EBUS-TBNA FOR HILIOMEDIASTINAL LYMPH NODES DIAGNOSIS IN NON-PULMONARY NEOPLASMS

Abstract

Introduction: CT or PET scan detects enlarged mediastinal lymph nodes (LN) in many extrathoracic neoplasms, that must be ruled out to be metastatic to decide adequate therapies. The objective of the study is to analyze EBUS-TBNA in the diagnosis of these LN.

Method: Retrospective analysis of patients undergoing EBUS-TBNA in our center, with non-pulmonary neoplasms, in order to diagnose hiliomediastinal enlarged LN, from February 2016 to September 2019.

Results: 453 procedures analyzed, 88 patients met study criteria. Median age 61.2 , 45 male. EBUS was performed in outpatient regime under conscious sedation. Primary neoplasm was digestive (22), breast (20), urological (10), hematological (9), ENT (9), gynecological (7), sarcoma (4), skin (4) and combined (3). 190 punctures performed, 3.55 passes per LN. Punctured LN station was 7 (n=69), 4R (n=38), 4L (n=28), 2R (n=13), 11L (n=12), 11R (n=11), 10R (n=6), 2L (n=5), 10L (n=3), 3p (n=1) and 8 (n=1). Cell block obtained in 117 cases (61.5%). Needle size 19G (n=1), 21G (n=23), 22G (n=12), not recorded (n=52). Malignancy diagnosis achieved in 25 cases (28.4%), sarcoidosis in 11 (12.5%) and negative in 52 (59.1%). EBUS-TBNA provided diagnosis in 36 cases (40.9%). Surgical exploration done in 28 cases, confirming 5 cases with EBUS-TBNA sarcoidosis diagnosis, and 2 cases with EBUS-TBNA malignancy diagnosis. In 22 cases with EBUS-TBNA negative diagnosis, mediastinoscopy was negative in 17, sarcoidosis in 3 and malignancy in 2.

Conclusion: EBUS-TBNA is an useful technique to diagnose hiliomediastinal LN in non-lung neoplasms, avoiding surgical exploration. Frequent presence of sarcoidosis forces cytohistological diagnosis before deciding oncological therapies.