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Transbronchial needle aspiration accurately diagnoses subcentimetre mediastinal and hilar lymph nodes detected by integrated positron emission tomography and computed tomography
Author(s) -
HSU LiHan,
KO JenSheng,
YOU DongLing,
LIU ChiaChuan,
CHU NeiMin
Publication year - 2007
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2007.01164.x
Subject(s) - medicine , radiology , lymph , positron emission tomography , lymph node , cytopathology , lung cancer , pet ct , mediastinal lymph node , tomography , sampling (signal processing) , mediastinum , nuclear medicine , cancer , cytology , pathology , metastasis , computer science , computer vision , filter (signal processing)
Objective and background: Integrated PET and CT (PET/CT) is accurate in detecting hilar‐mediastinal metastases. However, it has a moderate positive predictive value, necessitating pathological verification, especially in situations in which the result would make a difference to treatment. This study aimed to evaluate the performance of transbronchial needle aspiration (TBNA) for hilar‐mediastinal lesions suspicious on PET/CT. Methodology: A retrospective study was conducted on 19 patients with a total of 25 positive hilar‐mediastinal lymph nodes localized on PET/CT. Standard TBNA technique with rapid on‐site cytopathology was performed. Results: The mean short‐axis diameter of the positive lymph nodes identified on PET/CT was 9.9 ± 3.0 mm. The sensitivity, specificity and diagnostic accuracy of PET/CT‐guided TBNA were 81.8%, 100% and 84%, respectively. The number of needle passes to successful lymph node aspiration or a diagnosis of cancer was 2.36 ± 0.49. Nine of the 25 positive lymph nodes (36%) on PET/CT were smaller than 1.0 cm. The accuracy and sensitivity of TBNA for these subcentimetre nodes was 88.9% and 87.5%, respectively. TBNA replaced s urgical sampling in 15 patients (78.9%) with positive lymph nodes on PET/CT. In seven non‐small cell lung cancer patients, diagnosis and staging were possible in the one procedure. No complications were encountered. Conclusion: PET/CT can identify small malignant lymph nodes that can then be successfully biopsied by TBNA with on‐site cytopathology.