Endoscopic ultrasonography–guided fine needle aspiration in the management of mediastinal diseases: local experience of a novel investigation

YT Lee, Larry H Lai, Joseph JY Sung, Fanny WS Ko, David SC Hui
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

OBJECTIVE. To study the efficacy and safety of endoscopic ultrasonography– guided fine-needle aspiration in the management of mediastinal diseases in Hong Kong.

DESIGN. Retrospective review of prospectively collected data.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. A total of 125 consecutive patients with various mediastinal and pulmonary lesions that underwent trans-oesophageal endoscopic ultrasonography–guided fine-needle aspiration from July 1998 to June 2007.

MAIN OUTCOME MEASURES. The diagnostic accuracy and safety of the procedure and its influence in patient management.

RESULTS. Malignancy was confirmed in 62 (50%) of the patients and excluded in 42 (34%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic ultrasonography–guided fine-needle aspiration in diagnosing mediastinal malignancies were 75% (95% confidence interval, 64-83%), 100% (90-100%), 100% (93-100%), 67% (54-78%), and 83%, respectively. Eighty-six (69%) of the patients had their initial plan of invasive investigations changed. Only one (0.8%) patient developed a septic complication in a mediastinal cyst after puncturing, and was treated surgically.

CONCLUSIONS. Trans-oesophageal endoscopic ultrasonography–guided fine-needle aspiration is a minimally invasive, effective, and safe method of diagnosing malignant mediastinal disease. It may reduce the need for other invasive investigations.

Hong Kong Med J 2009;16:Epub 2010 Feb 3

Key words: Biopsy, needle; Carcinoma, non-smallcell lung; Endosonography; Lung neoplasms; Mediastinum