Clinical impact of isolated mediastinal and hilar lymphadenopathy (IMHL). Insights from thoracic endosonography (EBUS/EUS-b).
A. Papaporfyrioua (Dr), T. Karampitsakosb (Mr), S. Koukidoua (Ms), M. Anyfantic (Mrs), E. Zervasa (Mr), G. Hillasa (Dr), A. Tzouvelekisb (Prof), K. Dimakoua (Dr), S. Chrysikos*a (Dr)
a Sotiria Athens Chest Diseases Hospital, Athens, GREECE ; b Department of Respiratory Medicine, University Hospital of Patras, Greece, Patras, GREECE ; c ICU, G Gennimatas, General Hospital, Athens, Greece, Athens, GREECE
Background: Patients with IMHL are always a challenge for the clinician. Often an invasive procedure is required to obtain tissue for cytopathological and microbiologic assessment.
Aim:To evaluate the performance of EBUS/EUS-b for diagnosing IMHL.
Methods: We conducted a prospective study in‘’Sotiria’’ Athens chest hospital from September 2016 to September 2021. Patients with IMHL on chest computed tomography underwent EBUS/EUS-b as the first evaluation.Patients with known or suspected primary lung cancer were excluded. Final diagnosis was made using cytopathology or microbiology reports.
Results: Overall, 140 patients with IMHL underwent EBUS/EUS-b [mean age 57.1 years (SD = 14.3), men 83, smokers 61.4%]. EUS-b alone or in combination with EBUS was performed in 10.7%. In total, 270 lymph nodes were sampled (264 through EBUS/ 15 through EUS-b).Diagnostic yield of EBUS/EUS-b was 65%. Most cases (n = 59, 42.1%) involved benign disease (88.1% sarcoidosis/10.2% tuberculosis), 22.9% malignant disease (62.6% primary lung cancer, 21.9% metastatic, and 12.5% lymphoma), while 35 % (n=49) of patients remained undiagnosed. Mediastinoscopy was performed in 18.4% of patients with non-diagnostic EBUS, while the rest (79.6%) remained in clinical and radiological follow up for at least six months. Diagnosis was achieved in 21% of patients with negative EBUS [sarcoidosis (n=4), lymphoma (n=1), primary lung cancer (n=2), other (n=2)]. Reactive lymphadenopathy was identified in 28.5%. Sensitivity, specificity, positive and negative predictive value of EBUS/EUS-b in total was 91%, 100%, 100%, and 81.6%, respectively. For sarcoidosis,the sensitivity was93%.
Conclusion: In patients with IMHL, EBUS/EUS-b is a reliable and effective first-line diagnostic technique.
Disclosure of funding source(s): none