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EBUS-TBNA in patients with extra-pulmonary malignancies with thoracic lymphadenopathy

Background: Thoracic lymphadenopathy, in extra pulmonary malignancies(EPM) need not always represent a malignant process, the knowledge of which is of prime therapeutic and prognostic implications. Positive imaging can also be due to benign causes, and therefore a minimally invasive, tissue diagnosis is required. Aims and Objectives: To determine the role of EBUS TBNA in diagnosis of PET positive/enlarged mediastinal lymph nodes(LNs)in patients with a known EPM. Methods: Retrospective study on 40 patients with proven EPM and with PET active LN(SUV>2.5) or short-axis diameter>1cm on CT, who underwent EBUS-TBNA with Rapid on-site evaluation(ROSE). Pathological examination was done in all and mycobacterial tests done where indicated. Clinical and radiological follow-up done in patients with benign nodes for at least 6 months. Results: Nodes were positive for malignancy in 18(45%) and benign in 22(55%). 13(32.5%)had reactive LN, 6(15%) had non specific granulomatous LN and 3(7.5%) had TB LN. One among those negative, who had LN enlargement on follow up, was found to be positive for malignancy by CT guided FNA. All 3 patients with TB lymphadenitis responded to treatment. 2 patients with reactive LN were lost to followup, while all the rest were stable. EBUS-TBNA sensitivity-94.7%, specificity-100%, positive predictive value-100%, negative predictive value-95.45%, overall diagnostic accuracy-97.5% and complications-0% Conclusions: More than half of patients with EPM, despite having PET /CT positive thoracic nodes, were diagnosed to have benign adenopathy with EBUS TBNA, which makes it a safe, minimally invasive, accurate and essential tool for diagnosing thoracic lymphadenopathy in these patients.