EUS for unexplained mediastinal lesions

Introduction

Trans-esophageal endoscopic ultrasound (EUS) with fine needle aspiration (FNA) offers a unique ability to assess and biopsy posterior mediastinal lesions. This review will focus on EUS diagnosis of unexplained posterior mediastinal, lymph nodes, masses, and cysts. Table [1] shows the types of posterior mediastinal lesions which can be diagnosed with trans-esophageal EUS/FNA cytology.

Table 1 Posterior mediastinal lesions that can be diagnosed with EUS/FNA Primary pulmonary cancer Non-small cell lung cancer Small Cell Lung Cancer Metastatic cancer from extra-thoracic malignancy Lymphoma Reactive Lymph Nodes Granulomatous Disease Sarcoid Histoplasmosis Tuberculosis Neurogenic Tumors Duplication Cysts Mediastinal Abscess/Mediastinitis

References

• 1 Wiersema M J, Hassig W M, Hawes R H, Wonn M J. Mediastinal lymph node detection with endosonography.  Gastrointest Endosc. 1993;  39 (6) 788-793
• 2 Catalano M F, Sivak Jr M V, Rice T, Gragg L A, Van Dam J. Endosonographic features predictive of lymph node metastasis.  Gastrointest Endosc. 1994;  40 (4) 442-446
• 3 Bhutani M S, Hawes R H, Hoffman B J. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion.  Gastrointest Endosc. 1997;  45 (6) 474-479
• 4 Wallace M B, Fritscher-Ravens A, Savides T J. Endoscopic ultrasound for the staging of non-small-cell lung cancer.  Endoscopy. 2003;  35 (7) 606-610
• 5 Levy M J, Jondal M L, Clain J, Wiersema M J. Preliminary experience with an EUS-guided trucut biopsy needle compared with EUS-guided FNA.  Gastrointest Endosc. 2003;  57 (1) 101-106
• 6 Gines A, Wiersema M J, Clain J E, Pochron N L, Rajan E, Levy M J. Prospective study of a Trucut needle for performing EUS-guided biopsy with EUS-guided FNA rescue.  Gastrointest Endosc. 2005;  62 (4) 597-601
• 7 Levy M J, Wiersema M J. EUS-guided Trucut biopsy.  Gastrointest Endosc. 2005;  62 (3) 417-426
• 8 Savides T J, Perricone A. Impact of EUS-guided FNA of enlarged mediastinal lymph nodes on subsequent thoracic surgery rates.  Gastrointest Endosc. 2004;  60 (3) 340-346
• 9 Fritscher-Ravens A, Soehendra N, Schirrow L. et al . Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer.  Chest. 2000;  117 (2) 339-345
• 10 Eloubeidi M A, Cerfolio R J, Chen V K, Desmond R, Syed S, Ojha B. Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans.  Ann Thorac Surg. 2005;  79 (1) 263-268
• 11 Will U, Meyer F, Bosseckert H. Successful endoscopic management of iatrogenic mediastinal infection and subsequent esophagomediastinal fistula, following endosonographically guided fine-needle aspiration biopsy.  Endoscopy. 2005;  37 (1) 88-90
• 12 Pai K R, Page R D. Mediastinitis after EUS-guided FNA biopsy of a posterior mediastinal metastatic teratoma.  Gastrointest Endosc. 2005;  62 (6) 980-981
• 13 Fritscher-Ravens A, Sriram P V, Bobrowski C. et al . Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients.  Am J Gastroenterol. 2000;  95 (9) 2278-2284
• 14 Devereaux B M, LeBlanc J K, Yousif E. et al . Clinical utility of EUS-guided fine-needle aspiration of mediastinal masses in the absence of known pulmonary malignancy.  Gastrointest Endosc. 2002;  56 (3) 397-401
• 15 DeWitt J, Ghorai S, Kahi C. et al . EUS-FNA of recurrent postoperative extraluminal and metastatic malignancy.  Gastrointest Endosc. 2003;  58 (4) 542-548
• 16 Kramer H, Koeter G H, Sleijfer D T, van Putten J W, Groen H J. Endoscopic ultrasound-guided fine-needle aspiration in patients with mediastinal abnormalities and previous extrathoracic malignancy.  Eur J Cancer. 2004;  40 (4) 559-562
• 17 Hahn M, Faigel D O. Frequency of mediastinal lymph node metastases in patients undergoing EUS evaluation of pancreaticobiliary masses.  Gastrointest Endosc. 2001;  54 (3) 331-335
• 18 Ribeiro A, Vazquez-Sequeiros E, Wiersema L M, Wang K K, Clain J E, Wiersema M J. EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma.  Gastrointest Endosc. 2001;  53 (4) 485-491
• 19 Hoda R S, Picklesimer L, Green K M, Self S. Fine-needle aspiration of a primary mediastinal large B-cell lymphoma: a case report with cytologic, histologic, and flow cytometric considerations.  Diagn Cytopathol. 2005;  32 (6) 370-373
• 20 Mehra M, Tamhane A, Eloubeidi M A. EUS-guided FNA combined with flow cytometry in the diagnoses of suspected or recurrent intrathoracic or retroperitoneal lymphoma.  Gastrointest Endosc. 2005;  62(4) 508-513
• 21 Noh K W, Wallace M B. Can EUS-guided FNA with flow cytometry be used to diagnose lymphoma?.  Gastrointest Endosc. 2005;  62 (4) 514-516
• 22 Storch I, Jorda M, Ribeiro A. EUS-guided biopsy in the diagnosis of pulmonary lymphoma in a patient with an esophagopulmonary fistula.  Gastrointest Endosc. 2005;  61 (7) 904-906
• 23 Mishra G, Sahai A V, Penman I D. et al . Endoscopic ultrasonography with fine-needle aspiration: an accurate and simple diagnostic modality for sarcoidosis.  Endoscopy. 1999;  31 (7) 377-382
• 24 Fritscher-Ravens A, Sriram P V, Topalidis T. et al . Diagnosing sarcoidosis using endosonography-guided fine-needle aspiration.  Chest. 2000;  118 (4) 928-935
• 25 Annema J T, Veselic M, Rabe K F. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis.  Eur Respir J. 2005;  25 (3) 405-409
• 26 Wildi S M, Judson M A, Fraig M. et al . Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think?.  Thorax. 2004;  59 (9) 794-799
• 27 Wiersema M J, Chak A, Wiersema L M. Mediastinal histoplasmosis: evaluation with endosonography and endoscopic fine-needle aspiration biopsy.  Gastrointest Endosc. 1994;  40 (1) 78-81
• 28 Savides T J, Gress F G, Wheat L J, Ikenberry S, Hawes R H. Dysphagia due to mediastinal granulomas: diagnosis with endoscopic ultrasonography.  Gastroenterology. 1995;  109 (2) 366-373
• 29 Hainaut P, Monthe A, Lesage V, Weynand B. Tuberculous mediastinal lymphadenopathy.  Acta Clin Belg. 1998;  53 (2) 114-116
• 30 Kramer H, Nieuwenhuis J A, Groen H J, Wempe J B. Pulmonary tuberculosis diagnosed by esophageal endoscopic ultrasound with fine-needle aspiration.  Int J Tuberc Lung Dis. 2004;  8 (2) 272-273
• 31 Fritscher-Ravens A, Schirrow L, Pothmann W, Knofel W T, Swain P, Soehendra N. Critical care transesophageal endosonography and guided fine-needle aspiration for diagnosis and management of posterior mediastinitis.  Crit Care Med. 2003;  31 (1) 126-132
