Endosonography-guided real-time fine-needle aspiration biopsy.
Twenty-six patients were prospectively evaluated with endosonography-guided real-time fine-needle-aspiration biopsy. This cohort comprised 14 patients with a pancreatic mass revealed by CT or a stricture of the main pancreatic duct seen at ERCP, 7 patients with mediastinal lymphadenopathy, 3 patients with extrapancreatic abdominal masses, and 2 patients with subepithelial or infiltrative lesions. Endosonography-guided real-time fine-needle-aspiration biopsy was diagnostic in 18 of 20 patients in whom surgical confirmation was available or in whom malignancy was found and confirmed by clinical follow-up (accuracy of 90%). In the subgroup of patients with pancreatic lesions, 3 had previously undergone nondiagnostic CT-guided fine-needle-aspiration biopsy and 2 did not have evidence of a mass by CT. Real-time fine-needle-aspiration biopsy was diagnostic for malignancy in 4 of these individuals. In the 7 patients with mediastinal lymph nodes, 2 had nondiagnostic transbronchial biopsy and 2 had no evidence of mediastinal lymphadenopathy by CT scan. Endosonography-guided real-time fine-needle-aspiration biopsy diagnosed malignancy in both individuals with nondiagnostic transbronchial studies and was able to identify mediastinal lymphadenopathy in the 2 patients with negative CT scans (malignancy confirmed with real-time fine-needle-aspiration biopsy in 1). Overall, in 9 of 10 lesions in which visualization by CT was not possible (5), CT-guided fine-needle aspiration was unsuccessful (3), or prior nonsurgical biopsy techniques were unsuccessful (2), real-time fine-needle-aspiration biopsy was diagnostic.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Medicine, St. Vincent Hospitals and Health Care Center, Indianapolis, Indiana.
M J
MJ
Wiersema
M L
ML
Kochman
H M
HM
Cramer
L C
LC
Tao
L M
LM
Wiersema
D000008:Abdominal Neoplasms / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000473:pathology; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D011446:Prospective Studies; D018084:Ultrasonography, Interventional