J Korean Med Sci.  2011 Feb;26(2):274-278. 10.3346/jkms.2011.26.2.274.

Endobronchial Ultrasound-guided Transbronchial Needle Biopsy for Diagnosis of Mediastinal Lymphadenopathy in Patients with Extrathoracic Malignancy

• Park J
• Jang SJ
• Park YS
• Oh YM
• Shim TS
• Kim WS
• Choi CM

• KMID: 1782118
• DOI: http://doi.org/10.3346/jkms.2011.26.2.274

Abstract

Mediastinal lymphadenopathy associated with extrathoracic malignancy or a metastasis of unknown origin (MUO) requires pathological verification. Surgical exploration or endoscopic ultrasound-guided fine needle aspiration is limited to application. We investigated the effectiveness of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) for evaluating mediastinal lymphadenopathy in patients with an extrathoracic malignancy. We retrospectively analyzed data from 59 patients who underwent EBUS-TBNA with a core biopsy because of a suspected mediastinal metastasis between September 2008 and August 2010. All patients had previously been diagnosed with an extrathoracic malignancy (n = 39, 66.1%) or a suspected MUO without a thoracic lesion (n = 20, 33.9%). A total of 88 lymph nodes was analyzed. EBUS-TBNA findings indicated malignancies in 34 patients (57.6%). The EBUS-TBNA sensitivity and specificity for the detection of mediastinal malignancy in patients with a previous extrathoracic malignancy were 96.3% and 100%, respectively. For MUO patients without a thoracic lesion, the sensitivity and specificity were 61.5% and 100%, respectively. The overall sensitivity and specificity were 81.0% and 100%, respectively (P = 0.053). EBUS-TBNA is a safe and effective modality for evaluating mediastinal lymphadenopathy in patients with a previous extrathoracic malignancy or a MUO without a thoracic lesion. The application of this diagnostic tool is likely to have significant clinical implications.

Keyword

EBUS; Extrathoracic Malignancy; Mediastinal Adenopathy; Metastatic Cancer of Unknown Primary Site; MUO

MeSH Terms

Adult
Aged
Aged, 80 and over
Biopsy, Needle/*methods
Endosonography/*methods
Humans
Lymph Nodes/pathology/ultrasonography
*Lymphatic Diseases/diagnosis/surgery/ultrasonography
*Lymphatic Metastasis/diagnosis/pathology
Male
*Mediastinal Neoplasms/diagnosis/surgery/ultrasonography
Middle Aged
Neoplasms/*pathology
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 Histologic finding on EBUS-TBNA sample using tissue specific immunohistochemical stains. (A) Histologic findings breast cancer (H&E stain, × 100) with (a) positive ER stains (× 200), (B) hepatocelluar carcinoma (H&E stain, ×200) with (b) positive CK stain (×400), (C) malignant melanoma including brownish pigments (H&E stain, × 200) with (c) positive S100 stains (× 400), and (D) renal cell carcinoma cells (H&E stain, × 100) with (d) positive CD10 stains (× 200). EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration.

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