Endoscopic ultrasound-guided fine needle aspiration is useful for nodal staging in patients with pleural mesothelioma

Patients with malignant pleural mesothelioma and negative N2 stage lymph nodes may benefit from extrapleural pneumonectomy with adjuvant therapy. The objective of this study is to describe the use of EUS-FNA to determine N2 stage status in patients with mesothelioma and its impact in the management of such patients. Six patients (mean age, 62 yr; median age, 63 yr; range, 52-70 yr; 5 men; 1 woman) underwent EUS-FNA for staging of N2 lymph nodes from July 2000 to July 2006. Follow-up included operative notes, treatment summaries, and surgical pathology. Eight sites were aspirated: four subcarinal lymph nodes, three aorto-pulmonary window lymph nodes, and one paraesophageal mass. Two of 8 (25%) aspirates were positive for metastatic disease in two different patients. Two false negative EUS-FNAs were observed and were attributed to sampling error not diagnostic error. No complications were observed. EUS-FNA is a safe N2 node staging technique in patients with mesothelioma. A positive N2 lymph node by EUS-FNA may be a contraindication to definitive surgery in patients with malignant mesothelioma.     

Impact of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lymph nodal and mediastinal lesions: a multicenter experience

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established procedure in lung cancer (LC) staging and in the diagnosis of mediastinal masses. Most of the experiences reported refer to single specialized centers where dedicated teams of endoscopists and pathologists perform the procedure. We report the EUS-FNA experience of a cooperation group involving clinicians and cytopathologists from three hospitals. Fifty-seven consecutive EUS-FNA of mediastinal nodes in LC patients, eight mediastinal and two subdiaphragmatic masses were collected in 3 years. EUS-FNA was performed by two endoscopists and three experienced pathologists. On-site evaluation was performed in all cases by the three cytopathologists. Lymph node negative cases underwent surgery, which confirmed the cytological diagnoses but also detected two false negatives. Four of the 10 EUS cytological diagnoses of mediastinal and subdiaphragmatic masses were histologically confirmed. All EUS diagnoses were blindly reviewed by three pathologists to assess intra and interpersonal reproducibility. FNA-EUS diagnoses were: 10 inadequate (17%), 10 negative (17%), 4 suspicious (7%) and 33 positive (59%). Diagnoses of mediastinal and subdiaphragmatic masses were: relapse of lung carcinoma (3), mesenchimal tumor not otherwise specifiable (3), gastrointestinal stromal tumor (GIST) (1), esophageal carcinoma (2) and paraganglioma (1). The sensitivity attained was 85% and the specificity 100%; revision of the slides demonstrated a significant diagnostic reproducibility of the three cytopathologists (P < 0.5). The sensitivity and specificity attained were similar to those reported in the literature suggesting that experienced cytopathologists and endoscopists from different institutions can employ the same procedure reaching comparable results.     

Endoscopic ultrasound–guided fine needle aspiration as a diagnostic and staging tool for rectal and perirectal lesions—an institutional experience

The role of endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) in evaluating lesions adjacent to the upper gastrointestinal tract wall is well established. However, this tool is underused in evaluating rectal and perirectal lesions, possibly due to insufficient experience and underrecognized value of this procedure. In this study, we report our institutional experience with EUS-FNA as a diagnostic and staging tool for rectal and perirectal lesions. A retrospective chart review was performed and a cohort of 38 patients who underwent rectal EUS-FNA (41 specimens) at our institution between January 2002 and July 2012 was retrieved. The cytology diagnoses were compared with the concurrent or follow-up histologic and clinical diagnoses. Among the total 41 cases, rectal EUS-FNA was performed as a diagnostic procedure in 22 (54%) and a staging procedure in 19 (46%) cases. On cytology examination, 18 cases (44%) were diagnosed as malignant; 1 (2%), as atypical/suspicious for malignancy; 3 (7%), as benign neoplastic; 13 (32%), as nonneoplastic; and 6 (15%), as nondiagnostic cases. Concurrent or follow-up histologic diagnoses were available in 20 cases (48%), 19 of them had concordant cytological/histologic findings (10 benign, 9 malignant). One perirectal lymph node with negative cytology diagnosis was found to be positive on histologic examination, probably due to sampling error on cytology. The sensitivity and specificity of EUS-FNA for detecting malignant rectal/perirectal lesions in this study were 91% and 100%, respectively. Endoscopic ultrasound–guided fine needle aspiration is a useful diagnostic tool for rectal/perirectal lesions; it confirms or excludes malignancy for lesions with high or low clinical suspicions. It serves as a reliable staging method to identify patients for proper clinical management.     

