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Endoscopy 2006; 38: 84-87
DOI: 10.1055/s-2006-946663
Invited papers
Mediastinal EUS
© Georg Thieme Verlag KG Stuttgart · New York

State of the art lecture: Mediastinal EUS

P. Vilmann1 , F. Herth2 , M. Krasnik3
  • 1Department of Surgical Gastroenterology, Gentofte University Hospital, Copenhagen, Denmark
  • 2Department of pulmonary medicine, thorax clinic Heidelberg, Heidelberg, Germany
  • 3Department of cardiothoracic surgery, Gentofte University Hospital, Copenhagen, Denmark
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Publication History

Publication Date:
26 June 2006 (online)

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Introduction

Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) was originally developed for gastrointestinal diseases [1]. However, it very soon became apparent that a considerable part of the mediastinum can be reached and tissue sampled by this method [2]. Trans-esophageal EUS guided biopsy of lesions in the mediastinum is a minimal invasive diagnostic method which can spare patients from much more aggressive and risky methods. At present both cytology as well as histology can be obtained by EUS guidance which has broadened the range of applications for EUS even further. The main indications of EUS guided biopsy in the mediastinum is at present staging of non-small cell lung cancer (NSCLC), diagnosis of lymph nodes of unknown nature, staging of a wide range of cancers if CT has demonstrated enlarged mediastinal lymph nodes and differentiation between specific cancers or lymphomas for accurate diagnosis (EUS guided histology).

The aim of the following is to present the status of EUS guided biopsy of the mediastinum based on a literature survey.

