Diagnostic accuracy and clinical impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in Positron Emission Tomography - Computed Tomography (PET-CT)-positive mediastinal lymphadenopathies in patients with thoracic or extra-thoracic malignancies - 10/06/22
, Carine Bellera c, d, Lisa Gauquelin c, Isabelle Soubeyran e, Pippa McKelvie-Sebileau f, Marc Debled a, François Chomy a, Guilhem Roubaud a, Marianne Fonck a, Simon Pernot a, b, Alexandre Roch g, Anne-Laure Cazeau gHIGHLIGHTS |
• | From: Contrast Media Mol Imaging, volume 28, 2018, pages 1-9.
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• | From: Am J gastroenterol, volume 95, 2000, pages 2278-2284.
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• | From: Dig Dis Sci, Volume 66, August 2021, Pages 2763-2775.
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• | In our prospective study, we conclude that the diagnostic accuracy of EUS-FNA, without ROSE, is sufficiently robust to avoid the need for a surgical diagnosis. | ||||||||
• | EUS-FNA made it possible to diagnose 46.8% of granulomatous adenopathies at different stages of the management of thoracic or extra-thoracic cancers. | ||||||||
• | The combination of PET-CT and EUS-FNA may alter the therapeutic strategy that would have been considered after PET-CT alone. |
Abstract |
Background |
The high sensitivity of PET-CT can identify hypermetabolic mediastinal adenopathies during cancer management, but specificity is low and a biopsy is sometimes required to eliminate benign adenopathies.
Methods |
This prospective diagnostic accuracy study included patients with hypermetabolic mediastinal lymphadenopathies revealed on PET-CT during either the initial management of a cancer, treatment evaluation, or monitoring. All patients underwent EUS-FNA. Diagnoses of malignancy based on cytological analysis following EUS-FNA were compared with clinical and radiological follow-up information. The treatment strategy decided before the results of the EUS-FNA pathology reports (Multidisciplinary Team Meeting [MTM-1]) was recorded and compared to the treatment strategy decided once pathological data from EUS-FNA were available (MTM-2).
Main findings |
Between 2013 and 2018, 75 patients were included with 47 eligible and evaluable patients. Sensitivity, specificity, and positive and negative predictive values of EUS-FNA were 93%, 100%, 100% and 90%, respectively. The concordance value between the therapeutic strategies determined for MTM-1 and MTM-2 was 44.7%. There were no significant differences in the intensity of fixation on PET-CT between malignant and benign lesions.
Conclusion |
The diagnostic accuracy of the minimally invasive EUS-FNA procedure is sufficiently robust to avoid the need for diagnostic surgery. The combination of PET-CT and EUS-FNA may alter the therapeutic strategy that would be considered after PET-CT alone.
REGISTRATION |
NCT01892501
Il testo completo di questo articolo è disponibile in PDF.Keywords : endoscopic ultrasound-guided fine-needle aspiration, mediastinal lymphadenopathy, Positron Emission Tomography - Computed Tomography, clinical impact on cancer management
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Vol 46 - N° 5
Articolo 101912- Maggio 2022 Ritorno al numero
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