Impact of parenchymal tuberculosis sequelae on mediastinal lymph node staging in patients with lung cancer

Because tuberculous (TB) involvement of mediastinal lymph nodes (LN) could cause false positive results in nodal staging of lung cancer, we examined the accuracy of nodal staging in lung cancer patients with radiographic sequelae of healed TB. A total of 54 lung cancer patients with radiographic TB sequelae in the lung parenchyma ipsilateral to the resected lung, who had undergone at least ipsilateral 4- and 7-lymph node dissection after both chest computed tomography (CT) and fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT were included for the analysis. The median age of 54 subjects was 66 yr and 48 were males. Calcified nodules and fibrotic changes were the most common forms of healed parenchymal pulmonary TB. Enlarged mediastinal lymph nodes (short diameter > 1 cm) were identified in 21 patients and positive mediastinal lymph nodes were identified using FDG-PET/CT in 19 patients. The overall sensitivity and specificity for mediastinal node metastasis were 60.0% and 69.2% with CT and 46.7% and 69.2% with FDG-PET/CT, respectively. In conclusion, the accuracy of nodal staging using CT or FDG-PET/CT might be low in lung cancer patients with parenchymal TB sequelae, because of inactive TB lymph nodes without viable TB bacilli.     

The role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in distinguishing pancreatic cystic lesions

Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed.Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.     

Size and histologic characteristics of lymph node material retrieved from tissue discarded after routine pathologic examination of lung cancer resection specimens

Redissection of discarded lung resection specimens after routine pathology examination reveals missed lymph node metastasis. We sought to determine if size can be used to grossly select lymph nodes for microscopic examination. This is a prospective cohort study of lymph nodes retrieved from discarded lung resection specimens. The association between size and histologic characteristics of retrieved material was compared by the Wilcoxon-Mann-Whitney test. We retrieved 1094 grossly ‘lymph node–like” tissue from 112 remnant lung resection specimens, of which 345 (32%) proved not to be lymph nodes and 71 (9%) of 749 lymph nodes had metastasis. Metastasis was present in discarded nodes in 26 (23%) of 112 patients. The non–lymph node tissue was significantly smaller than lymph nodes (P < .0001); lymph nodes with metastases were significantly larger than those without metastases (P < .0001). However, there was significant size overlap between the 3 types of grossly lymph node–like tissue. Thirty-two percent of nodes with metastasis were less than 1 cm; 15% of patients had at least 1 lymph node less than 1 cm with metastasis. The size difference between lymph nodes with and without metastasis is clinically unhelpful because of broad overlap. Size is insufficiently discriminatory and cannot be relied on to select materials for histologic examination. A third of grossly retrieved material was non–lymph node tissue. This probably occurs during routine pathologic examination and likely contributes to the low N1 lymph node count.     

A correlation study on diagnostic endoscopic ultrasound-guided fine-needle aspiration of lymph nodes with histological and clinical diagnoses, the UCLA Medical Center experience

Endoscopic ultrasound guided (EUS) FNA procedure has two aspects, the endoscopic sampling and the FNA interpretation. The two aspects of the procedure are performed in two different disciplines; gastroenterology (EUS) and pathology (FNA). The aim of this study was to evaluate the concordance, sensitivity, specificity, positive predictive (PPV), and negative predictive values (NPV).Sixty-one EUS-FNA procedures of the lymph nodes were analyzed by correlating the FNA results with histological or clinical diagnoses. The lymph nodes were divided in five groups; mediastinal, gastrohepatic, peripancreatic, portal, and perirectal.The study showed a concordance of 92% in mediastinal, 80% in gastrohepatic, 81% in peripancreatic, 95% in portal, and 100% in perirectal lymph nodes with an overall sensitivity of 84%, specificity of 92%, PPV of 88%, and NPV of 89%. In conclusion, EUS-FNA offers an invaluable approach for diagnostic examination of the internal lymph nodes where percutaneous FNA is either difficult or impossible. impossible.     

Acetonbehandlung zur Lymphknotenpräparation beim Staging von kolorektalen Resektaten

Lymph node staging is the most important prognostic factor after radical surgery for colorectal carcinoma. The probability of correctly classifying a colorectal tumor increases with the number of lymph nodes harvested. This number varies with the methods used by the pathologist. An accurate examination of the surgical specimens is essential for the correct assessment of the lymph node status of the tumor. The purpose of this study was to evaluate an easy fat clearance method using pure acetone. A total of 188 surgical specimens of colorectal carcinoma were investigated. The first lymph node preparation was made using the manual method. Thereafter, the mesenteric fat tissue was treated with pure acetone for 16 h and subjected to a second lymph node examination. In 111 of the samples the required number of 12 lymph nodes for TNM classification was not reached by the manual preparation method. With the acetone treatment, 12 or more lymph nodes were found 91% of these samples (average 27 lymph nodes). In 29 samples (15%) additional lymph node metastases could be detected. In 16 samples (8% of all investigated samples) an upstaging of the pN status was necessary. This indicates the importance of our method for the optimal lymph node staging of colorectal carcinomas. Lymph node preparation after acetone treatment is an easy, low cost method resulting in a much larger number of lymph nodes for more accurate staging.     

Utility of endoscopic ultrasound‐guided fine‐needle aspiration in the diagnosis and staging of colorectal carcinoma

The objective of this study is to assess the utility of endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) in the diagnosis and staging of colorectal cancer. The study includes patients who underwent EUS‐FNA at our institution for staging of colorectal carcinoma or for evaluation peri‐rectal masses or distal metastases from August 2000 to November 2010. We assessed the frequency with which EUS‐FNA procedure confirms the diagnosis of malignancy and the percent of cases in which it modifies staging of colorectal carcinoma. Using histology as a reference standard, we also assessed the diagnostic performance. We identified 79 cases of EUS‐FNA from 77 patients, mean (SD) age of 60 (12.5), 44 males. Twenty‐seven (34%) aspirates were from patients with primary rectal/peri‐rectal masses, 15 (19%) were from patients with suspected regional lymph node metastasis, and 37 (47%) were cases of suspected of distal metastasis. All lesions were clinically suspicious for primary or metastatic colorectal carcinoma. On cytologic examinations, 43 (54%) cases were confirmed as malignant, 6 (8%) were benign neoplasms, 4 (5%) were suspicious for malignant neoplasm, 2 (3%) showed atypical cells, and the rest 24 (30%) were negative for neoplasms. Fourteen of 27 (52%) of the local rectal masses were confirmed as colorectal carcinoma. Eleven of 15 (73%) regional lymph nodes were positive for metastasis—all, but two of these metastases, were of colorectal origin. Twenty of 37(54%) distal lesions were metastatic neoplasms and 15 of those were colorectal in origin. Diagnosis of primary colorectal carcinoma was confirmed in 52% of the clinically suspicious primary lesions and in 42% regional or distal metastatic lesions. Using histology as a reference standard in 27 of 79 (29%) cases, we calculated an overall sensitivity, specificity, and positive and negative predictive values (C.I) of EUS‐FNA of 89% (74–100%), 79% (50–100%) 89% (74–100%), and 79% (51–100%). EUS‐FNA is useful for assessing primary and metastatic colorectal lesion. This technique improves staging of suspected nodal or distant metastases. Diagn. Cytopathol. 2013;41:1031–1037. © 2011 Wiley Periodicals, Inc.     