References

  • 1 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
    PubMedGoogle Scholar
  • 2 Pedersen B H, Vilmann P, Milman N. et al . Endoscopic ultrasonography with guided fine needle aspiration biopsy of a mediastinal mass lesion.  Acta Radiol. 1995;  36 326-328
    PubMedGoogle Scholar
  • 3 Shields T W. Surgical treatment of non-small cell bronchial carcinoma.  In General Thoracic Surgery. edited by Shields TW 4th Edition Williams & Wilkins, USA 1994: 2, 1159-1169
    Google Scholar
  • 4 Mountain C F, Dresler C M. Regional lymph node classification for lung cancer staging.  Chest. 1997;  111 1486-1487
    PubMedGoogle Scholar
  • 5 Toloza E M, Harpole L, McCrory D C. Noninvasive staging of non-small cell lung cancer: a review of the current evidence.  Chest. 2003;  123 137-146
    CrossrefPubMedGoogle Scholar
  • 6 Kamiyoshihara M, Kawashima O, Ishikawa S. et al . Mediastinal lymph node evaluation by computed tomographic scan in lung cancer.  J Cardiovasc Surg.. 2001;  42 119-124
    PubMedGoogle Scholar
  • 7 van Tinteren H, Hoekstra O S, Smit E F. et al . Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial.  Lancet. 2002;  359 1388-1393
    CrossrefPubMedGoogle Scholar
  • 8 Hammoud Z T, Anderson R C, Meyers B F, Guthrie T J, Roper C L, Cooper J D, Patterson G A. The current role of mediastinoscopy in the evaluation of thoracic disease.  J Thorac Cardiovasc Surg. 1999;  118 894-899
    CrossrefPubMedGoogle Scholar
  • 9 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 2278-2284
    CrossrefPubMedGoogle Scholar
  • 10 Wallace M B, Silvestri G A, Sahai A V. et al . Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung.  Ann Thorac Surg. 2001;  72 1861-1867
    CrossrefPubMedGoogle Scholar
  • 11 Kondo D, Imaizumi M, Abe T. et al . Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer.  Chest. 1990;  98 586-593
    PubMedGoogle Scholar
  • 12 Annema J T, Veselic M, Rabe K F. Analysis of subcarinal lymph nodes in (suspected) non-small-cell lung cancer after a negative transbronchial needle aspiration - what's next? A preliminary report.  Respiration. 2004;  71 555-556
    CrossrefPubMedGoogle Scholar
  • 13 Khoo K L, Ho K Y, Nilsson B, Lim T K. EUS-guided FNA immediately after unrevealing transbronchial needle aspiration in the evaluation of mediastinal lymphadenopathy: a prospective study.  . 2006;  63 215-220
    PubMedGoogle Scholar
  • 14 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;  117 339 -345
    CrossrefPubMedGoogle Scholar
  • 15 Serna D L, Aryan H E, Chang K J. et al . An early comparison between endoscopic ultrasound-guided fine-needle aspiration and mediastinoscopy for diagnosis of mediastinal malignancy.  Am Surg. 1998;  64 1014-1018
    PubMedGoogle Scholar
  • 16 Larsen S S, Vilmann P, Krasnik M, Dirksen A, Clementsen P, Jacobsen G K. Endoscopic ultrasound guided biopsy versus mediastinoscopy for analysis of paratracheal and subcarinal lymph nodes in lung cancer staging.  Lung Cancer. 2005;  48 85-92
    CrossrefPubMedGoogle Scholar
  • 17 Eloubeidi M A, Tamhane A, Chen V K, Cerfolio R J. Endoscopic ultrasound-guided fine-needle aspiration in patients with non-small cell lung cancer and prior negative mediastinoscopy.  Ann Thorac Surg.. 2005;  80 1231-1239
    CrossrefPubMedGoogle Scholar
  • 18 Annema  J T, Versteegh M I, Veselic M, Welker L, Mauad T, Sont J K, Willems L N, Rabe K F. Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer.  JAMA. 2005;  294 931-936
    CrossrefPubMedGoogle Scholar
  • 19 Fritscher-Ravens A, Davidson B L, Hauber H P, Bohuslavizki K H, Bobrowski C, Lund C, Knofel W T, Soehendra N, Brandt L, Pepe M S, Pforte A. Endoscopic ultrasound, positron emission tomography, and computerized tomography for lung cancer.  Am J Respir Crit Care Med. 2003;  168 1293-1297
    CrossrefPubMedGoogle Scholar
  • 20 Fritscher-Ravens A. et al . Mediastinal Lymph Node Involvement in Potential Resectable Lung Cancer: Comparison of CT, PET and EUS-FNA.  Chest. 2003;  123 442-451
    CrossrefPubMedGoogle Scholar
  • 21 Wallace M B, Ravenel J, Block M I. et al . Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography.  Ann Thorac Surg. 2004;  77 1763-1768
    CrossrefPubMedGoogle Scholar
  • 22 Annema J T, Hoekstra O S, Smit E F, Veselic M, Versteegh M I, Rabe K F. Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA.  Lung Cancer. 2004;  44 53-60
    CrossrefPubMedGoogle Scholar
  • 23 Kramer H, van Putten J W, Post W J, van Dullemen H M, Bongaerts A H, Pruim J, Suurmeijer A J, Klinkenberg T J, Groen H, Groen H J. Oesophageal endoscopic ultrasound with fine needle aspiration improves and simplifies the staging of lung cancer.  Thorax. 2004;  59 596-601
    CrossrefPubMedGoogle Scholar
  • 24 Fritscher-Ravens A, Davidson B L, Hauber H P. et al . Endoscopic ultrasound, positron emission tomography, and computerized tomography for lung cancer.  Am J Respir Crit Care Med. 2003;  168 1293-1297
    CrossrefPubMedGoogle Scholar
