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Béchade D, Bellera C, Gauquelin L, Soubeyran I, McKelvie-Sebileau P, Debled M, Chomy F, Roubaud G, Fonck M, Pernot S, Roch A, Cazeau AL. 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. Clin Res Hepatol Gastroenterol 2022; 46:101912. [PMID: 35341993 DOI: 10.1016/j.clinre.2022.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023]
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.
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Affiliation(s)
- Dominique Béchade
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France.
| | - Carine Bellera
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, 229 Cours de l'Argonne, 33076 Bordeaux, France; Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000 Bordeaux, France
| | - Lisa Gauquelin
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, 229 Cours de l'Argonne, 33076 Bordeaux, France
| | | | | | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - François Chomy
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Marianne Fonck
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Simon Pernot
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France
| | - Alexandre Roch
- Department of Nuclear Medicine, Institut Bergonié, 33076 Bordeaux, France
| | - Anne-Laure Cazeau
- Department of Nuclear Medicine, Institut Bergonié, 33076 Bordeaux, France
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Lee DW, Kim EY. Which Needle Needs to Be Chosen for Better Outcome of Endoscopic Ultrasound-Guided Tissue Acquisition? Gut Liver 2019; 13:223-224. [PMID: 31092725 PMCID: PMC6529168 DOI: 10.5009/gnl19121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Dong Wook Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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