Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience

Abstract

Background: Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) is a recent innovation in the evaluation of gastrointestinal and pulmonary malignancies.

Aims: To review the experience with EUS-FNA of a large single centre.

Methods: 333 consecutive patients underwent EUS-FNA. Follow up data were available on 327 lesions in 317 patients, including 160 lymph nodes, 144 pancreatic lesions, 15 extraintestinal masses, and eight intramural tumours.

Results: A primary diagnosis of malignancy was obtained by EUS-FNA in 62% of patients with clinically suspicious lesions. The overall accuracy of EUS-FNA for the diagnosis of malignancy was 86%, with sensitivity of 84% and specificity of 96%. With respect to lesion types, the sensitivity, specificity, and accuracy were 85%, 100%, and 89% for lymph nodes; 82%, 100%, and 85% for pancreatic lesions; 88%, 100%, and 90% for perirectal masses; and 50%, 25%, and 38% for intramural lesions, respectively. Compared with size and sonographic criteria, EUS-FNA in the evaluation of lymph nodes provided superior accuracy and specificity, without compromising sensitivity. Inadequate specimens were obtained from only six patients, including 3/5 with stromal tumors. Only one complication occurred.

Conclusions: EUS-FNA is safe and can readily obtain tissue specimens adequate for cytopathological diagnoses. Compared with size and sonographic criteria, it is a superior modality for the detection of nodal metastases. While providing accurate diagnosis of pancreatic and perirectal malignancies, results suggest the technique is less useful for intramural lesions.

Figures

Figure 1

(A) Using a radial scanning echoendoscope, bulky hypoechoic lymph nodes are identified in the subcarinal region in a patient with NSCLC. (B) Real time, ultrasound directed needle aspiration biopsy of a subcarinal lymph node is performed. The echogenic needle is visualised within the target node. (C) The aspirate confirms sheets of malignant cells with large nuclei and prominent nucleoli. Necrotic debris is noted in the background. Papanicolou stain (original magnification ×200).

Figure 1

(A) Using a radial scanning echoendoscope, bulky hypoechoic lymph nodes are identified in the subcarinal region in a patient with NSCLC. (B) Real time, ultrasound directed needle aspiration biopsy of a subcarinal lymph node is performed. The echogenic needle is visualised within the target node. (C) The aspirate confirms sheets of malignant cells with large nuclei and prominent nucleoli. Necrotic debris is noted in the background. Papanicolou stain (original magnification ×200).

Figure 2

(A) A heterogenous hypoechoic mass is identified in the head of pancreas and is obstructing both the common bile duct (CBD) and main pancreatic duct (PD). The mass can also be seen to invade the portal vein (PV). (B) Using a linear scanning echoendoscope, the echogenic fine needle tip is directed into the pancreatic mass. Aspiration cytology confirmed adenocarcinoma.