Evaluation of mediastinal masses by endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration

OBJECTIVE: Interest has been growing in using endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the evaluation of mediastinal masses. The purpose of this study was to review the spectrum of mediastinal masses encountered using endoscopic ultrasound. METHODS: We reviewed all cases of mediastinal masses examined by endoscopic ultrasound, with or without endoscopic ultrasound-guided fine needle aspiration, prospectively gathered from our electronic database from April 1995 to July 2000. RESULTS: Of 1447 upper endoscopic ultrasound examinations, 33 (2.3%) involved a mediastinal mass. Sixty-one percent of the patients were male and the average age was 65 yr. Fifty-five percent of patients had dysphagia, 48 percent experienced weight loss, and only 12 percent were totally asymptomatic. Seventy-three percent had masses by chest CT. Sixty-seven percent were ultimately found to be malignant, 21 percent were solid benign lesions, and four were cystic. Only two lesions were resected. Endoscopic: ultrasound-guided fine needle aspiration was used in 76 percent of all patients. The median survival of patients with malignant lesions was only 87 days. CONCLUSIONS: Lesions of the deep mediastinum are often difficult to conclusively diagnose with nonendoscopic studies. Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration can easily access this region to aid in the diagnosis and management of these lesions.