Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy

PURPOSE: To evaluate the safety and accuracy of endoscopic ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the para tracheal, aortopulmonic, subcarinal, and posterior mediastinal regions. MATERIALS AND METHODS: Eighty-six consecutive patients with mediastinal lym phadenopathy who did not have a primary gastrointestinal neoplasm were exam ined. In 29 patients, endoscopic US-guided FNAB of mediastinal lymphadenopa thy was performed as a component of staging non-small cell lung cancer (NSC LC); in the remaining 57 patients, it was performed to obtain a primary dia gnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results. RESULTS: In 82 patients in whom a final diagnosis was available, the sensit ivity, specificity, accuracy, negative predictive value, and positive predi ctive value of endoscopic US-guided FNAB in distinguishing benign from mali gnant mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectiv ely. In those patients who underwent staging of NSCLC, endoscopic US-guided FNAB had superior mediastinal lymph node staging accuracy compared with en doscopic US alone (79%) and CT alone (79%) (P =.01). The results of endosco pic US-guided FNAB prompted a change to nonsurgical management in 66 (80%) of 82 patients who underwent the procedure. One minor complication, postpro cedural fever that resolved with oral antibiotics, occurred (1%; 95% Cl: 0% , 6%). CONCLUSION: Endoscopic US-guided FNAB is accurate and safe for biopsy of me diastinal lymph nodes to stage NSCLC, establish a primary diagnosis, or exa mine patients with prior inconclusive biopsy results.