Introduction: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has proven to be helpful in obtaining tissue samples from enlarged mediastinal and intra-abdominal lymph nodes. This is especially beneficial in the diagnosis and staging of malignancy. We retrospectively reviewed the clinical utility of this method at a tertiary care cancer hospital in Pakistan. Patients and Methods: The medical records of 183 consecutive patients referred to the gastroenterology service from August 2008 to March 2012 were reviewed in this retrospective study. The mean age of the patients at presentation was 46.7 years (range 6-87; 62% males); 119 patients had mediastinal and 64 had intra-abdominal lymphadenopathy. Major indications for referral were diagnosis of lymphadenopathy of unknown origin detected on CT scan or PET-CT, to exclude lymph node metastasis in patients with a known primary tumor and to rule out relapse of lymphoma following treatment or during follow-up. Rapid on-site evaluation (ROSE) was performed in all patients to confirm the adequacy of sampling, followed by definitive cytopathological evaluation. Results: EUS-FNA with ROSE obtained adequate tissue for cytology in 97.3% of the patients in this cohort. These results were further confirmed on final cytopathological analysis in 96.2% of patients. Two patients (1.1%) had inadequate specimens for final interpretation (97.3 vs. 96.2; p = 0.001). Clinical utility was 95% for mediastinal lymphadenopathy and 98.4% for intra-abdominal lymphadenopathy. Only 1 patient had a serious complication requiring hospitalization and this was successfully managed conservatively. Conclusion: EUS-FNA is safe and has a high clinical utility in diagnosing unexplained mediastinal and intra-abdominal lymphadenopathy.

Keywords:
Endoscopic ultrasound-guided fine-needle aspiration cytology, Clinical utility, Mediastinal and intra-abdominal lymphadenopathy, Rapid on-site evaluation
1.
Hussain T, Salamat A, Farooq MA, Hassan F, Hafeez M: Indications for endoscopic ultrasound and diagnosis on fine-needle aspiration and cytology. J Coll Physicians Surg Pak 2009;19:223-227.
2.
Nakahara O, Yamao K, Bhatia V, Sawaki A, Mizuno N, Takagi T, et al: Usefulness of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for undiagnosed intra-abdominal lymphadenopathy. Gastroenterology 2009;44:562-567.
3.
Larsen S, Vilmann P, Krasnik M, Dirksen A, Clementsen P, Skov G, et al: Comparison of endoscopic ultrasound guided biopsy and positron emission tomography with integrated computed tomography in lung cancer staging. Curr Sci J 2009;35:7-13.
4.
Vilmann P, Larsen SS: Endoscopic ultrasound-guided biopsy in the chest: little to lose, much to gain. Eur Respir J 2005;25:400-401.
5.
Yusuf A, Khalid SR, Ahmed Q, Faruqui ZS: Endoscopic ultrasound guided biopsy of mediastinal mass. J Ayub Med Coll Abbottabad 2004;16:72-73.
6.
Puri R, Mangla R, Eloubeidi M, Vilmann P, Thandassery R, Sud R: Diagnostic yield of EUS-guided FNA and cytology in suspected tubercular intra-abdominal lymphadenopathy. Gastrointest Endosc 2012;75:1005-1010.
7.
Wildi SM, Judson MA, Fraig M, Fickling WE, Schmulewitz N, Varadarajulu S, et al: Is endosonographer guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think? Thorax 2004;59:794-799.
8.
Yasuda I, Tsurumi H, Omar S, Iwashita T, Kojima Y, Yamada T, et al: Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin. Endoscopy 2006;38:919-924.
9.
Moehler M, Voigt J, Kastor M, Heil M, Sengespeick C, Biesterfeld S, Dippold W, Kanzler S, Galle PR: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) as primary diagnostic tool for unclear lesions in the upper gastrointestinal tract. Dtsch Med Wochenschr 2011;136:303-308.
10.
Fernández-Esparrach G, Pellisé M, Solé M, Belda J, Sendino O, Llach J, et al: Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions. Arch Bronconeumol 2007;43:219-224.
11.
Kramer H, Sanders J: Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration. Cancer Cytopathol 2006;108:206-211.
12.
