Impact of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in Lymph Nodal and Mediastinal Lesions: A Multicenter Experience(623 views) Zeppa P, Barra E, Napolitano V, Cozzolino I, Troncone G, Picardi M, De Renzo A, Mainenti PP, Vetrani A, Palombini L
Keywords: Eus-Fna, Lymph-Node, Mediastinal Mass, Article, Aspiration Biopsy, Cancer Patient, Cancer Relapse, Controlled Study, Cytology, Diagnostic Test Accuracy Study, Endoscopic Echography, Esophagus Carcinoma, Gastrointestinal Stromal Tumor, Histology, Human, Human Tissue, Lung Cancer, Lung Carcinoma, Lymphadenopathy, Major Clinical Study, Mediastinum Lymph Node, Mediastinum Mass, Mesenchymoma, Paraganglioma, Pathologist, Priority Journal, Reproducibility, Sensitivity And Specificity, Subphrenic Abscess, Fine-Needle, Cytodiagnosis, Diagnostic Errors, Endosonography, Lung Diseases, Medical Laboratory Personnel, Neoplasms, Hospital, Reproducibility Of Results,
Affiliations: *** IBB - CNR ***
Dipartimento di Scienze Biomorfologiche e Funzionali, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, Via Pansini n. 5, 80131 Napoli, Italy
Servizio di Anatomia Patologica, Azienda Ospedaliera V. Monaldi, Seconda Università di Napoli, Italy
Dipartimento di Chirurgia Generale e Specialistica, Seconda Università di Napoli, Italy
Dipartimento di Biochimica e Tecnologie Biomediche, Università di Napoli Federico II, Napoli, Italy
References: Dwamena, B.A., Sonnad, S.S., Angobaldo, J.O., Wahl, R.L., Metastases from non-small cell lung cancer: Mediastinal staging in the 1990s - Meta-analytic comparison of PET and CT (1999) Radiology, 213 (2), pp. 530-53
Spiro, S.G., Porter, J.C., Lung cancer - Where are we today? Current advances in staging and nonsurgical treatment (2002) American Journal of Respiratory and Critical Care Medicine, 166 (9), pp. 1166-1196. , DOI 10.1164/rccm.200202-070SO
Eloubeidi, M.A., Tamhane, A., Chen, V.K., Cerfolio, R.J., Endoscopic ultrasound-guided fine-needle aspiration in patients with non-small cell lung cancer and prior negative mediastinoscopy (2005) Annals of Thoracic Surgery, 80 (4), pp. 1231-1239. , DOI 10.1016/j.athoracsur.2005.04.001, PII S0003497505005977
Sawhney, M.S., Kratzke, R.A., Lederle, F.A., Holmstrom, A.M., Nelson, D.B., Kelly, R.F., EUS-guided FNA for the diagnosis of advanced lung cancer (2006) Gastrointestinal Endoscopy, 63 (7), pp. 959-965. , DOI 10.1016/j.gie.2005.11.061, PII S0016510705033626
Toloza, E.M., Harpole, L., Detterbeck, F., McCrory, D.C., Invasive staging of non-small cell lung cancer: A review of the current evidence (2003) Chest, 123 (1 SUPPL.), pp. 157S-166S
Lloyd, C., Silvestri, G.A., Mediastinal staging of non-small-cell lung cancer (2001) Cancer Control, 8 (4), pp. 311-317
Fritscher-Ravens, A., Petrasch, S., Reinacher-Schick, A., Graeven, U., Konig, M., Schmiegel, W., Diagnostic value of endoscopic ultrasonography-guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy (1999) Respiration, 66 (2), pp. 150-155
Herth, F.J.F., Eberhardt, R., Krasnik, M., Ernst, A., Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer (2008) Chest, 133 (4), pp. 887-891. , DOI 10.1378/chest.07-2535
Skov, B.G., Baandrup, U., Jakobsen, G.K., Kiss, K., Krasnik, M., Rossen, K., Vilmann, P., Cytopathologic diagnoses of fine-needle aspirations from endoscopic ultrasound of the mediastinum: Reproducibility of the diagnoses and representativeness of aspirates from lymph nodes (2007) Cancer, 111 (4), pp. 234-241. , DOI 10.1002/cncr.22866
Block, M.I., Transition from mediastinoscopy to endoscopic ultrasound for lung cancer staging (2010) Ann Thorac Surg, 89, pp. 885-890
