Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 28, 2009; 15(48): 6096-6101
Published online Dec 28, 2009. doi: 10.3748/wjg.15.6096
First endoscopic procedure for diagnosis and staging of mediastinal lymphadenopathy
Kay-Leong Khoo, Khek-Yu Ho, Christopher Jen-Lock Khor, Barbro Nilsson, Tow-Keang Lim
Kay-Leong Khoo, Khek-Yu Ho, Tow-Keang Lim, Department of Medicine, National University Health System, Singapore 119074, Singapore
Christopher Jen-Lock Khor, Department of Gastroenterology, National University Health System, Singapore 119074, Singapore
Barbro Nilsson, Department of Pathology, National University Health System, Singapore 119074, Singapore
Author contributions: Khoo KL, Ho KY and Khor CJL were involved with the endoscopic procedures; Nilsson B was involved in cytopathology of the specimens; Lim TK and Khoo KL designed the study and analyzed the data; Khoo KL wrote the manuscript, which has been reviewed by the co-authors.
Correspondence to: Dr. Kay-Leong Khoo, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Telephone: +65-67795555 Fax: +65-67794112
Received: August 31, 2009
Revised: October 5, 2009
Accepted: October 12, 2009
Published online: December 28, 2009

AIM: To compare a first diagnostic procedure of transbronchial needle aspiration (TBNA) with selection of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or TBNA for mediastinal lymphadenopathy.

METHODS: Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography (CT), who required cytopathological diagnosis, were recruited. The first 34 underwent a sequential approach in which TBNA was performed first, followed by EUS-FNA if TBNA was unrevealing. The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings.

RESULTS: The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%. In the selective approach, the diagnostic yield of the first procedure was 71%. There was no significant difference in the overall diagnostic yield, but there were significantly fewer combined procedures with the selective approach.

CONCLUSION: Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.

Keywords: Aspiration biopsy, Needle biopsy, Endoscopy, Ultrasound, Mediastinum, Lymphadenopathy, Lung neoplasms, Diagnosis, Neoplasms staging