title: The additional value of EUS-guided Tru-cut biopsy to EUS-guided FNA in patients with mediastinal lesions.
abstract: OBJECTIVE
  EUS-guided FNA is a sensitive method to obtain cytologic specimens from solid lesions in close proximity to the GI tract. Although FNA provides cells for analysis, large-caliber Tru-cut biopsy (EUS-TCB) needles obtain samples that can be used for additional histopathologic analysis. We assessed the additional diagnostic yield of EUS-TCB in patients with solid mediastinal lesions in whom EUS-FNA was performed.
  
  
  METHODS
  In the period from July 2003 to July 2007, all patients with mediastinal lesions accessible to EUS-FNA and EUS-TCB were evaluated. In all patients, a mean of 3 passes of EUS-FNA was followed by EUS-TCB. Cytologic and histologic specimens were evaluated by 2 pathologists blinded for patient condition. A final diagnosis was obtained by combining all information present (EUS-FNA and EUS-TCB results, mediastinoscopy, bronchoscopy [if performed], and other investigations).
  
  
  RESULTS
  The diagnostic accuracy of EUS-FNA, EUS-TCB, and the combination of both techniques was 93%, 90%, and 98%, respectively (not significant). In EUS-FNA-negative patients, EUS-TCB provided a final diagnosis in an additional 3 patients (5%). Malignant disease found by EUS-FNA could be specified by EUS-TCB in 15 patients (25% of patients). The granulomatous disease established by cytologic samples of clinically suspected tuberculosis could be specified by EUS-TCB in 2 patients (3%). In 1 patient (2%), both FNA and TCB were inconclusive.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  The diagnostic yield of EUS-FNA and EUS-TCB is comparable. We recommend limiting the use of EUS-TCB to specific cases in which EUS-FNA is not conclusive.
authors.affiliation: Department of Gastroenterology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Lieke P V
authors.initials: LP
authors.lastname: Berger
authors.forename: Robert C H
authors.initials: RC
authors.lastname: Scheffer
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
authors.forename: Cees A
authors.initials: CA
authors.lastname: Seldenrijk
authors.forename: Peter C
authors.initials: PC
authors.lastname: de Bruin
authors.forename: Robin
authors.initials: R
authors.lastname: Timmer
authors.forename: Mark F J
authors.initials: MF
authors.lastname: Stolk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000295:instrumentation*; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012507:Sarcoidosis / Q000000981:diagnostic imaging / Q000473:pathology; D018084:Ultrasonography, Interventional; D055815:Young Adult