title: Factors affecting the diagnostic accuracy of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) for upper gastrointestinal submucosal or extraluminal solid mass lesions.
abstract: OBJECTIVE
  A number of potential variables are associated with the diagnostic accuracy of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). The aim of this study was to evaluate factors affecting the diagnostic accuracy of EUS-FNA for upper gastrointestinal submucosal or extraluminal solid lesions.
  
  
  METHODS
  Patients with such lesions who underwent EUS-FNA between January 2009 and December 2010 were studied retrospectively. Needles of 22, 25 and 19 gauge were used. The associations between the EUS-FNA results and factors such as mass location, mass size, needle size, number of needle passes, combined histologic-cytologic analysis and final diagnosis were analyzed.
  
  
  RESULTS
  A total of 170 EUS-FNA procedures were performed in 158 patients with upper gastrointestinal submucosal or extraluminal solid lesions. The overall accuracy of EUS-FNA was 86.5% (147/170). The diagnostic accuracy with three or more needle passes was higher than with less than 3.0 needle passes (90.0%, 108/120 vs 78.0%, 39/50; P < 0.05). Mass location, mass size, and final diagnosis were not associated with EUS-FNA accuracy. Combined cytologic-histologic analysis had significantly higher diagnostic accuracy than either cytologic or histologic analysis alone (P < 0.001). In a subgroup of 90 patients, both 22 and 25 gauge needles were used for EUS-FNA. The overall diagnostic accuracy was similar for 25 gauge needles and 22 gauge needles (80.0% vs 78.9% P = 1.000) in this subgroup.
  
  
  CONCLUSIONS
  Overall, 25 and 22 gauge needles have a similar diagnostic accuracy. Our results suggest that 3.0 or more needle passes and combined cytologic-histologic analysis enhance the diagnostic accuracy of EUS-FNA.
authors.affiliation: Department of General Surgery, Peking University First Hospital, Beijing, China.
authors.forename: Long
authors.initials: L
authors.lastname: Rong
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Kousuke
authors.initials: K
authors.lastname: Okuwaki
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyazawa
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Iwai
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Maya
authors.initials: M
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaizumi
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation*; D019160:Endosonography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies