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
Weitere Informationen

Publikationsverlauf

Submitted 17 January 2006

Accepted after revision 11 June 2006

Publikationsdatum:
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

  • 1 Catalano M F, Nayar R, Gress F. et al . EUS-guided fine needle aspiration in mediastinal lymphadenopathy of unknown etiology.  Gastrointest Endosc. 2002;  55 863-869
  • 2 Williams D B, Sahai A V, Aabakken L. et al . Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience.  Gut. 1999;  44 720-726
  • 3 Ribeiro A, Vazquez-Sequeiros E, Wiersema L M. et al . EUS-guided fine-needle aspiration combined with flow cytometry and immunochemistry in the diagnosis of lymphoma.  Gastrointest Endosc. 2001;  53 485-491
  • 4 Gong J Z, Snyder M J, Lagoo A S. et al . Diagnostic impact of core-needle biopsy on fine-needle aspiration of non-Hodgkin lymphoma.  Diagn Cytopathol. 2004;  31 23-30
  • 5 Demharter J, Muller P, Wagner T. et al . Percutaneous core-needle biopsy of enlarged lymph nodes in the diagnosis and subclassification of malignant lymphomas.  Eur Radiol. 2001;  11 276-283
  • 6 de Kerviler E, Guermazi A, Zagdanski A M. et al . Image-guided core-needle biopsy in patients with suspected or recurrent lymphomas.  Cancer. 2000;  89 647-652
  • 7 Zinzani P L, Colecchia A, Festi D. et al . Ultrasound-guided core-needle biopsy is effective in the initial diagnosis of lymphoma patients.  Haematologica. 1998;  83 989-992
  • 8 Screaton N J, Berman L H, Grant J W. Head and neck lymphadenopathy: evaluation with US-guided cutting-needle biopsy.  Radiology. 2002;  224 75-81
  • 9 Varadarajulu S, Fraig M, Schmulewitz N. et al . Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration.  Endoscopy. 2004;  36 397-401

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

    >