Endoscopy 2006; 38(9): 919-924
DOI: 10.1055/s-2006-944665
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin

I.  Yasuda1 , H.  Tsurumi1 , S.  Omar2 , T.  Iwashita1 , Y.  Kojima1 , T.  Yamada1 , M.  Sawada1 , T.  Takami3 , H.  Moriwaki1 , N.  Soehendra2
  • 1First Dept. of Internal Medicine, Gifu University, Gifu, Japan
  • 2Dept. of Interdisciplinary Endoscopy, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
  • 3Dept. of Cellular Pathology, Gifu University, Gifu, Japan
Further Information

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.


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