Improved technique for performing endoscopic ultrasound guided fine needleaspiration of lymph nodes

Background and Study Aims: Trans-esophageal real-time endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as an important tech nique for sampling perigastrointestinal lymph nodes. The purpose of this st udy was to compare the yield of EUS-guided FNA of mediastinal lymph nodes u sing different techniques, Materials and Methods: A 2 cm mediastinal lymph node was dissected at autop sy, FNA was performed on this lymph node with a 21 gauge needle which is us ed clinically for EUS-guided FNA (GIP-Mediglobe), FNA of the lymph node was performed for 60 sec, while continuous or intermittent suction was applied with a 10 mi, 20 mi and 30 mi syringe, The pathologist was blinded to the technique used for FNA of the lymph node. The slides were examined and the results recorded independently by two pathologists who were blinded to each other's findings. A similar procedure was repeated in a 2 cm lymph node re moved during another autopsy Results: Pathologic examination revealed metastatic transitional cell bladd er carcinoma in the first lymph node, and metastatic non-small cell lung ca rcinoma in the second lymph node, The cellularity and quality of FNA perfor med with the 10 mi syringe was better than with the 20 mi or 30 mi syringe. With the 10 mi syringe, continuous suction for one minute provided a bette r sample than intermittent suction. FNA with a 20 mi or 30 ml syringe was m ore cumbersome, as it required more physical force, Conclusions: Our study reveals that continuous rather than intermittent suc tion with smaller syringes (5-10 mi) provides optimal cellularity in EUS-gu ided FNA of mediastinal lymph nodes and that use of larger (20-30 mi) syrin ges does not improve the rate of obtaining a diagnostic specimen.