Impact of EUS-guided fine needle aspiration on evaluating lymph nodes in gastrointestinal and lung cancer

W. Wassef, N. Fahmy, J. Beets, J. Stastny, K. Willis, A. Zfass

Research output: Contribution to journalArticlepeer-review


EUS-guided fine needle aspiration of lymph nodes is a safe technique. Its impact on the management of patients with gastrointestinal and lung cancer is yet to be fully elucidated. Methods: Patients with CT evidence of lymphadenopathy (in the presence of documented gastrointestinal cancer or suspected lung cancer) were studied via the linear array ultrasound endoscope (FG 32UA, Pentax, Orangeburg, N.Y.). The largest node in each patient was defined as the index node. Its size and homogeneity were recorded and it was subsequently aspirated using the GIP 22 gauge needle (Medi-Globe, Tempe, AZ). Passes were performed until the on-site cytopathologist identified infiltrating malignant cells in the lymph node, or a total of 5 passes with adequate cells had been obtained. The surgical pathology or the clinical follow-up of each index node was used to calculate the sensitivity, specificity, and accuracy of the technique. Patients were then followed to evaluate the safety of the technique and its impact on clinical management. Results: A total of 52 patients with lymphadenopathy were referred for evaluation. They were distributed as follows: esophageal gastric colorectal pancreatic lung sum benign 11 1 0 1 8 21 malignant 8 3 3 3 14 31 total 19 4 3 4 22 52 EUS guided fine needle aspiration correctly identified 29/31 malignant lymph nodes (sensitivity 93.5%) and 21/21 benign lymph nodes (specificity 100%) for an overall accuracy of 96%. Non invasive radiologic features such as nodal size and echo-features could not differentiate between the two types of nodes. There were no complications. The procedure impacted on the management of 23/52 patients (44%): 10 patients with documented gastrointestinal cancer were upstaged and had a change in their therapy as a result of the presence of malignancy in their nodes, and 13 patients with suspected lung cancer had tissue diagnosis as a result of this test which obviated the need for mediastinoscopy. Conclusions: EUS-guided fine needle aspiration of lymph nodes provides information crucial to the management of up to 44% of the patients with gastrointestinal and lung cancer.

Original languageEnglish (US)
Pages (from-to)AB156
JournalGastrointestinal endoscopy
Issue number4
StatePublished - 1998
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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