IMPACT OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION IN MEDIASTINAL AND LUNG LESIONS: A COMBINED EXPERIENCE OF DIFFERENT INSTITUTIONS

BACKGROUND: 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. METHODS: Fifthy-seven consecutive EUS-FNA of mediastinal nodes in LC patients, 8 mediastinal and 2 sub-diaphragmatic masses were collected in three 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 diagnoses of mediastinal masses were histologically confirmed. All EUS diagnoses were blindly reviewed by three pathologists to assess intra and interpersonal reproducibility. RESULTS: FNA-EUS diagnoses were: 10 inadequate (17%), 10 negative (17%), 4 suspicious ( 7% ) and 33 positive (59%). Diagnoses of mediastinal and sub-diaphragmatic masses were: relapse of LC (3), mesenchimal tumour NOS (3), gastrointestinal stromal tumor (GIST) (1), esophageal carcinoma (2) and paraganglioma (1). Attained sensitivity and specificity were 85% and 100% with an high interpersonal diagnostic reproducibility (P