Endoscopic ultrasound-guided fine-needle aspiration of lymph nodes: the Hennepin County Medical Center experience

Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) allows for the sampling and diagnosis of lesions of the gastrointestinal system and adjacent tissues. It has also proved helpful with the sampling of lymphadenopathy both for the staging of malignancy and for the diagnosis of lymphadenopathy of other causes. We review our experience with EUS-guided FNA of lymph nodes. The cytology files were searched at Hennepin County Medical Center (HCMC) for all cases of lymph nodes sampled by EUS. Clinical history, biopsy site, diagnosis, and follow-up information (including ancillary testing) were reviewed. Between January 1, 2000 and December 5, 2002, 217 lymph nodes from 185 different patients were sampled by EUS at HCMC. Biopsy sites included 62 mediastinal, 9 paraesophageal, and 146 intra-abdominal lymph nodes. Diagnoses were as follows: metastatic non-small cell carcinoma (n = 69); benign, reactive lymph node (n = 76); granulomatous lymphadenopathy (n = 18); malignant lymphoma (n = 7); atypical-suspicious for malignancy (n = 5); metastatic small cell carcinoma (n = 2); necrotic debris (n = 4), and foreign material (n = 1); 35 cases were nondiagnostic (16.1%) in 22 of 185 patients (11.9%). Ancillary tests including flow cytometry, cytogenetics, and cultures were performed. EUS-guided FNA of mediastinal and intra-abdominal lymph nodes provides diagnostic material from which ancillary testing may be performed.     

鼻咽癌咽后淋巴结转移规律对放疗靶区设计的影响

目的 探讨鼻咽癌咽后淋巴结的转移规律,为优化鼻咽癌的靶区勾画提供依据。方法 收集我院2009年1月~2017年12月初诊的190例鼻咽癌患者的临床资料,分析咽后淋巴结转移的影像学特征及与分期的关系。结果 190例鼻咽癌患者中有121例出现咽后淋巴结转移,咽后淋巴结转移率为63.68%。121例患者咽后淋巴结均分布于外侧组,无内侧组淋巴结转移;其中单侧转移者66例（54.54%）,双侧转移者55例（45.45%）;淋巴结的中心位置最主要分布于C1椎体。不同T分期、N分期及临床分期咽后淋巴结转移率比较,差异有统计学意义（P＜0.05）。结论 鼻咽癌咽后淋巴结主要以外侧组转移为主,中心位置主要位于C1椎体,咽后淋巴结的转移可能与分期相关。咽后淋巴结内侧组转移率较低,IMRT时可不进行预防性照射。     

Lymph node harvest in colon cancer specimens depends on tumour factors, patients and doctors, but foremost on specimen handling

There are good indications that the number of lymph nodes found in the specimen after resections for colon cancer somehow has a bearing on prognosis. Many factors have been reported in the literature to influence lymph node retrieval. We wanted to assess these closer with special focus on the pathology handling process in our own practice. A range of international literature was reviewed to study what has been found to influence lymph node harvest. A questionnaire was sent to 13 renowned national and international institutions to explore their handling of the colon cancer specimens to obtain a histological diagnosis. A retrospective, hospital audit was undertaken to examine if the number of lymph nodes and staging after examinations of the specimens varied between individual pathologists. In the literature, tumour and patient characteristics, as well as the surgeon and the pathologist, are found to be influential, but it is difficult to ascertain which ones are truly essential. Fat solvents were found by several to increase the lymph node yield, although some also opposed this finding. Our questionnaire showed some variations in the routines of each Department. A junior pathologist was more likely to inspect the specimen first hand and not more than half employed specific lymph node detection strategies while three of 13 did not seek a minimum number of lymph nodes. Still every department had implemented a standard procedure for such examinations. The internal audit showed without doubt that the devotion of the pathologist secured significantly more lymph nodes from the specimen and this may also have detected more stage III cancers. Several tumour and individual patient characteristics, surgical approach and specimen handling may influence lymph node yield and theoretically, TNM staging. Our investigation specifically suggests that tissue handling by pathologists may be a prominent factor in lymph node harvest from colon cancer specimens.     

Large platelet aggregates in endoscopic ultrasound‐guided fine‐needle aspiration of the pancreas and peripancreatic region: A clue for the diagnosis of intrapancreatic or accessory spleen

Intrapancreatic and intraabdominal accessory spleens (IPIASs) are rarely encountered in endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) biopsies. However, as incidentally discovered IPIAS can mimic a benign or malignant pancreatic neoplasm on imaging studies, a definitive diagnosis made by EUS‐FNA can avert an unnecessary surgical intervention or additional radiologic follow‐up. We report five cases of intrapancreatic splenules and one case of accessory spleen (AS) in which a definitive diagnosis was made on EUS‐FNA. Previously recognized FNA cytomorphologic features of splenic tissue, including ASs and splenosis, are endothelial cells and polymorphous lymphocytes admixed with neutrophils, eosinophils, plasma cells, histiocytes, and lymphoglandular bodies. We describe the additional finding of abundant large platelet aggregates as another distinguishing feature of splenic tissue on FNA. In all six cases, large platelet aggregates were identified along with polymorphous lymphoid cells, lymphoglandular bodies, loose aggregates of endothelial cells and scattered or aggregated bland spindle cells. A review of 10 consecutive cases of EUS‐FNA‐sampled benign intraabdominal lymph nodes showed that the presence of large platelet aggregates, three‐dimensional aggregates of lymphoid cells and of bland slender spindle cells and the absence of follicular germinal cell components (tingible body macrophages and lymphohistiocytic aggregates) are useful in differentiating IPIASs from reactive lymph nodes. Immunoperoxidase stains were useful to confirm a suspected IPIASs by showing CD31‐positive acellular flocculent material, consistent with large platelet aggregates and a rich CD8‐positive endothelial cell network between CD45‐positive lymphoid cells and CD68‐positive histiocytes in all six cases. Diagn. Cytopathol. 2013;41:661–672. © 2013 Wiley Periodicals, Inc.     

Morphometric analysis of regional lymph nodes in surgically resected non-small cell lung cancer

Nodal staging is a crucial factor in choosing the treatment option for non-small cell lung cancer (NSCLC). However, so far as we know, a computer-based histomorphometric analysis of lymph nodes in NSCLC has never been developed. We studied 299 surgically resected lymph nodes from 108 patients with NSCLC. Microscopic digital images were analyzed with Scion Image software. Seventy lymph nodes had at least one metastatic focus. The metastasis occupancy area per node ranged from 0.01 to 209.58 mm² (mean, 29.58 ± 5.87 mm²). The metastasis occupancy ratio ranged from 0.01% to 100% (mean, 48.70% ± 42.10%). The short-axis diameter of malignant lymph nodes was significantly longer than that of benign lymph nodes (P = 0.0002). The average metastasis occupancy area in the regional lymph nodes of NSCLC is quite small. Various inflammatory conditions can result in a false-positive diagnosis when these techniques are used. Studies that combine analysis of primary tumor size and serum carcinoembryonic antigen (CEA) levels with imaging methods should be considered. Finally, the use of mediastinoscopy or video-assisted thoracoscopic surgery is encouraged in determining the exact nodal status in NSCLC.     