Herth, F.J., Krasnik, M., Kahn, N., Eberhardt, R., Ernst, A., Combined endoesophageal-endobronchial ultrasound-guided, fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer (2010) Chest, , Epub ahead of print
Krasnik, M., Endoscopic transesophageal and endoscopic transbronchial real-time ultrasound-guided biopsy (2003) Respiration, 70 (3), pp. 293-298. , DOI 10.1159/000072011
Annema, J.T., Versteegh, M.I., Veseliç, M., Voigt, P., Rabe, K.F., Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging (2005) J Clin Oncol, 23, pp. 8357-8361
Annema, J.T., Veselic, M., Rabe, K.F., EUS-guided FNA of centrally located lung tumours following a non-diagnostic bronchoscopy (2005) Lung Cancer, 48 (3), pp. 357-361. , DOI 10.1016/j.lungcan.2004.11.017, PII S0169500204006105
Pedersen, B.H., Vilmann, P., Folke, K., Jacobsen, C.K., Krasnik, M., Milman, N., Hancke, S., Endoscopic ultrasonography and real-time guided fine-needle aspiration biopsy of solid lesions of the mediastinum suspected of malignancy (1996) Chest, 110 (2), pp. 539-544
Larsen, S.S., Krasnik, M., Vilmann, P., Jacobsen, G.K., Pedersen, J.H., Faurschou, P., Folke, K., Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management (2002) Thorax, 57 (2), pp. 98-103. , DOI 10.1136/thorax.57.2.98
Mountain, C.F., Dresler, C.M., Regional lymph node classification for lung cancer staging (1997) Chest, 111 (6), pp. 1718-1723
Zeppa, P., Marino, G., Troncone, G., Fulciniti, F., De Renzo, A., Picardi, M., Benincasa, G., Palombini, L., Fine-Needle Cytology and Flow Cytometry Immunophenotyping and Subclassification of Non-Hodgkin Lymphoma: A Critical Review of 307 Cases with Technical Suggestions (2004) Cancer, 102 (1), pp. 55-65. , DOI 10.1002/cncr.11903
Zeppa, P., Cozzolino, I., Vigliar, E., Vetrani, A., Lymph node cytology Module, 4. , Eurocytology web-based training system
Alsharif, M., Andrade, R.S., Groth, S.S., Stelow, E.B., Pambuccian, S.E., Endobronchial ultrasound-guided transbronchial fine-needle aspiration: The University of Minnesota experience, with emphasis on usefulness, adequacy assessment, and diagnostic difficulties (2008) Am J Clin Pathol, 130, pp. 434-443
Baker, J.J., Solanki, P.H., Schenk, D.A., Van Pelt, C., Ramzy, I., Transbronchial fine needle aspiration of the mediastinum. Importance of lymphocytes as an indicator of specimen adequacy (1990) Acta Cytologica, 34 (4), pp. 517-523
Herth, F.J.F., Lunn, W., Eberhardt, R., Becker, H.D., Ernst, A., Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes (2005) American Journal of Respiratory and Critical Care Medicine, 171 (10), pp. 1164-1167. , DOI 10.1164/rccm.200411-1560OC
Vilmann, P., Krasnik, M., Larsen, S.S., Jacobsen, G.K., Clementsen, P., Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: A combined approach in the evaluation of mediastinal lesions (2005) Endoscopy, 37 (9), pp. 833-839. , DOI 10.1055/s-2005-870276
Becker, H.D., EBUS: A new dimension in bronchoscopy. of sounds and images-A paradigm of innovation (2006) Respiration, 73, pp. 583-486
Stigt, J.A., Oostdijk, A.H., Timmer, P.R., Shahin, G.M., Boers, J.E., Groen, H.J., Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer (2009) Lung Cancer, 66, pp. 198-204
Tournoy, K.G., Praet, M.M., Van Maele, G., Van Meerbeeck, J.P., Esophageal endoscopic ultrasound with fine-needle aspiration with an on-site cytopathologist: High accuracy for the diagnosis of mediastinal lymphadenopathy (2005) Chest, 128 (4), pp. 3004-3009. , DOI 10.1378/chest.128.4.3004
