Endosonography for the diagnosis of malignant lymphoma presenting with mediastinal lymphadenopathy.

Background: Endosonography combined with fine needle aspiration (FNA) is a minimally invasive technique for intrathoracic mediastinal nodal sampling. The value of endosonography with FNA for the diagnosis of malignant mediastinal lymphoma is under debate. In this study, the sensitivity and negative predictive value of endosonography for the assessment of primary versus recurrent malignant lymphoma were assessed.

Methods: Forty-nine patients with suspected primary (n=32) or recurrent (n=17) lymphoma were retrospectively analyzed. They presented with mediastinal nodal enlargement and underwent endosonography for diagnostic purposes between 2001 and 2011. The final diagnosis was based on surgical biopsy, conclusive cell block analysis, or longstanding clinical and radiologic follow-up.

Results: In 33 patients, a final diagnosis of lymphoma was established; in 16 patients (33%) alternative diagnoses (eg, small cell lung cancer, sarcoidosis) were found. Sensitivity and negative predictive value of endosonography in diagnosing primary versus recurrent mediastinal lymphoma were 55% and 57% versus 88% and 90%, respectively. No complications occurred during these procedures.

Conclusions: On the basis of these data, we conclude that endosonography is a minimally invasive, safe, and sensitive method for the assessment of recurrent mediastinal malignant lymphoma or alternative diagnoses but has limitations in assessing a primary lymphoma diagnosis.