Pathologic evaluation of sentinel lymph nodes in colorectal carcinoma

BACKGROUND: The identification of lymph node metastases in colorectal resection specimens is necessary for accurate tumor staging. However, routine lymph node dissection by the pathologist yields only a subset of nodes removed surgically and may not include those nodes most directly in the path of lymphatic drainage from the tumor. Intraoperative mapping of such sentinel lymph nodes (SLNs) has been reported in cases of melanoma and breast cancer. We applied a similar method to cases of colorectal carcinoma, with emphasis on the pathology of the SLNs. METHODS: Eighty-three consecutive patients with colorectal carcinoma were evaluated after intraoperative injection of 1 to 2 mL of 1% isosulfan blue dye (Lymphazurin) into the peritumoral subserosa. Blue-stained lymph nodes were suture-tagged by the surgeon within minutes of the injection for identification by the pathologist, and a standard resection was performed. Designated SLNs were sectioned at 10 levels through the block; a cytokeratin immunostain (AE1) was also obtained. To evaluate the possibility that increased detection of metastases in the SLN might be solely due to increased histologic sampling, all initially negative non-SLNs in the first 25 cases were sectioned also at 10 levels. RESULTS: Sentinel lymph nodes were identified intraoperatively in 82 (99%) of 83 patients and accounted for 152 (11.9%) of 1275 lymph nodes recovered, with an average of 1.9 SLNs per patient. A total of 99 positive lymph nodes (38 positive SLNs and 61 positive non-SLNs) were identified in 34 node-positive patients. The SLNs were the only site of metastasis in 17 patients (50%), while 14 patients (41%) had both positive SLNs and non-SLNs. Three patients (9%) had positive non-SLNs with negative SLNs, representing skip metastases. In patients with positive SLNs, 91 (19%) of 474 total lymph nodes and 53 (12%) of 436 non-SLNs were positive for metastasis. In patients with negative SLNs, 8 (1%) of 801 total lymph nodes and 8 (1.2%) of 687 non-SLNs were positive for metastasis. Multilevel sections of 330 initially negative non-SLNs in the first 25 patients yielded only 2 additional positive nodes (0. 6%). All patients with positive SLNs were correctly staged by a combination of 4 representative levels through the SLN(s) together with a single cytokeratin immunostain. CONCLUSIONS: Intraoperative mapping of SLNs in colorectal carcinoma identifies lymph nodes likely to contain metastases. Focused pathologic evaluation of the 1 to 4 SLNs so identified can improve the accuracy of pathologic staging.     

颈部淋巴结针吸细胞学580例诊断分析

目的 探讨颈部淋巴结针吸细胞学诊断的准确率及误诊原因.方法 分析580例颈部淋巴结针吸细胞学检查结果.其中161例在原部位取活检,分析针吸细胞学与组织学诊断符合率及误诊原因.结果 580例中淋巴结反应性增生226例,特异性炎202例,恶性淋巴瘤45例,转移癌107例.161例针吸细胞学与组织学诊断符合率为94.4%.107例转移癌中96例经临床及病理检查确定了原发灶.细胞学与组织学对照结果显示,细胞学检查有9例误诊,针吸细胞学误诊主要原因是吸取组织量少,对病变了解不全面;误诊病例结合病史及临床表现均有考虑到其他疾病的可能性.结论 颈部淋巴结针吸细胞学诊断准确率较高,但对可疑病变及原发肿瘤的分型,针吸细胞学仅可给予提示件初步诊断,需经组织学活检,必要时免疫组织化学诊断分型.     

