title: Performance of the forward-viewing linear echoendoscope for fine-needle aspiration of solid and cystic lesions throughout the gastrointestinal tract: a large single-center experience.
abstract: BACKGROUND
  A newly developed forward-viewing linear echoendoscope (FV-EUS) has recently become available. To date, however, only scanty data on the performance of the FV-EUS scope for fine-needle aspiration (FNA) of lesions throughout the gastrointestinal (GI) tract are available. This study aimed to evaluate the technical performance of the FV-EUS scope for FNA of solid and cystic lesions located throughout the GI tract in a large cohort of patients referred to a tertiary care center.
  
  
  METHODS
  All patients who underwent endoscopic ultrasound (EUS)-guided FNA using the FV-EUS scope between January 2007 and December 2008 were included in this retrospective study. The performance of the FV-EUS scope for FNA was evaluated.
  
  
  RESULTS
  During the study period, 285 patients with solid or cystic lesions throughout the GI tract underwent the procedure with the FV-EUS scope. A total of 300 FNAs were attempted, 6 (2%) of which could not be performed. Of the 294 successful EUS-FNA procedures, 130 (44.2%) were performed using a 22-gauge needle, 89 (30.3%) using a 25-gauge needle, and 75 (25.5%) using a 19-gauge needle. In all 67 cases of pancreatic cyst or dilated pancreatic duct, a specimen for cystic fluid analysis or cytologic examination could be obtained. Among the remaining 217 patients with solid lesion, a definitive diagnosis could be established for 211 patients (97.2%). The FV-EUS scope had a sensitivity of 74.7% (95% confidence interval [CI] 68.1-80.6%), a specificity of 100% (95% CI 89.9-100%), a positive likelihood ratio of infinity, and a negative likelihood ratio of 0.251 (95% CI 0.196-0.323).
  
  
  CONCLUSIONS
  The FV-EUS scope is highly effective for FNA of solid and cystic lesions throughout the GI tract. Prospective studies comparing the FV-EUS scope and a curved linear scope are needed.
authors.affiliation: Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy, albertolarghi@yahoo.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
authors.forename: Fabia
authors.initials: F
authors.lastname: Attili
authors.forename: Ester Diana
authors.initials: ED
authors.lastname: Rossi
authors.forename: Matteo
authors.initials: M
authors.lastname: Napoleone
authors.forename: Domenico
authors.initials: D
authors.lastname: Galasso
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D016001:Confidence Intervals; D003560:Cysts / Q000000981:diagnostic imaging* / Q000473:pathology*; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity