Comparison endoscopic ultrasound with computed tomograpy for the detection of mediastinal lymphadenopathy

ABSTRACT

To compare the rate of detección of mediastinal lymphadenopathy by endoscopic ultrasound (EUS) and computed tomography (CT) scan. Data collected from 40 consecutive mediastinal EUS examinations. EUS examination revealed lymphadenopathy in 33 patients. Only 7(21 per cent) had mediastinal adenopathy detected by CT scan while 26(79 per cent) had mediastinal lympha nodes by EUS that were not detected by CT scan. Non-detection of mediastinal lymph nodes by CT was significantly associated with small lymph nodes (p=0.035), location in the paraesophageal area (p<0,001), and co-existing esophageal cancer (p=0.009). Ten patients among these 56 cases after EUS underwent linear EUS-guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes. CT scan did not detect lymph nodes in 4 out of these 10 patients (40 per cent), two of which were found to have malignant lymph nodes. Conclusion: The detection rate of mediatinal lymphadenopathy is significantly better by EUS compared to CT scan. It may be reasonable to perform EUS in cases of thoracic malignancies even if CT scan does not show mediatinal lymph nodes. If lymph nodes are seen on EUS, they can be subjected to EUS-FNA and the information obtained could alter management decisions