Trans-esophageal endoscopic ultrasound guided fine needle aspiration: A minimally invasive method for tissue sampling of mediastinal lymph nodes in thoracic malignancies

Purpose: To report the utility and safety of trans-esophageal endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) for tissue diagnosis of mediastinal lymph nodes. Methods: Five patients (1=non small cell lung Ca, 1=breast Ca, 1=prostate Ca, 1=mediastinal adenopathy of ? origin, 1=squamous cell esophageal Ca) underwent EUS evaluation with radial and linear scanning echoendoscope at 7.5 MegaHertz after conscious sedation with intravenous diazepam and meperidine. Four of 5 patients had lymph nodes (LNs) in the subcarina or A-P window by CT Scan. Trans-esophageal fine needle aspiration of LNs in the subcarina or the A-P window was performed under real time ultrasound guidance. Two to 6 passes were made. There were no complications. Results: EUS guided lymph node FNA revealed metastatic squamous cell esophageal Ca in 1 patient and metastatic prostatic adenoca in another. The other 3 patients had a benign LN aspirate. Conclusion: EUS guided transesophageal FNA is a safe, minimally invasive technique to sample mediastinal LNs. Clinical Implications: EUS guided FNA of mediastinal LNs can play a significant role in staging thoracic malignancies e.g. lung Ca, esophageal Ca. A positive FNA for malignancy can avert more invasive procedures such as mediastinoscopy or surgery. We continue to perform this technique and study its clinical utility.