Mediastinal lymphadenopathy: Causes, symptoms and factors predicting good yield of endoscopic ultrasound-guided biopsy

Table 1 Frequency of patients with referrals from various specialties (n = 243)

Referral source	n (%)
General physicians/pulmonologists	101 (41.6)
Oncologist	90 (37.0)
Nephrologist/Urologist	52 (21.4)
Hemodialysis dependent patients	29
Potential renal donors	12
Renal transplanted patients	11

Table 2 Frequency of locations in mediastinum targeted for endoscopic ultrasound-guided mediastinal lymph node biopsy (n = 243)

Mediastinal location	n (%)
Subcarinal/Precarinal	196 (80.7)
Right hilar	24 (9.9)
Left hilar	10 (4.1)
Aortopulmonary window	7 (2.9)
Lower para-esophageal	3 (1.2)
Upper para-esophageal/Para-tracheal	2 (0.8)

Table 3 Summary of the needles used and diagnostic yield (n = 243)

Characteristics of needles and histopathology specimen	n (%)
Size of needle
22 G	236 (97.1)
25 G	7 (2.9)
Number of passes
2 or more passes	222 (91.4)
1 pass only	21 (8.6)
Macroscopic onsite evaluation
Satisfactory	211 (86.8)
Unsatisfactory	32 (13.2)
Yield on histopathology
Good	218 (89.7)
Poor	25 (10.3)

Table 4 Causes of mediastinal lymphadenopathy found on endoscopic ultrasound guided biopsy (n = 243)

Causes of mediastinal lymphadenopathy	n (%)
Tuberculosis	82 (33.7%)
Anthracosis	53 (21.8)
Minimal to mild	32
Moderate	14
Severe	7
Neoplastic disease	43 (17.7)
Metastatic
Breast cancer	9
Lung cancer	7
Pancreatobiliary cancer	6
Esophageal cancer	5
Renal cancer	5
Hepatocellular cancer	2
Neuroendocrine cancer	2
Gastrointestinal stromal tumor	1
Undetermined origin	3
Primary
Lymphoproliferative disorder	2
Kaposi’s sarcoma	1
Sarcoidosis	14 (5.8)
Miscellaneous	12 (4.9)
Epithelioid cell collection	5
Post chemotherapy changes	2
Necrotic tissue	2
Keratin slough	2
Granulomatous inflammation	1
Normal histology	23 (9.5)
Suboptimal tissue	16 (6.6)

Table 5 Histologic findings found on mediastinal lymph node biopsies

Diagnosis	Histological features
Tuberculosis	Granulomas with caseating necrosis; Epithelioid granulomas
Sarcoidosis	Granulomas without caseating necrosis
Anthracosis	CLM
	Occasional CLMs: Minimal to mild anthracosis
	Significant CLMs: Moderate anthracosis
	Abundant CLMs: Severe anthracosis
Metastatic disease	Abnormal cells with large nuclei, nucleoli and scanty cytoplasm
	Immunohistochemical markers used
	CK AE1/3: Esophageal cancer
	GATA-3, Mammaglobin: Breast cancer
	TTF-1: Lung adenocarcinoma
	Hep par, Alfafetoprotein: Hepatocellular cancer
	PAX-8: Renal cell carcinoma
	CK7, CK19: Pancreatobiliary cancer
	CD31, CD34: Kaposi’s sarcoma
	CD15, CD20, CD30: Hodgkin’s lymphoma

CLM: Carbon (anthracotic pigment) laden macrophages.

Table 6 Frequency of patient with absent chest related symptoms among the major causes of mediastinal lymphadenopathy

	Total number of patients (n)	Patients with absent chest related symptoms (n)	Percentage
Tuberculosis	82	51	62.2%
Anthracosis	53	31	58.5%
Malignant disease	43	28	65.1%
Sarcoidosis	14	5	35.7%
Others	12	9	75.0%

Table 7 Factors predicting good yield of endoscopic ultrasound guided biopsy of enlarged mediastinal lymph nodes (n = 243)

Clinical variable		Univariate analysis					Multivariate analysis
		Good yield	Poor yield	Odds Ratio	Confidence interval	P value
Age	< 40	68	11	0.57	0.249–1.337	0.195
	> 40	150	14
Gender	Male	115	16	0.63	0.266–1.482	0.285
	Female	103	9
Location of node	Subcarinal	180	16	2.66	1.096–6.478	0.026
	Others	38	9
Size of LN	≥ 12 mm	200	13	10.25	4.083–25.762	< 0.0001	0.005
	< 12 mm	18	12
Bore of the needle used	22G	211	25	0.89	0.856–0.934	1.000
	25G	7	0
Type of needle	FNB	202	20	3.16	1.046–9.523	0.049
	FNA	16	5
Number of passes	≥ 2	201	21	2.25	0.693–7.317	0.247
	< 2	17	4
MOSE	Satisfactory	202	9	22.44	8.574–58.753	< 0.0001	< 0.0001
	Unsatisfactory	16	16

FNA: Fine needle aspiration; FNB: Fine needle biopsy; LN: Lymph node; MOSE: Macroscopic on-site evaluation.