Diagnostic work-up of mediastinal lymph nodes by trans-oesophageal endoscopic ultrasound and fine-needle aspiration

Background: Trans-oesophageal endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is a diagnostic technique allowing direct sampling of posterior mediastinum lymph nodes under continuous visual control. Main indications of this technique include the diagnostic work-up of isolated enlarged mediastinal lymph nodes or mediastinal lymph nodes associated with intrapulmonary lesions of unknown histology.

Methods: Retrospective study of a series of consecutive patients who underwent EUS with FNA for diagnostic work-up of mediastinal lymph nodes in two department of respiratory diseases in northern France.

Results: Nineteen patients were studied. Twenty-nine lymph nodes in the 5, 7 and 8 (ATS classification) areas were sampled. Mean mediastinal lymph node size was 24.3 mm (4-50 mm). The diagnostic yield was 68.7%. The sensitivity and specificity for malignancy were 91.7% and 100% respectively. There were no complications.

Conclusions: Our study suggests that EUS with FNA is a safe and reliable diagnostic tool that could be incorporated into the diagnostic work-up of mediastinal lymphadenopathy.