Diacon, A.H., Schuurmans, M.M., Theron, J., Louw, M., Wright, C.A., Brundyn, K., Bolliger, C.T., Utility of rapid on-site evaluation of transbronchial needle aspirates (2005) Respiration, 72 (2), pp. 182-188. , DOI 10.1159/000084050
Layfield, L.J., Bentz, J.S., Gopez, E.V., Immediate on-site interpretation of fine-needle: Aspiration smears: A cost and compensation analysis (2001) Cancer, 93 (5), pp. 319-322. , DOI 10.1002/cncr.9046
Boccato, P., Maioli, P., Cyto-assistance (2008) Pathologica, 100, pp. 431-432
Wallace, W.A.H., Monaghan, H.M., Salter, D.M., Gibbons, M.A., Skwarski, K.M., Endobronchial ultrasound-guided fine-needle aspiration and liquid-based thin-layer cytology (2007) Journal of Clinical Pathology, 60 (4), pp. 388-391. , DOI 10.1136/jcp.2006.038901
Saad, R.S., Silverman, J.F., Respiratory cytology: Differential diagnosis and pitfalls (2010) Diagn Cytopathol, 38, pp. 297-307
Bardales, R.H., Stelow, E.B., Mallery, S., Lai, R., Stanley, M.W., Review of endoscopic ultrasound-guided fine-needle aspiration cytology (2006) Diagnostic Cytopathology, 34 (2), pp. 140-175. , DOI 10.1002/dc.20300
Kramer, H., Sanders, J., Post, W.J., Groen, H.J.M., Suurmeijer, A.J.H., Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration (2006) Cancer, 108 (4), pp. 206-211. , DOI 10.1002/cncr.21914
Al-Haddad, M., Savabi, M.S., Sherman, S., Role of endoscopic ultrasound-guided fine-needle aspiration with flow cytometry to diagnose lymphoma: A single center experience (2009) J Gastroenterol Hepatol, 24, pp. 1826-1833
Stelow, E.B., Murad, F.M., Debol, S.M., Stanley, M.W., Bardales, R.H., Lai, R., Mallery, S., A limited immunocytochemical panel for the distinction of subepithelial gastrointestinal mesenchymal neoplasms sampled by endoscopic ultrasound-guided fine-needle aspiration (2008) American Journal of Clinical Pathology, 129 (2), pp. 219-225. , http://ajcp.metapress.com/media/gl91504ywq6wpg8twc2l/contributions/9/3/2/ 8/9328u2552361r530.pdf, DOI 10.1309/NL2WYAD8EUH3XFRF
Groth, S.S., Whitson, B.A., D'Cunha, J., Maddaus, M.A., Alsharif, M., Andrade, R.S., Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: A single institution's early learning curve (2008) Ann Thorac Surg, 86, pp. 1104-1109
Micames, C.G., McCrory, D.C., Pavey, D.A., Jowell, P.S., Gress, F.G., Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis (2007) Chest, 131 (2), pp. 539-548. , DOI 10.1378/chest.06-1437
Dwamena, B. A., Sonnad, S. S., Angobaldo, J. O., Wahl, R. L., Metastases from non-small cell lung cancer: Mediastinal staging in the 1990s - Meta-analytic comparison of PET and CT (1999) Radiology, 213 (2), pp. 530-53
Spiro, S. G., Porter, J. C., Lung cancer - Where are we today? Current advances in staging and nonsurgical treatment (2002) American Journal of Respiratory and Critical Care Medicine, 166 (9), pp. 1166-1196. , DOI 10. 1164/rccm. 200202-070SO
Eloubeidi, M. A., Tamhane, A., Chen, V. K., Cerfolio, R. J., Endoscopic ultrasound-guided fine-needle aspiration in patients with non-small cell lung cancer and prior negative mediastinoscopy (2005) Annals of Thoracic Surgery, 80 (4), pp. 1231-1239. , DOI 10. 1016/j. athoracsur. 2005. 04. 001, PII S0003497505005977
Sawhney, M. S., Kratzke, R. A., Lederle, F. A., Holmstrom, A. M., Nelson, D. B., Kelly, R. F., EUS-guided FNA for the diagnosis of advanced lung cancer (2006) Gastrointestinal Endoscopy, 63 (7), pp. 959-965. , DOI 10. 1016/j. gie. 2005. 11. 061, PII S0016510705033626
Toloza, E. M., Harpole, L., Detterbeck, F., McCrory, D. C., Invasive staging of non-small cell lung cancer: A review of the current evidence (2003) Chest, 123 (1 SUPPL.), pp. 157S-166S
