choice is thoracic CT with a variable sensitivity and specificity requiring tissue diagnosis. We used endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for cytodiagnosis of ML in patients with and without previous malignancy. The cause, distribution of lesions, and incidence of second cancers were investigated. METHODS: Linear echoendoscopes and 22-gauge needles for cytology were used for EUS-FNA. A cytological diagnosis of malignancy was accepted, and histology or consistent follow-up of at least 9 months confirmed benign results. RESULTS: One hundred fifty-three patients underwent EUS-FNA between November 1997 and November 1999 (mean age, 60 yr; range, 13-82 yr; 105 men). Cytology was adequate in 150 patients. Final diagnosis was malignancy in 84 and benign in 66 patients (sensitivity, specificity, and diagnostic accuracy: 92{\%}, 100{\%}, 95{\%}, respectively). In 101 patients without previous cancer cytology identified 48 malignant (lung, 41; extrathoracic, 7) and 51 benign lesions (inflammation, 35; various, 9; sarcoidosis, 7) (sensitivity, specificity, accuracy: 88{\%}, 100{\%}, 94{\%}). Fifty-two patients had prior malignancy, mostly in extrathoracic sites. Cytology revealed recurrences in 21 patients, second cancer in 9 and benign lesions in 21 patients (inflammatory, 11; sarcoidosis, 8; tuberculosis, 1; abscess, 1) (sensitivity, specificity, accuracy: 97{\%}, 100{\%}, 98{\%}). CONCLUSIONS: In patients without previous cancer malignant ML originates from the lung >80{\%}. In those with previous malignancy recurrence of extrathoracic sites is the major cause. Benign lesions and treatable second cancers occur in a significant frequency, emphasizing the need for tissue diagnosis. EUS-FNA is a safe and minimally invasive alternative for cytodiagnosis in the mediastinum. (C) 2000 by Am. Coll. of Gastroenterology.",
author = "A. Fritscher-Ravens and Sreeram Parupudi and C. Bobrowski and A. Pforte and T. Topalidis and C. Krause and S. Jaeckle and F. Thonke and N. Soehendra",
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TY - JOUR

T1 - Mediastinal lymphadenopathy in patients with or without previous malignancy

T2 - EUS-FNA-based differential cytodiagnosis in 153 patients

AU - Fritscher-Ravens, A.

AU - Parupudi, Sreeram

AU - Bobrowski, C.

AU - Pforte, A.

AU - Topalidis, T.

AU - Krause, C.

AU - Jaeckle, S.

AU - Thonke, F.

AU - Soehendra, N.

PY - 2000

Y1 - 2000

N2 - OBJECTIVE: Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. The investigation of choice is thoracic CT with a variable sensitivity and specificity requiring tissue diagnosis. We used endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for cytodiagnosis of ML in patients with and without previous malignancy. The cause, distribution of lesions, and incidence of second cancers were investigated. METHODS: Linear echoendoscopes and 22-gauge needles for cytology were used for EUS-FNA. A cytological diagnosis of malignancy was accepted, and histology or consistent follow-up of at least 9 months confirmed benign results. RESULTS: One hundred fifty-three patients underwent EUS-FNA between November 1997 and November 1999 (mean age, 60 yr; range, 13-82 yr; 105 men). Cytology was adequate in 150 patients. Final diagnosis was malignancy in 84 and benign in 66 patients (sensitivity, specificity, and diagnostic accuracy: 92%, 100%, 95%, respectively). In 101 patients without previous cancer cytology identified 48 malignant (lung, 41; extrathoracic, 7) and 51 benign lesions (inflammation, 35; various, 9; sarcoidosis, 7) (sensitivity, specificity, accuracy: 88%, 100%, 94%). Fifty-two patients had prior malignancy, mostly in extrathoracic sites. Cytology revealed recurrences in 21 patients, second cancer in 9 and benign lesions in 21 patients (inflammatory, 11; sarcoidosis, 8; tuberculosis, 1; abscess, 1) (sensitivity, specificity, accuracy: 97%, 100%, 98%). CONCLUSIONS: In patients without previous cancer malignant ML originates from the lung >80%. In those with previous malignancy recurrence of extrathoracic sites is the major cause. Benign lesions and treatable second cancers occur in a significant frequency, emphasizing the need for tissue diagnosis. EUS-FNA is a safe and minimally invasive alternative for cytodiagnosis in the mediastinum. (C) 2000 by Am. Coll. of Gastroenterology.

AB - OBJECTIVE: Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. The investigation of choice is thoracic CT with a variable sensitivity and specificity requiring tissue diagnosis. We used endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for cytodiagnosis of ML in patients with and without previous malignancy. The cause, distribution of lesions, and incidence of second cancers were investigated. METHODS: Linear echoendoscopes and 22-gauge needles for cytology were used for EUS-FNA. A cytological diagnosis of malignancy was accepted, and histology or consistent follow-up of at least 9 months confirmed benign results. RESULTS: One hundred fifty-three patients underwent EUS-FNA between November 1997 and November 1999 (mean age, 60 yr; range, 13-82 yr; 105 men). Cytology was adequate in 150 patients. Final diagnosis was malignancy in 84 and benign in 66 patients (sensitivity, specificity, and diagnostic accuracy: 92%, 100%, 95%, respectively). In 101 patients without previous cancer cytology identified 48 malignant (lung, 41; extrathoracic, 7) and 51 benign lesions (inflammation, 35; various, 9; sarcoidosis, 7) (sensitivity, specificity, accuracy: 88%, 100%, 94%). Fifty-two patients had prior malignancy, mostly in extrathoracic sites. Cytology revealed recurrences in 21 patients, second cancer in 9 and benign lesions in 21 patients (inflammatory, 11; sarcoidosis, 8; tuberculosis, 1; abscess, 1) (sensitivity, specificity, accuracy: 97%, 100%, 98%). CONCLUSIONS: In patients without previous cancer malignant ML originates from the lung >80%. In those with previous malignancy recurrence of extrathoracic sites is the major cause. Benign lesions and treatable second cancers occur in a significant frequency, emphasizing the need for tissue diagnosis. EUS-FNA is a safe and minimally invasive alternative for cytodiagnosis in the mediastinum. (C) 2000 by Am. Coll. of Gastroenterology.

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