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DOI: 10.1055/s-2006-944665
Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin
Publication History
Submitted 17 January 2006
Accepted after revision 11 June 2006
Publication Date:
18 September 2006 (online)
Background and study aims: The diagnosis of mediastinal and intra-abdominal lymphadenopathy is sometimes difficult,
especially in patients who have no other primary lesions. Lymphoma is one of the main
causes of this condition. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)
is a safe and accurate diagnostic procedure for lesions surrounding the gastrointestinal
tract. However, diagnosing lymphoma using the EUS-FNA technique remains a diagnostic
challenge, due to limitations in the amount of material sampled. The aim of the present
study was to evaluate the yield of EUS-FNA biopsy (EUS-FNAB) using a large-gauge needle
in patients with mediastinal and intra-abdominal lymphadenopathy of unknown origin,
especially in relation to subclassification of the lymphomas.
Patients and methods: Consecutive patients with mediastinal and intra-abdominal lymphadenopathy of unknown
origin who were referred between October 2003 and March 2005 were enrolled in the
study. EUS-FNAB was carried out using a 19-gauge needle, passing through the esophageal,
gastric, and duodenal walls. Pathological diagnoses were made on the basis of histological
findings, including immunopathological staining.
Results: A total of 104 patients were included in the study. The locations of the lymph nodes
were mediastinal in 50 patients, intra-abdominal in 48 patients, and both mediastinal
and intra-abdominal in six patients. The diagnoses made using EUS-FNAB were lymphoma
(n = 48), metastasis (n = 16), and benign/reactive (n = 40). The overall accuracy
of EUS-FNAB for unknown lymphadenopathy was 98 %, and it was possible to classify
the lymphomas in accordance with the World Health Organization classifications in
88 % of cases. No serious complications occurred with the procedure.
Conclusions: Open thoracic surgery, laparotomy, and other invasive diagnostic procedures such
as mediastinoscopy and laparoscopy can now be avoided, as EUS-FNAB is potentially
a safe and accurate tool for diagnosing unknown lymphadenopathy, including lymphoma.
References
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I. Yasuda, M. D., Ph. D.
First Dept. of Internal Medicine
Gifu University · 1-1 Yanagido · Gifu 501-1194 · Japan
Fax: +81-58-230-6310
Email: yasudaic@aol.com