Herth, F. J. F., Eberhardt, R., Krasnik, M., Ernst, A., Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer (2008) Chest, 133 (4), pp. 887-891. , DOI 10. 1378/chest. 07-2535
Skov, B. G., Baandrup, U., Jakobsen, G. K., Kiss, K., Krasnik, M., Rossen, K., Vilmann, P., Cytopathologic diagnoses of fine-needle aspirations from endoscopic ultrasound of the mediastinum: Reproducibility of the diagnoses and representativeness of aspirates from lymph nodes (2007) Cancer, 111 (4), pp. 234-241. , DOI 10. 1002/cncr. 22866
Block, M. I., Transition from mediastinoscopy to endoscopic ultrasound for lung cancer staging (2010) Ann Thorac Surg, 89, pp. 885-890
Herth, F. J., Krasnik, M., Kahn, N., Eberhardt, R., Ernst, A., Combined endoesophageal-endobronchial ultrasound-guided, fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer (2010) Chest, , Epub ahead of print
Annema, J. T., Versteegh, M. I., Veseli, M., Voigt, P., Rabe, K. F., Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging (2005) J Clin Oncol, 23, pp. 8357-8361
Annema, J. T., Veselic, M., Rabe, K. F., EUS-guided FNA of centrally located lung tumours following a non-diagnostic bronchoscopy (2005) Lung Cancer, 48 (3), pp. 357-361. , DOI 10. 1016/j. lungcan. 2004. 11. 017, PII S0169500204006105
Pedersen, B. H., Vilmann, P., Folke, K., Jacobsen, C. K., Krasnik, M., Milman, N., Hancke, S., Endoscopic ultrasonography and real-time guided fine-needle aspiration biopsy of solid lesions of the mediastinum suspected of malignancy (1996) Chest, 110 (2), pp. 539-544
Larsen, S. S., Krasnik, M., Vilmann, P., Jacobsen, G. K., Pedersen, J. H., Faurschou, P., Folke, K., Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management (2002) Thorax, 57 (2), pp. 98-103. , DOI 10. 1136/thorax. 57. 2. 98
Mountain, C. F., Dresler, C. M., Regional lymph node classification for lung cancer staging (1997) Chest, 111 (6), pp. 1718-1723
Baker, J. J., Solanki, P. H., Schenk, D. A., Van Pelt, C., Ramzy, I., Transbronchial fine needle aspiration of the mediastinum. Importance of lymphocytes as an indicator of specimen adequacy (1990) Acta Cytologica, 34 (4), pp. 517-523
Herth, F. J. F., Lunn, W., Eberhardt, R., Becker, H. D., Ernst, A., Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes (2005) American Journal of Respiratory and Critical Care Medicine, 171 (10), pp. 1164-1167. , DOI 10. 1164/rccm. 200411-1560OC
Becker, H. D., EBUS: A new dimension in bronchoscopy. of sounds and images-A paradigm of innovation (2006) Respiration, 73, pp. 583-486
Stigt, J. A., Oostdijk, A. H., Timmer, P. R., Shahin, G. M., Boers, J. E., Groen, H. J., Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer (2009) Lung Cancer, 66, pp. 198-204
Tournoy, K. G., Praet, M. M., Van Maele, G., Van Meerbeeck, J. P., Esophageal endoscopic ultrasound with fine-needle aspiration with an on-site cytopathologist: High accuracy for the diagnosis of mediastinal lymphadenopathy (2005) Chest, 128 (4), pp. 3004-3009. , DOI 10. 1378/chest. 128. 4. 3004
Diacon, A. H., Schuurmans, M. M., Theron, J., Louw, M., Wright, C. A., Brundyn, K., Bolliger, C. T., Utility of rapid on-site evaluation of transbronchial needle aspirates (2005) Respiration, 72 (2), pp. 182-188. , DOI 10. 1159/000084050
Layfield, L. J., Bentz, J. S., Gopez, E. V., Immediate on-site interpretation of fine-needle: Aspiration smears: A cost and compensation analysis (2001) Cancer, 93 (5), pp. 319-322. , DOI 10. 1002/cncr. 9046
