Combined Transbronchial Needle Aspiration and Tc-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-2-methoxy-isobutyl-isonitrile single photon emission computed tomography (Tc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy. Methods: Sixty-one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and Tc-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), and negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of Tc-MIBI-SPECT were 96%, 80%, 97%, and 73%, respectively. Combining TBNA and Tc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, were obtained. TBNA alone avoided mediastinoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%. Conclusions: Tc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy. © 2013 SEPAR. Published by Elsevier España, S.L. All rights reserved. Uso combinado de aspiración por punción transbronquial y tomografía computarizada de emisión fotónica única con Tc-2-metoxi-isobutil-isonitrilo para el diagnóstico de ganglios linfáticos mediastínicos agrandados