Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2021; 13(10): 1475-1491
Published online Oct 15, 2021. doi: 10.4251/wjgo.v13.i10.1475
Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes
Giacomo Tamanini, Anna Cominardi, Nicole Brighi, Pietro Fusaroli, Andrea Lisotti
Giacomo Tamanini, Anna Cominardi, Pietro Fusaroli, Andrea Lisotti, Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
Nicole Brighi, Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola 47014, FC, Italy
Author contributions: Tamanini G and Lisotti A wrote the paper, Cominardi A and Tamanini G performed data collection for systematic review; Brighi N and Fusaroli P reviewed manuscript for pivotal intellectual content.
Conflict-of-interest statement: Authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Andrea Lisotti, MD, MSc, Adjunct Professor, Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, Imola 40026, BO, Italy.
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: April 6, 2021
Revised: April 16, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: October 15, 2021

The differential diagnosis between benign and malignant lymph nodes (LNs) has a fundamental role in the characterization and staging of malignant conditions, as well as in subsequent patients’ management. All imaging modalities (i.e. computed tomography and magnetic resonance imaging) rely mainly on size; endoscopic ultrasound (EUS) criteria based on B-mode evaluation and Doppler features fail to adequately characterize with high specificity LNs nature. The introduction of EUS-elastography and contrast-enhanced harmonic EUS are useful techniques to increase the diagnostic yield in identifying metastatic LNs, to identify which suspicious LN should require pathological characterization and, finally, to target tissue acquisition. EUS-guided tissue acquisition (EUS-TA) is increasingly being used for diagnosing lymphadenopathy whenever the characterization modifies patients’ subsequent management and when no superficial LN is accessible. Since target therapy are currently available (i.e. lung cancer, breast cancer), EUS-TA of malignant LNs could be required to identify tumor biology. In this field, both fine needle aspiration and biopsy needles are able to guarantee accurate results with almost perfect specificity and sub-optimal sensitivity. We finally propose a diagnostic algorithm based on most recent, high-level evidence for the diagnostic approach to suspected LNs assessment.

Keywords: Endoscopic ultrasound-guided tissue acquisition, Endoscopic ultrasound-fine needle aspiration, Endoscopic ultrasound-fine needle biopsy, Biopsy, Aspiration, Cancer

Core Tip: The characterization of suspected mediastinal or abdominal lymph nodes (LNs) represents a crucial indication for endoscopic ultrasound (EUS) and tissue acquisition, since may significantly impact patients’ management and clinical outcomes. Historically, ultrasound assessment was the first-line diagnostic modality for the evaluation of peripheral LNs. EUS allows a real-time assessment of suspected LNs located next to the gastrointestinal tract; moreover, the possibility to obtain pathological specimens from needle-based tissue acquisition allows to answer with optimal sensitivity and perfect specificity to clinical questions.