Endoscopic ultrasound-guided real-time fine-needle aspiration: Clinicopathologic features of 60 patients

Abstract

Diagnosis of lesions of the gastrointestinal tract and adjacent structures is possible using an imaging modality, endoscopic ultrasonography (EUS). Fine‐needle aspiration (FNA) is a suitable and cost‐effective technique for obtaining cytohistologic material to confirm the diagnosis. EUS is capable of both characterizing the lesion and then guiding the FNA under real‐time (RT) ultrasound guidance using a through‐the‐scope needle aspiration system. The goal of this study was to determine the diagnostic accuracy of this technique and to describe the clinicopathologic features. Sixty patients underwent EUS‐guided RTFNA of 64 lesions, including pancreas (n = 45), periluminal lymph nodes (n = 12), mediastinal and retroperitoneal masses (n = 4), and hepatobiliary masses (n = 3). Follow‐up data were obtained by surgery, histopathology, or clinical course. Thirty‐one lesions were malignant, eight were atypical/suspicious, 16 were non‐neoplastic, and nine were non‐diagnostic. Of the 55 lesions with sufficient material for interpretation, 54 had follow‐up confirmation of the RTFNA diagnosis. The calculated sensitivity and specificity for malignancy was 90% and 100%, respectively. Diagnostic accuracy for malignancy was excellent for gastrointestinal associated lymph nodes (100%), mediastinal and retroperitoneal masses (100%), somewhat less so for pancreatic tumors (94%), and poor for hepatobiliary lesions (33%). EUS‐guided RTFNA is accurate for sampling small gastrointestinal tract–associated lesions. EUS‐guided RTFNA should be considered as a procedure of choice in selected patients when the results will influence management decisions. Diagn. Cytopathol. 1998; 18:98–109.