Ultrasound Guided Procedures in the Diagnosis of Mediastinal Lymphadenopathy

Abstract Background : Mediastinal lymph node evaluation can be performed using several techniques. Imaging modalities such as positron emission tomography–computed tomography (PET‑CT), magnetic resonance imaging (MRI), and computed tomography (CT) provide relatively high sensitivity in detecting mediastinal disease. Mediastinoscopy remains the gold standard for diagnosing mediastinal lesions, though it carries intraoperative and postoperative risks. Ultrasound (US) offers two distinct advantages: it can be integrated into endoscopic procedures and allows real‑time sampling of mediastinal lesions. Aim: To assess the role of different ultrasound‑guided techniques in diagnosing mediastinal lymphadenopathy. Methods: This prospective, interventional, comparative cohort study was conducted at the Chest Department, Kasr Al Ainy Hospital, Cairo University. A total of 79 adult patients with CT‑confirmed mediastinal lymphadenopathy were enrolled. Patients were divided into three groups based on the biopsy technique: group (1) where 24 patients underwent cervical lymph node ultrasound guided biopsy (CUSB), group (2) included 31 patients who underwent trans-thoracic ultrasound guided mediastinal lymph node biopsy (TUSB) and group (3) included 24 patients who underwent convex probe endobronchial ultrasound (CP‑EBUS)‑guided biopsy Results : A definitive diagnosis was achieved in 74 of the 79 cases, while 5 required further intervention. Overall, ultrasound demonstrated a sensitivity of 93.67% and a positive predictive value of 100% in diagnosing mediastinal lymphadenopathy. Transthoracic ultrasound achieved the highest sensitivity (100%). The diagnostic accuracy for malignancy was 93.67%. Malignancy was identified in 60 cases, with ultrasound showing 92.31% sensitivity, 100% specificity, 100% positive predictive value, and 73.68% negative predictive value. Conclusions : Ultrasound is a non‑invasive, accessible, and highly sensitive diagnostic tool. It can serve as an effective screening method for cervical and mediastinal lymphadenopathy.