Role of endoscopic ultrasound [EUS] and EUS-guided-fine needle aspiration in diagnosis of mediastinal and abdominal lymphadenopathy

Background and aim: Endoscopic ultrasound [EUS] and the subsequent EUS-guided fine needle aspirate [EUS-FNA] represent a major breakthrough in interventional methods especially for sampling suspicious-appearing lymph nodes. Therefore, we aimed to evaluate the diagnostic yield EUS-FNA in setting of a given abdominal and/or mediastinal lymph nodes. Also, to detect the echo- features that may predict lymph node malignant potentials

Methods: Between January 2014 and May 2015, all consecutive patients with intra-abdominal and/or mediastinal lymphadenopathy were enrolled. EUS-FNA was carried out and the aspirate then sent for cytological and histological studies and Immune stains [IHC]. EUS-FNA results were categorized into benign or malignant. The gold- standards for final diagnosis were the postoperative pathological results or the follow-up course

Results: during the period of the study, a total of 86 patients [50 males, mean age 57.62 +/- 8.47] were enrolled. No major complications were reported. The main proven final diagnoses of the LNs were pancreatic cancer [34.88%, n=30], and cholangiocarcinoma [12.8%, n=11] and 75.6% [n=65] were malignant. The sensitivity, specificity, and accuracy rates of EUS-FNA were 95.38%, 100%, and 95.5%, respectively [No false positive cases]. The multivariate Binary logistic regression revealed that only the echo-texture [odds ratio 29.8; P=0.003] and short axis diameter of the lymph nodes [odds ratio 1.6; P=0. 025] are the most predictors of malignant potentiality

Conclusions: EUS-FNA is an accurate and safe method for diagnosis of abdominal and mediastinal lymphadenopathy

Interventional bronchoscopy: ain Shams University Hospital experience

Bronchoscopy has evolved considerably in our hospital. During recent years, we implemented the concept of interventional bronchoscopy [IB] for the first time in Egypt. IB is defined as a diagnostic and invasive therapeutic interventions that extend beyond routine Flexible bronchoscopy. In this article, we will review our clinical experience with IB during the last five years as regards methodology requirements, available equipments, clinical applications and presentation of selected research outcomes. We retrospectively reviewed all available reports of therapeutic IB performed in our bronchoscopy unit to determine the indications, application sites, methods of disobliteration and complications of therapeutic IB. In addition, recent interesting research work done on endobronchial ultrasound, autofluorescence bronchoscopy, Nd: YAG laser bronchoscopy and endobronchial electrocautery was reviewed. In order to perform an interventional procedure, well-equipped facilities, trained personnel, preprocedure evaluation, and monitoring are mandatory. More than 500 invasive therapeutic interventions were performed in the past 5 years. The results and analysis of these IB were reviewed. We concluded from the presented data that IB has quickly gained recognition and drawn interest with its promising results. Much effort is needed to overcome challenges facing IB awareness, financial concerns, training and verification of competency in our country