Clin Endosc.  2019 Mar;52(2):152-158. 10.5946/ce.2018.125.

Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration

• Fujii Y
• Kanno Y
• Koshita S
• Ogawa T
• Kusunose H
• Masu K
• Sakai T
• Yonamine K
• Kawakami Y
• Murabayashi T
• Kozakai F
• Noda Y
• Okada H
• Ito K

• KMID: 2447672
• DOI: http://doi.org/10.5946/ce.2018.125

Abstract

BACKGROUND/AIMS
This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation.
METHODS
Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others.
RESULTS
The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15-124; p=0.0015).
CONCLUSIONS
The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.

Keyword

Lymphadenopathy; Accuracy; Endosonography; Risk factors; Lymphoma

MeSH Terms

Diagnosis*
Endoscopic Ultrasound-Guided Fine Needle Aspiration*
Endosonography
Humans
Lymph Nodes*
Lymphatic Diseases
Lymphoma
Multivariate Analysis
Needles
Prospective Studies
Punctures
Retrospective Studies
Risk Factors
Sensitivity and Specificity

Figure

• 

  Fig. 1. The receiver operating characteristic (ROC) curve showing the relationship between lymph node size and the diagnostic yields of endoscopic ultrasound-guided fine needle aspiration for lymph nodes. Area under the ROC curve=0.76.

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