Combined Transbronchial Needle Aspiration and Tc-99m-2-Methoxy-Isobutyl-Isonitrile Single Photon Emission Computed Tomography for Diagnosing Enlarged Mediastinal Lymph Nodes

Background: To demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and Tc-99m-2-methoxy-isobutyl-isonitrile single photon emission computed tomography (Tc-99m-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy.Methods: Sixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and Tc-99m-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA.Results: Eighty three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of Tc-99m-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and Tc-99m-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could haveConclusions: Tc-99m-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy. (C) 2013 SEPAR. Published by Elsevier Espana, S.L. All rights reserved.