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Introduction: A study was undertaken to evaluate the clinical impact of endoscopic ultrasound-guided, fine needle aspiration biopsy (EUS-FNA) in patients with mediastinal masses suspected of malignancy. Material and methods: Eighty-four patients were referred for EUS-FNA. In all patients computer tomography (CT) had shown a lesion of the mediastinum suspected of malignancy, which was located adjacent to the oesophagus. The history of each patient up to referral for EUS-FNA was reviewed in order to evaluate the clinical impact of EUS-FNA. A board of thoracic specialists was asked to decide the further course of the patient if EUS-FNA had not been available, and this diagnostic strategy was compared with the actual clinical course after EUS-FNA. Results: For the 79 patients, in whom sufficient verification was obtained, EUS-FNA had a sensitivity of 92%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 80%, and an accuracy of 94% for cancer in the mediastinum. As a result of EUS-FNA, a thoracotomy was avoided in 18 of 37 patients (49%) and in 28 of 41 patients (68%) a mediastinoscopy was avoided. The direct result of the cytological diagnosis obtained by EUS-FNA was that a final diagnosis of small cell lung cancer was made in eight patients leading to referral for chemotherapy, and specific therapy could be initiated in another three patients with benign disease (sarcoidosis, mediastinal abscess and leiomyoma of the oesophagus). Discussion: EUS-FNA is a safe and sensitive, minimal invasive method in the evaluation of patients with a solid lesion of the mediastinum, suspected by CT. EUS-FNA has a significant impact on patient management; it should be considered for diagnosing the spread of cancer to the mediastinum of patients with lung cancer in whom surgery is contemplated, as well as for the primary diagnosis of solid lesions located in the mediastinum adjacent to the oesophagus.

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