Evaluating the Diagnostic Accuracy of EBUS-Guided FNA for FDG-PET-Avid Lymph Nodes in Patients with Extrapulmonary Cancers
Keywords:
Endobronchial Ultrasound (EBUS), Fine Needle Aspiration (FNA), Lymph Nodes, Extrapulmonary MalignanciesAbstract
Background: Finding fluorodeoxyglucose (FDG)-avid mediastinal and hilar lymphadenopathy on positron emission tomography-computed tomography (PET-CT) in patients with extrapulmonary malignancies is a concern for metastatic disease. Yet PET-CT is not specific enough to differentiate malignant from benign etiology of lymphadenopathy. Objective: To evaluate the diagnostic performance of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in the assessment of FDG-PET-avid lymph nodes in patients with established extrapulmonary malignancies. Methodology: A retrospective study was done in 145 patients with extrapulmonary cancers who were subjected to EBUS-FNA for FDG-PET-avid mediastinal or hilar lymph nodes. Demographic information, initial cancer diagnoses, PET-CT results, lymph node features, EBUS-FNA cytology findings, and discharge diagnoses were retrieved and compared. Results: In the present study182 lymph nodes were sampled in 145 patients. The average age was 58.6 ± 10.4 years, with a male predominance (60%). The most frequent primary malignancies were gastrointestinal (26.2%), breast (22.8%), and genitourinary (16.6%) cancers. Malignant cytology was obtained with EBUS-FNA in 81 cases (55.9%), benign reactive lymphadenopathy in 35 (24.1%), granulomatous inflammation in 17 (11.7%), and was non-diagnostic in 12 (8.3%). Final diagnoses were confirmed by EBUS-FNA alone (82.8%), mediastinoscopy (7.6%), or clinical/radiologic follow-up (9.6%). Conclusion: EBUS-FNA has excellent specificity and high diagnostic accuracy in assessing FDG-PET-avid lymphadenopathy in patients with extrapulmonary malignancies. It facilitates accurate and minimally invasive tissue sampling, decreasing the requirement for surgical procedures and facilitating proper staging and treatment planning. EBUS-FNA is the first-line diagnostic tool in this clinical setting.References
Hui D, Paiva CE, Del Fabbro EG, Steer C, Naberhuis J, van de Wetering M, et al. Prognostication in advanced cancer: update and directions for future research. Support Care Cancer. 2019;27:1973-84. DOI: 10.1007/s00520-019-04727-y.
Paydary K, Seraj SM, Zadeh MZ, Emamzadehfard S, Shamchi SP, Gholami S, et al. The evolving role of FDG-PET/CT in the diagnosis, staging, and treatment of breast cancer. Mol Imaging Biol. 2019;21:1-10. DOI: 10.1007/s11307-018-1234-4.
Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis. Eur J Cancer. 2013;49(8):1860-7. DOI: 10.1016/j.ejca.2013.01.033.
Lin X, Ubago JM, Ali R, Al Asadi A, Riaz A. Lungs, Mediastinum, and Pleura. Atlas Cytopathol Radiol. 2020:29-64. DOI: 10.1007/978-3-030-33647-9_4.
Navani N. The role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy [dissertation]. London: University College London; 2010.
McHugh KE, Policarpio-Nicolas ML. Metastatic SMARCB1 (INI-1)-deficient sinonasal carcinoma diagnosed by endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA): a potential diagnostic pitfall and review of the literature. Acta Cytol. 2019;63(5):431-7. DOI: 10.1159/000501749.
Navani N. The role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy [dissertation]. London: University College London; 2010.
Gupta AK, Lodha R, Kabra SK. Non cystic fibrosis bronchiectasis. Indian J Pediatr. 2015;82:938-44. DOI: 10.1007/s12098-015-1769-1.
Tournoy KG, Rintoul RC, van Meerbeeck JP, Carroll NR, Praet M, Buttery RC, van Kralingen KW, Rabe KF, Annema JT. EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy. Lung Cancer. 2009;63(1):45-9. DOI: 10.1016/j.lungcan.2008.04.014.
Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8. DOI: 10.1136/thx.2005.046649.
Yasufuku K, Nakajima T, Fujiwara T, Yoshino I, Keshavjee S. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg. 2011;91(3):831-6. DOI: 10.1016/j.athoracsur.2010.11.012.
Whitson BA, Groth SS, Odell DD, Briones EP, Maddaus MA, D'Cunha J, et al. True negative predictive value of endobronchial ultrasound in lung cancer: are we being conservative enough? Ann Thorac Surg. 2013;95(5):1689-94. DOI: 10.1016/j.athoracsur.2013.01.020.
Korkmaz C, Demirbas S, Vatansev H. The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes. Medicine (Baltimore). 2021;100(7):e24728. DOI: 10.1097/MD.0000000000024728.
Murthi M, Donna E, Arias S, Villamizar NR, Nguyen DM, Holt GE, et al. Diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in real life. Front Med. 2020;7:118. DOI: 10.3389/fmed.2020.00118.
Jhun BW, Um SW, Suh GY, Chung MP, Kim H, Kwon OJ, et al. Clinical value of endobronchial ultrasound findings for predicting nodal metastasis in patients with suspected lymphadenopathy: a prospective study. J Korean Med Sci. 2014;29(12):1632-8. DOI: 10.3346/jkms.2014.29.12.1632.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Chest Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
