AN EARLY COMPARISON BETWEEN ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION AND MEDIASTINOSCOPY FOR DIAGNOSIS OF MEDIASTINAL MALIGNANCY

Precise mediastinal lymph node staging is essential in non-small cell lung cancer for proper evaluation and treatment. In addition to CT, me diastinoscopy is routinely used for staging and diagnosis of mediastin al malignancy. Recently, endoscopic ultrasound (EUS) combined with fin e-needle aspiration (FNA) biopsy has been used to evaluate mediastinal disease. The purpose of this study was to assess and compare mediasti noscopy with EUS/FNA in the evaluation of mediastinal masses. From Aug ust 1995 to July 1997, 21 patients with suspected mediastinal malignan cy underwent cervical mediastinoscopy with biopsy. During this same pe riod, seven patients with suspected mediastinal malignancy were evalua ted using EUS/FNA. All patients were retrospectively studied. Both med iastinoscopy and EUS/FNA were highly sensitive in diagnosing mediastin al malignancy (100% and 86%, respectively). Specificity and positive p redictive value were 100 per cent for both procedures. Mediastinoscopy and EUS/FNA are highly accurate methods of staging mediastinal malign ancy. Mediastinoscopy provides better access to the upper and anterior mediastinum, whereas EUS/FNA can safely be used to biopsy subcarinal and posterior mediastinal masses. Mediastinoscopy and EUS/FNA target d ifferent areas of the mediastinum and maybe complimentary in the evalu ation of mediastinal malignancy and staging of bronchogenic carcinoma.