Endoscopic ultrasound–guided fine-needle aspiration biopsy using linear array and radial scanning endosonography,☆☆,

https://doi.org/10.1016/S0016-5107(97)70266-9Get rights and content

Abstract

Background: Endoscopic ultrasound (EUS) accurately stages gastrointestinal malignancies but is less able to differentiate between neoplastic and inflammatory processes. EUS-guided fine-needle aspiration (EUS FNA) has been reported useful for obtaining a diagnosis in suspected gastrointestinal lesions. We report our entire experience with EUS FNA using both radial and linear array endosonography, including our diagnostic accuracy and complication rate. Methods: Two hundred eight consecutive patients (119 men, 89 women) referred for EUS evaluation of suspected gastrointestinal or mediastinal masses underwent EUS-guided FNA. We performed EUS FNA using radial scanning or linear array endosonography and a 23 gauge, 4 cm needle or a 22 guage, 12 cm needle. Data collected included lesion types, number of passes, complications, and diagnostic accuracy. Results: Two hundred eight lesions were targeted, with a total of 705 FNA passes (mean 3.39 passes/patient). Overall diagnostic accuracy for our study population was 87% with a 89% sensitivity and 100% specificity. The diagnostic accuracy for each subgroup was 95% for mediastinal lymph node, 85% for intra-abdominal lymph node, 85% for pancreatic, 84% for submucosal, and 100% for perirectal masses. EUS FNA provided an adequate specimen in 90% of patients. The FNA results were similar for both types of endosonography. We observed immediate complications in 2% (4 of 208) of patients. All complications occurred with EUS FNA of pancreatic lesions and consisted of bleeding and pancreatitis in 2 patients each. For EUS FNA of pancreatic masses there was a 1.2% (2 of 121) risk of pancreatitis, 1% (1/121) risk of severe bleeding, and risk of death in less than 1%. Conclusions: EUS-guided FNA appears to be technically feasible, safe, and accurate for obtaining diagnostic tissue of suspicious gastrointestinal and mediastinal lesions and provides important preoperative information. (Gastrointest Endosc 1997;45:243-50.)

Section snippets

Data retrieval

Information on all patients undergoing EUS with or without FNA have been prospectively entered into a database since 1993. Data regarding follow-up were included in this database and used to make a subjective determination as to whether the FNA result changed the management of each patient. Computer search for all attempted and successful FNA patients yielded this study subset.

Patient selection

All patients referred for EUS-guided FNA biopsy based on the results of previous imaging studies (usually endoscopy or

Results

Two hundred eight consecutive patients (119 men/89 women) underwent EUS-guided FNA procedures through December 1995. The mean age of this group was 61 years (range 16 to 87 years). A total of 208 lesions were targeted in 208 patients and a total of 705 FNA passes were performed for a mean of 3.39 passes per patient. In 26% (54 of 208) of patients, previous attempts at biopsy by other methods were unsuccessful.

One hundred twenty-one (58%) of the lesions sampled were pancreatic masses, 27 (13%)

Discussion

EUS-guided FNA was highly accurate for detecting mediastinal lymph node metastasis and diagnosing perirectal and pancreatic masses. We had an overall diagnostic accuracy of 87%. We began utilizing the radial scanning instrument for EUS-guided FNA during prolonged absence of the linear array instrument due to several perforations sustained during early prototype FNA needle development. Our initial experience involved mediastinal LN and progressed to pancreatic and submucosal lesions. Since the

References (20)

There are more references available in the full text version of this article.

Cited by (0)

From the Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana.

☆☆

Reprint requests: Frank Gress, MD, Gastroenterology and Hepatology, Indiana University Medical Center, 550 North University Blvd., Room 2300, Indianapolis, IN 46202.

37/1/77636

View full text