  • 25 Fritscher-Ravens A, Bohuslavizki K H, Brandt L. et al . Mediastinal lymph node involvement in potentially resectable lung cancer: comparison of CT, positron emission tomography, and endoscopic ultrasonography with and without fine-needle aspiration.  Chest. 2003;  123 442-451
    CrossrefPubMedGoogle Scholar
  • 26 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;  79 263-268
    CrossrefPubMedGoogle Scholar
  • 27 Larsen S S, Krasnik M, Vilmann P. et al . Endoscopic ultrasound guided fine needle biopsy of mediastinal lesions has a major impact on patient management in lung cancer disease.  Thorax. 2002;  57 98-103
    CrossrefPubMedGoogle Scholar
  • 28 Larsen S S, Vilmann P, Krasnik M, Dirksen A, Clementsen P, Jacobsen G K. Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies: Preliminar results from a randomised trail.  Lung Cancer.. 2005;  49 377-385
    CrossrefPubMedGoogle Scholar
  • 29 Annema J, Versteegh M I, Veselic M, Voigt P, Rabe K F. Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis and Staging of Lung Cancer and Its Impact on Surgical Staging.  J Clin Oncol.. 2005;  23 8357-8361
    CrossrefPubMedGoogle Scholar
  • 30 Annema J T, Veselic M, Versteegh M I, Willems L N, Rabe K F. Mediastinal restaging: EUS-FNA offers a new perspective.  Lung Cancer. 2003;  42 311-318
    CrossrefPubMedGoogle Scholar
  • 31 Eloubeidi M A, Seewald S, Tamhane A, Brand B, Chen V K, Yasuda I, Cerfolio R J, Omar S, Topalidis T, Wilcox C M, Soehendra N. EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies.  Gastrointest Endosc. 2004;  59 627-633
    CrossrefPubMedGoogle Scholar
  • 32 Harewood G C, Wiersema M J, Edell E S. et al . Cost-minimization analysis of alternative diagnostic approaches in a modeled patient with non-small cell lung cancer and subcarinal lymphadenopathy.  Mayo Clin Proc. 2002;  77 155-164
    PubMedGoogle Scholar
  • 33 Aabakken L, Silvestri A, Hawes R. et al . Cost-efficacy of endoscopic ultrasonography with fine-needle aspiration vs. mediastinotomy in patients with lung cancer and suspected mediastinal adenopathy.  Endoscopy. 1999;  31 707-711
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Wiersema M J, Chak A, Wiersema L M. Mediastinal histoplasmosis: evaluation with endosonography and endoscopic fine-needle aspiration biopsy.  Gastrointest Endosc. 1994;  40 78-81
    PubMedGoogle Scholar
  • 35 Wiersema M J, Vazquez-Sequeiros E, Wiersema L M. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy.  Radiology. 2001;  219 252-257
    CrossrefPubMedGoogle Scholar
  • 36 Kochhar R, Sriram P V, Rajwanshi A. et al . Transesophageal endoscopic fine-needle aspiration cytology in mediastinal tuberculosis.  Gastrointest Endosc. 1999;  50 271
    CrossrefPubMedGoogle Scholar
  • 37 Lewis J D, Faigel D O, Dowdy Y. et al . Hodgkin’s disease diagnosed by endoscopic ultrasound-guided fine needle aspiration of a periduodenal lymph node.  Am J Gastroenterol. 1998;  93 834
    CrossrefPubMedGoogle Scholar
  • 38 Fritscher-Ravens A, Sriram P VJ, Topalidis T. et al . Endoscopic ultrasonography-guided fine-needle cytodiagnosis of mediastinal metastases from renal cell cancer.  Endosc. 2000;  32 531-536
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 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;  31 377-382
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Fritscher-Ravens A, Sriram P VJ, Topalidis T. et al . Diagnosing sarcoidosis using endosonography-guided fine needle aspiration.  Chest. 2000;  118 928
    CrossrefPubMedGoogle Scholar
  • 41 Annema J T, Veselic M, Rabe K F. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis.  Eur Respir J. 2005;  25 405-409
    CrossrefPubMedGoogle Scholar
  • 42 Wildi S M, Judson M A, Fraig M, Fickling W E, Schmulewitz N, Varadarajulu S, Roberts S S, Prasad P, Hawes R H, Wallace M B, Hoffman B J. Is endosonography guided fine needle aspiration for sarcoidosis as good as we think?.  Thorax. 2004;  59 794-799
    CrossrefPubMedGoogle Scholar
  • 43 O’Toole D, Palazzo L, Arotcarena R, Dancour A, Aubert A, Hammel P, Amaris J, Ruszniewski P. Assessment of complications of EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 470-474
    CrossrefPubMedGoogle Scholar
  • 44 Barawi M, Gottlieb K, Cunha B. et al . A prospective evaluation of the incidence of bacteremia associated with EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 189-192
    CrossrefPubMedGoogle Scholar
  • 45 Annema J T, Veselic M, Versteegh M I, Rabe K F. Mediastinitis caused by EUS-FNA of a bronchogenic cyst.  Endoscopy. 2003;  35 791-793
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 vilmann P, Krasnik M, Larsen S S, Jacobsen G K, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration biopsy: a combined approach in the evaluation of mediastinal lesions.  Endoscopy. 2005;  37 833-839
    Article in Thieme ConnectPubMedGoogle Scholar

Peter Vilmann

Department of surgical gastroenterology D

Gentofte University Hospital

Niels Andersensvej 65

2900 Hellerup

Denmark

Fax: 39 77 76 29

Phone: +45 39 77 79 50

Email: pevi@gentoftehosp.kbhamt.dk

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