title: 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.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Bentz
authors.forename: M L
authors.initials: ML
authors.lastname: Kochman
authors.forename: D O
authors.initials: DO
authors.lastname: Faigel
authors.forename: G G
authors.initials: GG
authors.lastname: Ginsberg
authors.forename: D B
authors.initials: DB
authors.lastname: Smith
authors.forename: P K
authors.initials: PK
authors.lastname: Gupta
mesh_terms: D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000473:pathology; D001707:Biopsy, Needle / Q000379:methods*; D002648:Child; D019723:Endoscopes; D019160:Endosonography / Q000295:instrumentation / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity