title: Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.
abstract: OBJECTIVE
  Endosonography-guided fine-needle aspiration biopsy (EUS-FNA) permits cytological confirmation of EUS findings. A multicenter prospective evaluation of EUS-FNA for primary diagnosis, staging, and/or follow-up purposes was undertaken.
  
  
  METHODS
  EUS-FNA was performed in 457 patients with 554 lesions. Clinical (n = 218) or histopathologic (n = 256) confirmation was available in 192 lymph nodes, 145 extraluminal masses, 115 gastrointestinal wall lesions, and 22 cystic lesions.
  
  
  RESULTS
  EUS-FNA sensitivity, specificity, and accuracy was 92%, 93%, and 92% for lymph nodes, 88%, 95%, and 90% for extraluminal masses, and 61%, 79%, and 67% for gastrointestinal wall lesions, respectively. The sensitivity and accuracy for lymph nodes and extraluminal masses was superior to that for gastrointestinal wall lesions. When EUS-FNA was compared with EUS size criteria in lymph node evaluation, specificity (93% vs. 24%) and accuracy (92% vs. 69%) were superior, whereas sensitivity (92% vs. 86%) was similar. The accuracy of EUS-FNA in patients with previously failed biopsy procedures was 81% (73 of 90). Five nonfatal complications occurred for a rate of 0.5% (95% confidence interval, 0.1%-0.8%) in solid lesions vs. 14% (95% confidence interval, 6%-21%) in cystic lesions.
  
  
  CONCLUSIONS
  EUS-FNA accurately and safely evaluates solid peri-intestinal lesions and improves lymph node staging accuracy.
authors.affiliation: Department of Medicine, St. Vincent Hospitals, Indianapolis, Indiana, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: P
authors.initials: P
authors.lastname: Vilmann
authors.forename: M
authors.initials: M
authors.lastname: Giovannini
authors.forename: K J
authors.initials: KJ
authors.lastname: Chang
authors.forename: L M
authors.initials: LM
authors.lastname: Wiersema
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects; D003560:Cysts / Q000000981:diagnostic imaging / Q000473:pathology; D004064:Digestive System / Q000000981:diagnostic imaging / Q000473:pathology; D019160:Endosonography / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies