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Tow K. Lim - One of the best experts on this subject based on the ideXlab platform.
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eus guided fna immediately after unrevealing transbronchial needle aspiration in the evaluation of Mediastinal Lymphadenopathy a prospective study
Gastrointestinal Endoscopy, 2006Co-Authors: Kayleong Khoo, B Nilsson, Tow K. LimAbstract:Background Transbronchial needle aspiration (TBNA) and EUS-guided FNA (EUS-FNA) are minimally invasive diagnostic approaches to Mediastinal Lymphadenopathy. Rapid on-site cytopathologic evaluation (ROSE) may facilitate the decision whether to proceed to a second procedure in the same session. The aim of this study was to determine the utility of TBNA with ROSE, combined with the option for immediate EUS-FNA in a single-session approach to Mediastinal Lymphadenopathy. Methods We prospectively recruited 20 patients (12 men; mean age 66.7 ± 10.2 years) with Mediastinal Lymphadenopathy on CT who required cytopathologic evaluation. Bronchoscopy was first performed with TBNA and ROSE. If this was unrevealing, EUS-FNA was performed immediately afterward with ROSE. All procedures were performed with the patient under local anesthesia and sedation. Results TBNA specimens were deemed adequate on-site in 13 patients, and EUS-FNA was performed in the remaining 7 patients. TBNA with ROSE was falsely negative in one patient. The diagnostic yield for TBNA and EUS-FNA alone was 65% and 86%, respectively. This single-session approach provided a yield of 90%, with no complications. The final diagnoses were 12 non-small-cell lung cancer, two small-cell lung cancer, one metastatic adenocarcinoma, two sarcoidosis, one tuberculosis, one lymphoma, and one with no definitive diagnosis. Conclusions Combining TBNA with the option for EUS-FNA immediately after unrevealing TBNA gave a yield approaching that of mediastinoscopy and, therefore, may reduce the need for invasive Mediastinal sampling. This single-session endoscopic approach was safe, required only local anesthesia and sedation, was convenient, and obviated the need for patients to return for a second procedure.
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Transbronchial Needle Aspiration Followed Immediately by Endoscopic Ultrasound Guided Needle Aspiration in the Evaluation of Mediastinal Lymphadenopathy
Gastrointestinal Endoscopy, 2005Co-Authors: Khay L. Khoo, Tow K. LimAbstract:Transbronchial Needle Aspiration Followed Immediately by Endoscopic Ultrasound Guided Needle Aspiration in the Evaluation of Mediastinal Lymphadenopathy Khay L. Khoo, Khek Y. Ho, Tow K. Lim Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is a useful diagnostic tool in the evaluation of Mediastinal Lymphadenopathy, both as a primary modality and in cases of negative transbronchial needle aspiration (TBNA). Aim: To determine the utility of TBNA with rapid on-site cytopathologic evaluation (ROSE) combined with the option for immediate EUS-FNA in the diagnosis of Mediastinal adenopathy of unknown etiology. Methods: We prospectively enrolled patients with Mediastinal Lymphadenopathy on CT scan who required cytologic evaluation. We first performed flexible videobronchoscopy with TBNA. If TBNA was inadequate on ROSE, EUS-FNA was performed immediately, all under topical anesthesia, conscious sedation, and in the same outpatient sitting. The same cytotechnologist was in attendance during both the consecutive procedures to make smears for instant examination. The procedures were terminated when adequate cellular specimens were achieved, or a maximum of six needle passages was done. Results: Twenty patients with Mediastinal Lymphadenopathy on chest CT underwent TBNA with ROSE. The TBNA specimens were adequate in 13 patients. In the remaining 7 patients, TBNA with ROSE was assessed to be inadequate; thus, EUS-FNA was also performed. Upon cytologic confirmation, TBNA with ROSE was falsely negative in one patient. The diagnostic yield of TBNA was thus 70%. EUS-FNA was positive in 6 of 7 patients, giving a diagnostic yield of 86%. Overall, this combined minimally invasive approach to Mediastinal Lymphadenopathy, which was well tolerated by all patients with no adverse effects, provided a diagnostic yield of 90%. The final diagnoses were non-small cell cancer (nZ 11), small cell cancer (nZ 2), metastatic adenocarcinoma (nZ 1), sarcoidosis (nZ 1), tuberculosis (nZ 1), and lymphoma (n Z 1). In the first case where this approach failed to give a diagnosis, TBNA showed lymphocytes but interval CT did not show progression of the Lymphadenopathy. The second patient had non-small-cell lung cancer. Conclusions: TBNA with ROSE combined with the option for back-to-back EUS-FNA raised the diagnostic yield of TBNA alone from 70% to 90%. This combined approach is safe, convenient and potentially cost-effective for the patient, who needs not undergo another procedure on another day. Abstracts
Lisa M Wiersema - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Mediastinal Lymphadenopathy with endoscopic us guided fine needle aspiration biopsy
Radiology, 2001Co-Authors: Maurits J Wiersema, Enrique Vazquezsequeiros, Lisa M WiersemaAbstract:PURPOSE: To evaluate the safety and accuracy of endoscopic ultrasonography (US)–guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior Mediastinal regions. MATERIALS AND METHODS: Eighty-six consecutive patients with Mediastinal Lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US–guided FNAB of Mediastinal Lymphadenopathy was performed as a component of staging non–small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results. RESULTS: In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US–guided FNAB in distinguishing benign from malignant Mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who und...
Sahar Elkhamary - One of the best experts on this subject based on the ideXlab platform.
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Diffusion-weighted MR imaging of Mediastinal Lymphadenopathy in children
Japanese Journal of Radiology, 2015Co-Authors: Ahmed Abdel Khalek Abdel Razek, Ghada Gaballa, Rasha Elashry, Sahar ElkhamaryAbstract:Purpose To assess Mediastinal Lymphadenopathy in children with diffusion-weighted MR imaging. Materials and methods Retrospective analysis of 29 consecutive children (18 boys and 11 girls aged 2–15 years) with Mediastinal Lymphadenopathy. They underwent single-shot echo planar diffusion-weighted MR imaging of the mediastinum with b factors of 0, 300, and 600 s/mm^2. The ADC value of the Mediastinal lymph nodes was calculated and correlated with biopsy results; statistical analysis was also performed. Results The mean ADC value for malignant Mediastinal Lymphadenopathy ( n = 20) (0.99 ± 0.18 × 10^−3 mm^2/s) was significantly lower ( P = 0.001) than that for benign Lymphadenopathy ( n = 9) (1.35 ± 0.26 × 10^−3 mm^2/s). There was significant difference between ADC values for non-Hodgkin lymphoma and metastatic nodes ( P = 0.04). For differentiating malignant from benign Mediastinal Lymphadenopathy, the best result was obtained when an ADC value of 1.22 × 10^−3 mm^2/s was used as a threshold value; area under the curve was 0.861, accuracy 93.1 %, sensitivity 100 %, specificity of 77.8 %, positive predictive value 90.9 %, and negative predictive value of 100 %. Conclusion Diffusion-weighted MR imaging is a promising non-invasive imaging modality that can be used for differentiation of malignant from benign Mediastinal Lymphadenopathy in children.
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Diffusion-weighted MR imaging of Mediastinal Lymphadenopathy in children.
Japanese Journal of Radiology, 2015Co-Authors: Ahmed Abdel Khalek Abdel Razek, Ghada Gaballa, Rasha Elashry, Sahar ElkhamaryAbstract:Purpose To assess Mediastinal Lymphadenopathy in children with diffusion-weighted MR imaging.
Maurits J Wiersema - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Mediastinal Lymphadenopathy with endoscopic us guided fine needle aspiration biopsy
Radiology, 2001Co-Authors: Maurits J Wiersema, Enrique Vazquezsequeiros, Lisa M WiersemaAbstract:PURPOSE: To evaluate the safety and accuracy of endoscopic ultrasonography (US)–guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior Mediastinal regions. MATERIALS AND METHODS: Eighty-six consecutive patients with Mediastinal Lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US–guided FNAB of Mediastinal Lymphadenopathy was performed as a component of staging non–small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results. RESULTS: In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US–guided FNAB in distinguishing benign from malignant Mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who und...
N Kaushik - One of the best experts on this subject based on the ideXlab platform.
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Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated Mediastinal Lymphadenopathy.
Endoscopy, 2010Co-Authors: R Puri, P Vilmann, R Sud, M Kumar, S Taneja, K Verma, N KaushikAbstract:Patients with suspected tuberculosis without pulmonary lesions and with Mediastinal Lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate Mediastinal and abdominal lesions. The aim of the present study was to evaluate the role of EUS-FNA in isolated Mediastinal Lymphadenopathy in patients suspected of having tuberculosis. Consecutive patients suspected of having tuberculosis with isolated Mediastinal Lymphadenopathy were included in a prospective study. Mediastinal Lymphadenopathy was diagnosed on a contrast-enhanced computed tomography scan of the chest. Patients with concomitant lung parenchymal lesions were excluded. Previous attempts to diagnose the etiology of Lymphadenopathy had failed in 69 % of patients. EUS-FNA was performed on an outpatient basis under conscious sedation. The sensitivity, specificity, and diagnostic accuracy of EUS-FNA were calculated. A total of 60 consecutive patients (mean age 39.8 years, 58 % males) with Mediastinal Lymphadenopathy were included. EUS confirmed the presence of Mediastinal lymph nodes ranging in size from 8 mm to 40 mm (mean 26 mm) in all patients. EUS-FNA provided an adequate tissue sample in 54 patients during the first examination and repeat EUS-FNA was necessary in six patients. A final diagnosis was obtained by EUS-FNA in 42 patients (tuberculosis in 32, sarcoidosis in six, and Hodgkin's disease in four patients). An additional 14 patients were treated for tuberculosis based on EUS-FNA and clinical features. Mediastinoscopy was required for diagnosis in the remaining four patients. EUS-FNA had an overall diagnostic yield of 93 %, sensitivity of 71 %, specificity of 100 %, and positive predictive value of 100 %. EUS-FNA is an accurate, safe, and minimally invasive modality for evaluating isolated Mediastinal Lymphadenopathy in patients suspected of having tuberculosis in an endemic area with a high prevalence of tuberculosis. Georg Thieme Verlag KG Stuttgart.New York.
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Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated Mediastinal Lymphadenopathy.
Endoscopy, 2010Co-Authors: R Puri, P Vilmann, R Sud, M Kumar, S Taneja, K Verma, N KaushikAbstract:BACKGROUND AND STUDY AIMS: Patients with suspected tuberculosis without pulmonary lesions and with Mediastinal Lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate Mediastinal and abdominal lesions. The aim of the present study was to evaluate the role of EUS-FNA in isolated Mediastinal Lymphadenopathy in patients suspected of having tuberculosis. METHODS: Consecutive patients suspected of having tuberculosis with isolated Mediastinal Lymphadenopathy were included in a prospective study. Mediastinal Lymphadenopathy was diagnosed on a contrast-enhanced computed tomography scan of the chest. Patients with concomitant lung parenchymal lesions were excluded. Previous attempts to diagnose the etiology of Lymphadenopathy had failed in 69 % of patients. EUS-FNA was performed on an outpatient basis under conscious sedation. The sensitivity, specificity, and diagnostic accuracy of EUS-FNA were calculated. RESULTS: A total of 60 consecutive patients (mean age 39.8 years, 58 % males) with Mediastinal Lymphadenopathy were included. EUS confirmed the presence of Mediastinal lymph nodes ranging in size from 8 mm to 40 mm (mean 26 mm) in all patients. EUS-FNA provided an adequate tissue sample in 54 patients during the first examination and repeat EUS-FNA was necessary in six patients. A final diagnosis was obtained by EUS-FNA in 42 patients (tuberculosis in 32, sarcoidosis in six, and Hodgkin’s disease in four patients). An additional 14 patients were treated for tuberculosis based on EUS-FNA and clinical features. Mediastinoscopy was required for diagnosis in the remaining four patients. EUS-FNA had an overall diagnostic yield of 93 %, sensitivity of 71 %, specificity of 100 %, and positive predictive value of 100 %. CONCLUSION: EUS-FNA is an accurate, safe, and minimally invasive modality for evaluating isolated Mediastinal Lymphadenopathy in patients suspected of having tuberculosis in an endemic area with a high prevalence of tuberculosis.