Combined transbronchial needle aspiration and (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography for diagnosing enlarged mediastinal lymph nodes.

Background: To demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography ((99m)Tc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy.

Methods: Sixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and (99m)Tc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA.

Results: Eighty three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of (99m)Tc-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and (99m)Tc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%.

Conclusions: (99m)Tc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy.