Tasneem AA, Luck NH, Mubarak M. Mediastinal lymphadenopathy: Causes, symptoms and factors predicting good yield of endoscopic ultrasound-guided biopsy. World J Clin Cases 2025; 13(22): 105596 [DOI: 10.12998/wjcc.v13.i22.105596]
Corresponding Author of This Article
Muhammed Mubarak, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Mediastinal lymphadenopathy: Causes, symptoms and factors predicting good yield of endoscopic ultrasound-guided biopsy
Abbas A Tasneem, Nasir H Luck, Muhammed Mubarak
Abbas A Tasneem, Nasir H Luck, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Author contributions: Tasneem AA, Luck NH, and Mubarak M contributed equally to the conception and study design, performed relevant research and participated in primary and final drafting; Luck NH, and Mubarak M critically reviewed and approved the final manuscript.
Institutional review board statement: The present study was exempted from the Institutional Review Board of Sindh Institute of Urology and Transplantation and was approved by the Head of the Gastroenterology and Hepatology Department, and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: All authors declared that they have no conflict of interest related to this work.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammed Mubarak, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Received: January 30, 2025 Revised: March 29, 2025 Accepted: April 11, 2025 Published online: August 6, 2025 Processing time: 105 Days and 16.1 Hours
Abstract
BACKGROUND
Mediastinal lymph nodes (MLNs) can be enlarged due to various benign or malignant causes. Endoscopic ultrasound (EUS) is often employed for the acquisition of tissue specimens of the enlarged MLN (EMLN).
AIM
To determine the causes, document the symptoms, and determine factors predicting good yield of EUS-guided EMLN biopsy.
METHODS
All patients having EMLN (> 10 mm) on thoracic imaging and referred for EUS-guided biopsy were included in this retrospective observational study. Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation (MOSE) and then sent to a histopathologist for final diagnosis. Analysis for factors predicting good biopsy yield was then performed.
RESULTS
Of the total 243 patients with EMLN, 131 (53.9%) were males. The mean age was 47.6 (± 14.7) and range 14-86 years. Commonest causes of EMLN were tuberculosis 82 (33.7%), anthracosis 53 (21.8%), neoplastic disease 43 (17.7%) and sarcoidosis 14 (5.8%). Among the 43 patients with neoplastic diseases: 40 had metastatic disease (breast 9, lung 7, pancreatobiliary 6, esophagus 5, kidney 5, hepatocellular 2, neuroendocrine 2, gastrointestinal stromal 1, undetermined 3) and 3 had primary malignancies (lymphoproliferative disorder 2, Kaposi sarcoma 1). Chest related clinical symptoms were absent in more than half the patients with tuberculosis 51/82 (62.2%), anthracosis 31/53 (58.5%) and neoplastic disease 28/43 (65.1%). Factors associated with good biopsy yield were: Subcarinal location of MLN (P = 0.026), MLN size > 12 mm (P < 0.0001), use of fine-needle biopsy (vs fine-needle aspiration) (P = 0.049) and satisfactory MOSE (P < 0.0001) on univariate analysis; while MLN size > 12 mm (P = 0.005) and satisfactory MOSE (P < 0.0001) on multivariate analysis.
CONCLUSION
Tuberculosis, anthracosis and metastatic disease were the commonest causes of EMLN. More than half the cases with EMLN had no chest-related symptoms. Large MLN size and satisfactory MOSE observation predicted a good biopsy yield.
Core Tip: Endoscopic ultrasound effectively diagnoses causes of enlarged mediastinal lymph nodes (MLNs), including tuberculosis, anthracosis, and metastatic diseases, with over half of cases lacking chest-related symptoms. Factors predicting good diagnostic yield include MLN size > 12 mm, subcarinal location, use of fine-needle biopsy over fine-needle aspiration, and satisfactory macroscopic on-site evaluation (MOSE). Larger MLNs and optimal MOSE were the strongest predictors on multivariate analysis, emphasizing the importance of accurate imaging and procedural technique in achieving reliable diagnostic outcomes.
