Endosonography-Guided Biopsy as a First Test in the Diagnosis of Lymphoma

      To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) in the diagnosis of lymphoma. A retrospective analysis of patients with suspected mediastinal lymphoproliferative disorders who underwent EBUS-TBNA, EUS-FNA or combined procedures from 2009 to 2019 was conducted using a prospectively maintained interventional thoracic endoscopy database. Demographic data, imaging, needle size, surgical biopsy, complications rate and pathology reports were reviewed. Over a 10-year period, a total of 444 patients were investigated with endosonography as the first diagnostic procedure for mediastinal adenopathy suspicious for lymphoma. Lymphoma was diagnosed in 77 patients (17.3%). In total, 68 patients (88.3%) were diagnosed using endosonographic mediastinal tissue sampling. Four patients had both lymphoproliferative disorders and lung cancer. Nine patients (11.7%) required a surgical biopsy to confirm the lymphoma diagnosis (6 non-diagnostic; 3 inadequate samples from endosonographic biopsies). In patients with adequate biopsies via endosonography, the sensitivity for the diagnosis of lymphoma, was 91.9% (n = 68/74). The histopathologic subtype of lymphoma was determined by endosonographic biopsies in 61 patients (89.7%) with an increased sensitivity (92.6%) for low grade Non-Hodgkin lymphoma (NHL). No acute complication related to endosonography was observed. Endosonographic biopsy (EBUS and/or EUS) of mediastinal adenopathy in patients with suspected lymphoma is a highly sensitive and safe diagnostic test. Endosonography should be the first test in the diagnosis of suspicious mediastinal lymphoma and should be followed by surgical biopsy in cases of insufficient sampling or indefinite diagnosis.

      Graphical Abstract



      EBUS-TBNA (Endobronchial Ultrasound-guided Transbronchial Needle Aspiration), EUS-FNA (Endoscopic Ultrasound-guided Fine Needle Aspiration), FC (Flow cytometry), IHC (Immunohistochemistry), LPD (Lymphoproliferative disorders), NHL (Non-Hodgkin lymphoma), ROSE (Rapid on-site evaluation), SLL/CLL (Small cell lymphocytic lymphoma/chronic lymphocytic leukemia), WHO (World Health Organization)
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      Linked Article

      • Commentary: Get Better Soon
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          I recently saw a card that said “Get Better Soon!” on the front and when I opened it, it read, “I know you're not sick. You could just get better.” I was tempted to buy a few of them, but realized that most people who needed one probably would not appreciate it! I was reminded of that card as I read the report from Dr. Liberman's group in this month's issue of Seminars,1 because it makes me think I could get better. The authors describe their 10-year, single center experience using a combination of endobronchial ultrasound- (EBUS) and endoscopic ultrasound- (EUS) guided biopsies for the diagnosis of mediastinal lymphoma.
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      • Commentary: Leave the Knife and Take the Needle and a Cytopathologist
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          A request for tissue biopsy for suspected lymphoma is a common thoracic surgical referral. Mediastinal nodes are consistently located and easily accessed. Mediastinoscopy is safe, but it requires general anesthesia, and is rarely associated with significant morbidity and mortality.1 Endosonography-guided biopsy using endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound fine needle aspiration (EUS-FNA) take advantage of the consistent location and ease of access of mediastinal nodes without the need for an incision or obligate general anesthesia.
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