Combined transbronchial needle aspiration and (99m)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 (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography ((99m)Tc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy. METHODS Sixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and (99m)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), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of (99m)Tc-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and (99m)Tc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%. CONCLUSIONS (99m)Tc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy.