Fine-needle tissue acquisition from subepithelial lesions using a forward-viewing linear echoendoscope.
OBJECTIVE
The overall diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for subepithelial lesions (SELs) is suboptimal. The aim of this study was to evaluate the diagnostic accuracy, defined as the proportion of correct diagnoses, obtained using the EUS-guided fine-needle tissue acquisition (FNTA) sampling technique performed with the newly developed forward-viewing EUS scope (FV-EUS).


METHODS
This was a retrospective analysis of a prospectively collected database including all consecutive patients with SELs who underwent EUS-FNTA using the FV-EUS scope from 2007 to 2011 in a tertiary referral center. All procedures were performed by a single expert endoscopist.


RESULTS
A total of 121 consecutive patients with SELs (13 in the esophagus, 96 in the stomach, 10 in the duodenum, 2 in the rectum) underwent sampling of the lesion using the FV-EUS scope. The procedure was technically feasible in all but one patient, and no complication related to EUS-FNTA occurred. Full histological assessment including immunostaining could be completed in 93.4% (113/121) of the patients. Considering neoplastic vs. non-neoplastic diseases, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 92.8% (95%CI 86.3-96.8), 100% (95%CI 69.0-100%), infinity, and 0.07 (95%CI 0.04-0.14), respectively.


CONCLUSIONS
EUS-FNTA performed in conjunction with the FV-EUS scope for sampling SELs of the gastrointestinal tract was safe and provided a very high diagnostic accuracy. Studies comparing FV-EUS with standard curved linear echoendoscopes are needed to clarify whether these results are due to the sampling technique or the type of scope utilized.
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Alberto
A
Larghi
Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Lorenzo
L
Fuccio
Department of Pathology, Catholic University, Rome, Italy.
Gaia
G
Chiarello
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Fabia
F
Attili
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Giuseppe
G
Vanella
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Giovanni Battista
GB
Paliani
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Matteo
M
Napoleone
Department of Pathology, Catholic University, Rome, Italy.
Guido
G
Rindi
Department of Pathology, Catholic University, Rome, Italy.
Luigi Maria
LM
Larocca
Department of Pathology, Catholic University, Rome, Italy.
Guido
G
Costamagna
Department of Pathology, Catholic University, Rome, Italy.
Riccardo
R
Ricci
D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation*; D019160:Endosonography / Q000295:instrumentation*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies