title: Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis.
abstract: BACKGROUND
  The immediate assistance of a cytologist during EUS-guided FNA is not universal. The optimal number of fine needle passes during EUS-guided FNA has not been determined in a prospective study. The aim of this study was to determine the optimal number of passes required to obtain a correct diagnosis.
  
  
  METHODS
  Seven or more passes were made with a fine needle into a variety of lesions during EUS-guided FNA. Adequacy of the aspirate, diagnosis, and a "certainty score" were recorded after each pass and interpreted sequentially by a cytopathologist. Surgical histopathology and 1-year clinical follow-up were used as reference standards. The percentage of correctly diagnosed cases was calculated and stratified according to organ, disease group, and EUS characteristics of the lesion.
  
  
  RESULTS
  Lesions from 95 patients were categorized into the following locations: pancreas, lymph node, and miscellaneous. The sensitivity and specificity for 7 passes from the pancreas and miscellaneous lesion groups were, respectively, 83% and 100%. The sensitivity and specificity for 5 passes from the lymph node group were, respectively, 77% and 100%.
  
  
  CONCLUSIONS
  During EUS-guided FNA, at least 7 passes with a fine needle into pancreatic and miscellaneous lesions, and 5 passes into lymph nodes are needed to ensure a high degree of certainty for making a correct diagnosis.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Division of Pathology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
authors.forename: Julia Kim
authors.initials: JK
authors.lastname: LeBlanc
authors.forename: Donato
authors.initials: D
authors.lastname: Ciaccia
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Al-Assi
authors.forename: Kevin
authors.initials: K
authors.lastname: McGrath
authors.forename: Tom
authors.initials: T
authors.lastname: Imperiale
authors.forename: Liang-Che
authors.initials: LC
authors.lastname: Tao
authors.forename: Steve
authors.initials: S
authors.lastname: Vallery
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Edith
authors.initials: E
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity