Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy

Several procedures are available for the cytopathological diagnosis of medi astinal lesions. The purpose of this study was to evaluate the diagnostic v alue of endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA ) in patients with mediastinal mass lesions/lymph node enlargement. All pat ients had intrapulmonary lesions on chest X ray and/or CT scan, and inconcl usive findings by endobronchial forceps biopsy and/or brush cytology. EUS-g uided FNA was performed in 16 patients using a modified oblique forward-vie wing gastroscope with an electronic multielement curved linear ultrasound t ransducer. After the region of interest was localized, a 22-gauge Vilmann-H ancke needle was introduced via the 2-mm biopsy channel. The cytological di agnosis of EUS-guided FNA was conclusive for cancer in 9 patients and in th e other 7 patients the aspirated samples revealed a benign lesion. In 10 pa tients the final diagnosis was cancer, thus EUS-guided FNA was diagnostic f or malignancy in all but 1 of the lesions (sensitivity 90.0%). In 1 patient epitheloid cell granuloma was detected by cytological examination of the F NA. Following tuberculostatic treatment the lesions disappeared completely on CT scan and EUS. The overall accuracy in this study amounted to 93.7%. F rom this and other studies discussed, it is assumed that the procedure is a n accurate and safe technique to examine nodular lesions suggestive of meta static lymph node involvement.