The additional value of EUS-guided Tru-cut biopsy to EUS-guided FNA in patients with mediastinal lesions.
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.
Berger
Lieke P V
LP
Department of Gastroenterology, St Antonius Hospital, Nieuwegein, the Netherlands.
Scheffer
Robert C H
RC
Weusten
Bas L A M
BL
Seldenrijk
Cees A
CA
de Bruin
Peter C
PC
Timmer
Robin
R
Stolk
Mark F J
MF
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