• 32 Catalano M F, Rosenblatt M L, Chak A, Sivak Jr M V, Scheiman J, Gress F. Endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal masses of unknown origin.  Am J Gastroenterol. 2002;  97 (10) 2559-2565
• 33 Panelli F, Erickson R A, Prasad V M. Evaluation of mediastinal masses by endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration.  Am J Gastroenterol. 2001;  96 (2) 401-408
• 34 Varadarajulu S, Hoffman B J, Hawes R H, Eloubeidi M A. EUS-guided FNA of lung masses adjacent to or abutting the esophagus after unrevealing CT-guided biopsy or bronchoscopy.  Gastrointest Endosc. 2004;  60 (2) 293-297
• 35 McGrath K M, Ballo M S, Jowell P S. Schwannoma of the mediastinum diagnosed by EUS-guided fine needle aspiration.  Gastrointest Endosc. 2001;  53 (3) 362-365
• 36 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 (5) 397-401
• 37 Van D J, Rice T W, Sivak Jr M V. Endoscopic ultrasonography and endoscopically guided needle aspiration for the diagnosis of upper gastrointestinal tract foregut cysts.  Am J Gastroenterol. 1992;  87 (6) 762-765
• 38 Geller A, Wang K K, DiMagno E P. Diagnosis of foregut duplication cysts by endoscopic ultrasonography.  Gastroenterology. 1995;  109 (3) 838-842
• 39 Bhutani M S, Hoffman B J, Reed C. Endosonographic diagnosis of an esophageal duplication cyst.  Endoscopy. 1996;  28 (4) 396-397
• 40 Faigel D O, Burke A, Ginsberg G G, Stotland B R, Kadish S L, Kochman M L. The role of endoscopic ultrasound in the evaluation and management of foregut duplications.  Gastrointest Endosc. 1997;  45 (1) 99-103
• 41 Wildi S M, Hoda R S, Fickling W. et al . Diagnosis of benign cysts of the mediastinum: the role and risks of EUS and FNA.  Gastrointest Endosc. 2003;  58 (3) 362-368
• 42 Westerterp M, van den Berg J G, van Lanschot J J, Fockens P. Intramural bronchogenic cysts mimicking solid tumors.  Endoscopy. 2004;  36 (12) 1119-1122
• 43 Fazel A, Moezardalan K, Varadarajulu S, Draganov P, Eloubeidi M A. The utility and the safety of EUS-guided FNA in the evaluation of duplication cysts.  Gastrointest Endosc. 2005;  62 (4) 575-580
• 44 Eloubeidi M A, Cohn M, Cerfolio R J. et al . Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of foregut duplication cysts: the value of demonstrating detached ciliary tufts in cyst fluid.  Cancer. 2004;  102 (4) 253-258
• 45 Ryan A G, Zamvar V, Roberts S A. Iatrogenic candidal infection of a mediastinal foregut cyst following endoscopic ultrasound-guided fine-needle aspiration.  Endoscopy. 2002;  34 (10) 838-839
• 46 Wiersema M J, Vilmann P, Giovannini M, Chang K J, Wiersema L M. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 (4) 1087-1095
• 47 Annema J T, Veselic M, Versteegh M I, Rabe K F. Mediastinitis caused by EUS-FNA of a bronchogenic cyst.  Endoscopy. 2003;  35 (9) 791-793
• 48 Prasad V M, Erickson R, Contreras E D, Panelli F. Spontaneous candida mediastinitis diagnosed by endoscopic ultrasound-guided, fine-needle aspiration.  Am J Gastroenterol. 2000;  95 (4) 1072-1075
• 49 Kahaleh M, Yoshida C, Kane L, Yeaton P. EUS drainage of a mediastinal abscess.  Gastrointest Endosc. 2004;  60 (1) 158-160
• 50 Wehrmann T, Stergiou N, Vogel B, Riphaus A, Kockerling F, Frenz M B. Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series.  Gastrointest Endosc. 2005;  62 (3) 344-349