Wallace, W. A. H., Monaghan, H. M., Salter, D. M., Gibbons, M. A., Skwarski, K. M., Endobronchial ultrasound-guided fine-needle aspiration and liquid-based thin-layer cytology (2007) Journal of Clinical Pathology, 60 (4), pp. 388-391. , DOI 10. 1136/jcp. 2006. 038901
Saad, R. S., Silverman, J. F., Respiratory cytology: Differential diagnosis and pitfalls (2010) Diagn Cytopathol, 38, pp. 297-307
Bardales, R. H., Stelow, E. B., Mallery, S., Lai, R., Stanley, M. W., Review of endoscopic ultrasound-guided fine-needle aspiration cytology (2006) Diagnostic Cytopathology, 34 (2), pp. 140-175. , DOI 10. 1002/dc. 20300
Stelow, E. B., Murad, F. M., Debol, S. M., Stanley, M. W., Bardales, R. H., Lai, R., Mallery, S., A limited immunocytochemical panel for the distinction of subepithelial gastrointestinal mesenchymal neoplasms sampled by endoscopic ultrasound-guided fine-needle aspiration (2008) American Journal of Clinical Pathology, 129 (2), pp. 219-225. , http: //ajcp. metapress. com/media/gl91504ywq6wpg8twc2l/contributions/9/3/2/ 8/9328u2552361r530. pdf, DOI 10. 1309/NL2WYAD8EUH3XFRF
Groth, S. S., Whitson, B. A., D'Cunha, J., Maddaus, M. A., Alsharif, M., Andrade, R. S., Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: A single institution's early learning curve (2008) Ann Thorac Surg, 86, pp. 1104-1109
Micames, C. G., McCrory, D. C., Pavey, D. A., Jowell, P. S., Gress, F. G., Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis (2007) Chest, 131 (2), pp. 539-548. , DOI 10. 1378/chest. 06-1437
Impact of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in Lymph Nodal and Mediastinal Lesions: A Multicenter Experience
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established procedure in lung cancer (LC) staging and in the diagnosis of mediastinal masses. Most of the experiences reported refer to single specialized centers where dedicated teams of endoscopists and pathologists perform the procedure. We report the EUS-FNA experience of a cooperation group involving clinicians and cytopathologists from three hospitals. Fifty-seven consecutive EUS-FNA of mediastinal nodes in LC patients, eight mediastinal and two subdiaphragmatic masses were collected in 3 years. EUS-FNA was performed by two endoscopists and three experienced pathologists. On-site evaluation was performed in all cases by the three cytopathologists. Lymph node negative cases underwent surgery, which confirmed the cytological diagnoses but also detected two false negatives. Four of the 10 EUS cytological diagnoses of mediastinal and subdiaphragmatic masses were histologically confirmed. All EUS diagnoses were blindly reviewed by three pathologists to assess intra and interpersonal reproducibility. FNA-EUS diagnoses were: 10 inadequate (17%), 10 negative (17%), 4 suspicious (7%) and 33 positive (59%). Diagnoses of mediastinal and subdiaphragmatic masses were: relapse of lung carcinoma (3), mesenchimal tumor not otherwise specifiable (3), gastrointestinal stromal tumor (GIST) (1), esophageal carcinoma (2) and paraganglioma (1). The sensitivity attained was 85% and the specificity 100%; revision of the slides demonstrated a significant diagnostic reproducibility of the three cytopathologists (P < 0.5). The sensitivity and specificity attained were similar to those reported in the literature suggesting that experienced cytopathologists and endoscopists from different institutions can employ the same procedure reaching comparable results. Diagn. Cytopathol. 2011; 39: 723-729. (C) 2010 Wiley-Liss, Inc.
Impact of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in Lymph Nodal and Mediastinal Lesions: A Multicenter Experience