Devereaux BM, LeBlanc JK, Yousif E, et al: Clinical utility of EUS-guided fine-needle aspiration of mediastinal masses in the absence of known pulmonary malignancy. Gastrointest Endosc 2002;56:397-401.
13.
Mamoon N, Mushtaq S, Rathore MU: Endoscopic ultrasound guided aspiration cytolo- gy - a useful diagnostic tool. J Pak Med Assoc 2011;61:367-371.
14.
Eloubeidi MA, Tamhane A, Jhala N, Chhieng D, Jhala D, Crowe DR, Eltoum IA: Agreement between rapid onsite and final cytologic interpretations of EUS-guided FNA specimens: implications for the endosonographer and patient management. Am J Gastroenterol 2006;101:2841-2847.
15.
Jhala D, Eloubeidi M, Chhieng D, et al: Accuracy of preliminary malignant diagnosis on endoscopic ultrasound guided fine needle aspiration: analysis of 120 cases. Acta Cytol 2001;45:859.
16.
Zwischenberger JB, van Sonnenberg E, Alpard SK, Goodacre BW: Interventional radiology in the chest; in Yim AP, et al (eds): Minimal Access Cardiothoracic Surgery. Philadelphia, Saunders, 2000, pp 388-397.
17.
Zwischenberger JB, Savage C, Alpard SK, Carryn M, et al: Mediastinal transthoracic needle and core lymph node biopsy - should it replace mediastinoscopy? Chest 2002;121:1165-1170.
18.
Serna DL, Aryan HE, Chang KJ, Brenner M, Tran LM, Chen JC: An early comparison between endoscopic ultrasound-guided fine-needle aspiration and mediastinoscopy for diagnosis of mediastinal malignancy. Am Surg 1998;64:1014-1018.
19.
Aabakken L, Silvestri GA, Hawes R, Reed CE, Marsi V, Hoffman B: Cost-efficacy of endoscopic ultrasonography with fine-needle aspiration vs mediastinoscopy in patients with lung cancer and suspected mediastinal adenopathy. Endoscopy 1999;31:707-711.
20.
Annema JT, Versteegh MI, Veseliç M, Lutz W, et al: Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer. JAMA 2005;294:931-936.
21.
Imazu H, Uchiyama Y, Kakutani H, Ikeda K, Sumiyama K, Kaise M, et al: A prospective comparison of EUS-guided FNA using 25-gauge and 22-gauge needles. Gastroenterol Res Pract 2009;2009:546390.
22.
Dhir V, Mathew P, Bhandari S, Bapat M, Kwek A, Doctor V, Maydeo A: Endosonography-guided fine needle aspiration cytology of intra-abdominal lymph nodes with unknown primary in a tuberculosis endemic region. J Gastroenterol Hepatol 2011;26:1721-1724.
23.
Srinivasan R, Bhutani MS, Thosani N, Săftoiu A, Rice DC, et al: Clinical impact of EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer or mediastinal lymph nodes of unknown etiology. J Gastrointestin Liver Dis 2012;21:145-152.
24.
Caddy G, Conron M, Wright M, Desmond M, Hart D, Chen RY: The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC. Eur Respir J 2005;25:410-415.
25.
Caraway NP: Strategies to diagnose lymphoproliferative disorders by fine-needle aspiration by using ancillary studies. Cancer 2005;105:432-442.
26.
Sun W, Caraway NP, Zhang HZ, Khanna A, Payne LG, Katz RL: Grading follicular lymphoma on fine needle aspiration specimens. Comparison with proliferative index by DNA image analysis and Ki-67 labeling index. Acta Cytol 2004;48:119-126.
27.
Ribeiro A, Vazquez-Sequeiros E, Wiersema LM, Wang KK, Clain JE, Wiersema MJ: EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma. Gastrointest Endosc 2001;53:485-491.
28.
Mehra M, Tamhane A, Eloubeidi MA: EUS-guided FNA combined with flow cytometry in the diagnoses of suspected or recurrent intrathoracic or retroperitoneal lymphoma. Gastrointest Endosc 2005;62:508-513.
29.
Wittmann J, Kocjan G, Sgouros SN, Deheragoda M, Pereira SP: Endoscopic ultrasound-guided tissue sampling by combined fine needle aspiration and trucut needle biopsy: a prospective study. Cytopathology 2006;17:27-33.
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