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Vol. 43. Issue 4.
Pages 219-224 (April 2007)
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Vol. 43. Issue 4.
Pages 219-224 (April 2007)
Original Articles
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Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Mediastinal Lesions
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Glòria Fernández-Esparracha, Maria Pelliséa, Manel Soléb, Josep Beldac, Oriol Sendinoa, Josep Llacha, Alfredo Mataa, Josep Maria Bordasa, Àngels Ginèsa,
Corresponding author
magines@clinic.ub.es

Correspondence: Dra. A. Ginès. Unidad de Endoscopia. Institut de Malalties Digestives. Hospital Clínic. Villarroel, 170. 08036 Barcelona. España
a Unidad de Endoscopia, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Spain
b Departamento de Patología, Centre de Diagnòstic Biomèdic, Barcelona, Spain
c Servicio de Cirugía Torácica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
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Objective

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions.

Patients and methods

A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated.

Results

EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm × 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P <.001). The diagnosis was obtained for 53 patients (90%) and 81 lesions (91%) with a mean of 2 (1) passes per lesion. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNA were 81%, 100%, 100%, 75%, and 88%, respectively, when analyzed by lesion, and 88%, 100%, 100%, 80%, and 92% when analyzed by patient.

Conclusions

EUS-FNA is an effective technique for the diagnosis of mediastinal lesions. The likelihood of malignancy increases with size.

Key words:
Fine-needle aspiration
Endoscopic ultrasound
Mediastinum
Objetivo

La punción aspirativa con aguja fina guiada por ultrasonografía endoscópica (USE-PAAF) es una técnica eficaz y segura en el diagnóstico de las lesiones focales del páncreas y las adenopatías intraabdominales. El objetivo de este estudio es describir su utilidad en el diagnóstico de las lesiones mediastínicas.

Pacientes y métodos

Se han revisado todos los casos consecutivos a los que se realizó una USE-PAAF para estudio de una lesión mediastínica desde enero de 2001 hasta septiembre de 2003. Las exploraciones se efectuaron con un ecoendoscopio radial para estudio de las características de la lesión y un ecoendoscopio sectorial para realizar la punción transesofágica usando una aguja de 22 G. Se utilizó como referencia la cirugía en los pacientes operados y el resultado de la citología obtenida con la USE-PAAF en los casos en que el tratamiento quirúrgico no estaba indicado.

Resultados

Se realizó USE-PAAF a 59 pacientes con un total de 89 lesiones, con diámetro medio ± desviación estándar de 2,4 ± 2 × 1,6 ± 1,4 cm. El tamaño de las lesiones malignas fue mayor que el de las benignas (diámetro corto: 2,7 ± 1,4 frente a 1 ± 0,9 cm, respectivamente; p < 0,001). El material obtenido permitió el diagnóstico en 53 pacientes (90%) y en 81 lesiones (91%), y el número de pases fue de 2 ± 1 por lesión. La sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la precisión para el diagnóstico fueron del 81, el 100, el 100, el 75 y el 88%, respectivamente (el 88, el 100, el 100, el 80 y el 92% al analizarlos por paciente).

Conclusiones

La USE-PAAF es una técnica eficaz en el estudio de la patología mediastínica. La probabilidad de malignidad es mayor cuanto mayor es el tamaño de la lesión.

Palabras clave:
Punción aspirativa
Ultrasonografía endoscópica
Mediastino
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This study was partially funded by a grant from Instituto de Salud Carlos III (03/10066).

Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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