Characteristics of pelvic lymph node metastases in prostatic adenocarcinoma: a study of 83 cases

Pelvic lymph node dissection (PLND) is currently the most accurate staging modality for lymph node metastases in prostate adenocarcinoma. There is no consensus on the optimal sampling method of PLND specimens among pathologists. This study analyzed the effectiveness of the submission of entire adipose tissue in 451 cases and its impact on total lymph node yield and detection of positive lymph nodes. The sizes of metastatic foci and positive lymph nodes in 83 cases were also studied. Submission of entire adipose tissue increased the lymph node yield and positive lymph node detection by 36.7 % and 1.99 %, respectively. Three cases had positive lymph nodes exclusively in adipose tissue. Of the patients examined, 68% had the largest positive lymph node, <1 cm. In conclusion, it was noted that metastases from prostate cancer were frequently small and seen within small lymph nodes. Submission of entire adipose tissue substantially increased the lymph node yield, but its impact on the detection of additional positive lymph nodes was low. Submission of the entire adipose tissue may be considered as an option in patients with high-risk factors for lymph node metastases.     

The diagnostic value of endobronchial ultrasound‐guided needle biopsy in lung cancer and mediastinal adenopathy

Endobronchial ultrasonography (EBUS) has emerged as a new diagnostic tool that allows the bronchoscopist to see beyond the airway, including pulmonary and mediastinal lesion. The real time EBUS‐guided transbronchial needle aspiration (TBNA) has advanced the diagnostic yield in primary lung pathology and mediastinal lymph node staging of lung carcinoma. Sixty‐four patients (36 males, 28 females, ages ranging from 16 to 86 years) with peribronchial lung lesions and mediastinal and/or hilar lymph node lesions underwent EBUS‐TBNA. All patients had intraoperative cytological assessment by smears on aspiration samples or touch preparation on needle core biopsies. The cytological final diagnoses were categorized as negative, suspicious/positive, and non‐diagnostic. Forty‐nine samples were obtained from lymph node lesions and 15 samples were obtained from lung lesions. In cytology specimens, 32 patients had suspicious/positive diagnoses and 32 patients had negative diagnosis. In follow‐up histology specimens, 35 patients had malignant diagnoses, including 18 adenocarcinomas, 8 small cell carcinomas, 6 squamous cell carcinomas, 1 metastatic hepatocellular carcinoma, 1 metastatic melanoma, and 1 lymphoma. Twenty‐nine patients had negative diagnoses. Sensitivity and specificity were 88.9% and 96.4%, respectively. Positive and negative predictive values were 97.0% and 87.1%, respectively. Diagnostic accuracy was 92.2%. EBUS‐TBNA is an efficient and effective technique for diagnosis of intrapulmonary and mediastinal/hilar lymph nodes. It becomes significantly invaluable on clinical management for staging in those patients with lung cancer of other metastatic malignancies. This technique enables us to obtain tissue samples for quick diagnoses beyond central airway with minimal complications. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Inguinal lymph nodes: size,number, and other characteristics in asymptomatic patients by CT

Purpose

The purpose of this study was to establish normative data for the CT appearance of inguinal lymph nodes.

Materials and methods

After Institutional Review Board approval, search of the radiology information system identified 500 consecutive CT examinations of the pelvis. Patients were included if no lower extremity or perineum pathology, or history of malignancy at the time of CT examination, and a clinical note documenting no tumor at least 2 years after the CT. The final study group was 77 patients. CT examinations were retrospectively reviewed and bilateral inguinal lymph nodes were characterized by size (short axis and largest size in general), number, and presence of fat attenuation.

Results

The mean short-axis inguinal lymph node size was 5.4 mm (range 2.1–13.6 mm), measured at 8.8 mm two standard deviations above the mean. The mean number of superficial and deep inguinal lymph nodes was 10.7 (range 3–18) and 1.2 per patient (range 1–2), respectively. Superficial and deep inguinal nodes showed internal fat attenuation in 85 and 78 % of nodes, and were oval in shape in 95 and 78 %, respectively.

Conclusion

Inguinal lymph nodes in asymptomatic patients have a mean short axis of 5.4 mm, a short axis of 8.8 mm at two standard deviations above the mean, and are multiple and symmetric in size and number (4–20 per patient). Normal inguinal lymph nodes were commonly oval in shape and contained fat, although such findings may be absent in smaller lymph nodes.