Endoscopic ultrasound with fine needle aspiration in the diagnosis of thoracic neoplasms

Leonard C. Moses, W. Wassef, W. Brewer, J. Stasney, A. Zfass

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Endoscopic ultrasound (EUS) has been used to stage gastrointestinal tumors, including cancers of the esophagus, stomach, pancreas and rectum. The technology has only recently been used for other thoracic malignancies. Endosonographic-guided fine needle aspiration can be used to successfully identify and sample mediastinal lymph nodes (paratracheal, aorta-pulmonary, subcarinal, and paraesophageal) and masses under direct visualization. METHOD: Patients with known or suspected thoracic malignancies and radiographic evidence of mediastinal disease were referred for evaluation. Esophageal EUS was performed using a linear array Pentax endoscope. Suspicious lymph nodes (>1cm) or mediastinal masses were identified by sonography and sampled under direct visualization using a 22 gauge needle. RESULTS: Two patients were successfully evaluated with EUS-guided FNA. One patient previously treated for esophageal carcinoma (XRT/chemotherapy) presented with a new pleural effusion and mediastinal adenopathy. Thoracentesis was non-diagnostic. EUS-guided FNA of the aortoesophageal lymph node revealed squamous cell carcinoma, metastatic from the esophagus. The second patient had a new left hilar mass with subcarinal adenopathy and a left effusion. Bronchoscopic brushings, biopsies, and transbronchial needle aspirations (TBNA) were non-diagnostic. Pleural fluid was also non-diagnostic. EUS-guided FNA of the subcarinal mass revealed undifferentiated carcinoma. In both cases, no procedural complications were observed. CONCLUSIONS: Endosonographic-guided fine needle aspiration is a safe and effective way to stage and diagnose thoracic malignancies with presumed mediastinal involvement. Further testing is needed to determine the sensitivity and specificity of this modality, compared with other established modalities such as TBNA. CLINICAL IMPLICATIONS: EUS-guided FNA may be an effective tool in the non-surgical staging of the mediastinum and may yield positive results when other modalities are non-diagnostic.

Original languageEnglish (US)
Pages (from-to)97S
JournalCHEST
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1996
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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