OUR EXPERIENCES WITH EUS-FNA IN PATIENTS WITH MEDIASTINAL LYMPHADENOMEGALY OF UNKNOWN-ORIGIN

Aims In Hungary there is limited access to perform EUS or EUS with fine-needle aspiration (FNA). Our aim was to overview the reports and the quality indicators of EUS(-FNA) interventions indicated by MLM.

Methods The reports of EUS-FNA interventions made with MLM indication at the First Department of Medicine, University of Szeged between 1. January 2015 and 31. August 2018 were studied. Epidemiological data, the characteristic of lymph nodes (LN), the rate and implementation of FNA, the quality of the collected samples, the diagnosis and the informativity of the reports (as quality indicators) were analysed.

Results In the given period of time EUS were made in a total of 23 cases with MLM, of which in 17 cases (73.9%) FNA was performed, too. MLM was present most often in the paraoesophageal, subcarinal (21,7%), the number of the affected LN ranged between 1-several. In 69% of the cases the size of the LN was given in one dimension (length: min. 5 mm max. 50 mm, median: 10–20 mm, average: 19 mm). In 17 patients FNA sampling was performed with an average of 4 passes pro patients. The rate of the slow-pull capillary technique and the suction technique were 66% and 34%, respectively (p = 0.025, p < 0.05). FNA was carried out with 22 G needle in the 67% of the cases. Cytology was diagnostic in 82%, and all cytological diagnosis was in accordance with the histological diagnoses. Non-diagnostical samples were collected with vacuum technique. Reactive LN was the most common diagnosis (7 cases), followed by sarcoidosis, neuroendocrine tumor/melanoma metastasis (2 cases respectively). By 2 patients mediastinoscopy/VATS lead to final diagnosis. No complication was observed after any EUS-FNA.

Conclusions In case of MLM EUS is a safe method with good diagnostic ability. Slow-pull capillary technique has a better value in getting diagnostic samples.