Combined Transbronchial Needle Aspiration and 99mTc-2-Methoxy-Isobutyl-Isonitrile Single Photon Emission Computed Tomography for Diagnosing Enlarged Mediastinal Lymph Nodes |
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| Institution: | 1. Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italy;2. Departamento de Radiología, Unidad de Medicina Nuclear, Segunda Universidad de Nápoles, Nápoles, Italy;3. Departamento de Salud Pública, Sección de Anatomía Patológica, Segunda Universidad de Nápoles, Nápoles, Italy;4. Departamento de Radiología, Unidad de Radiología, Segunda Universidad de Nápoles, Nápoles, Italy;1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;2. Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;1. Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia;2. Departamento de Radiología, Unidad de Medicina Nuclear, Segunda Universidad de Nápoles, Nápoles, Italia;3. Departamento de Salud Pública, Sección de Anatomía Patológica, Segunda Universidad de Nápoles, Nápoles, Italia;4. Departamento de Radiología, Unidad de Radiología, Segunda Universidad de Nápoles, Nápoles, Italia;1. Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan;2. Department of Thoracic Medicine, St. Paul Hospital, Taoyuan, Taiwan;1. Department of Respiratory Medicine, University Hospital of Lausanne, Lausana, Suiza;2. Department of Internal Medicine, Ospedale Civico di Lugano, Lugano, Suiza;3. Department of Radiology, University Hospital of Lausanne, Lausana, Suiza;1. Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA;2. Pulmonary and Critical Care Medicine, Emory University School of Medicine, 1365 Clifton Road, NE, Atlanta, GA 30322, USA;3. Pulmonary and Critical Care, Cancer Treatment Centers of America/Southeastern, 600 Parkway North, Newnan, Atlanta, GA 30265; Georgia Regents University, Augusta, GA, USA;1. Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan;2. Respiratory Unit, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand |
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| Abstract: | BackgroundTo demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and 99mTc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography (99mTc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy.MethodsSixty-one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and 99mTc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA.ResultsEighty-three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of 99mTc-MIBI-SPECT were 96%, 80%, 97%, and 73%, respectively. Combining TBNA and 99mTc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, were obtained. TBNA alone avoided mediastinoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%.Conclusions99mTc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy. |
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| Keywords: | Technetium-99m hexakis-2-methoxyisobutyl isonitrile Single photon emission chest tomography Lymph adenopathy Transbronchial needle aspiration Tecnecio-99m hexakis-2-metoxi-isobutil-isonitrilo Tomografía de emisión fotónica única torácica Adenopatía Aspiración por punción transbronquial |
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