title: Endoscopic ultrasound-guided fine-needle aspiration for suspected malignancies adjacent to the gastrointestinal tract.
abstract: OBJECTIVE
  To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.
  
  
  METHODS
  A cohort of 1019 patients with suspected malignant lesions adjacent to the gastrointestinal tract received EUS-FNA after a standardized multidisciplinary team evaluation (MTE) and were divided into 4 groups according to their specific malignant risk score (MRS). Patients with a MRS of 0 (without detectable risk of malignancy) received only EUS without FNA. For patients with a MRS score ranging from 1 (low risk) - through 2 (intermediate risk) - to 3 (high risk), EUS-FNA cytology of the lesion was planned for a different time and was prioritized for those patients at higher risk for cancer. The accuracy, efficiency and quality assessment for the early detection of patients with potentially curable malignant lesions were evaluated for the whole cohort and in the different classes of MRSs. The time to definitive cytological diagnosis (TDCD), accuracy, sensitivity, specificity, positive and negative predictive values, and the rate of inconclusive tests were calculated for all patients and for each MRS group.
  
  
  RESULTS
  A total of 1019 patients with suspected malignant lesions were evaluated by EUS-FNA. In 515 patients of 616 with true malignant lesions the tumor was diagnosed by EUS-FNA; 421 patients with resectable lesions received early surgical treatment, and 94 patients received chemo-radiotherapy. The overall diagnostic accuracy for the 1019 lesions in which a final diagnosis was obtained by EUS-FNA was 0.95. When patients were stratified by MTE into 4 classes of MRSs, a higher rate of patients in the group with higher cancer risk (MRS-3) received early treatment and EUS-FNA showed the highest level of accuracy (1.0). TDCD was also shorter in the MRS-3 group. The number of patients who received surgical treatment or chemo-radiotherapy was significantly higher in the MRS-3 patient group (36.3% in MRS-3, 10.7% in MRS-2, and 3.5% in MRS-1).
  
  
  CONCLUSIONS
  EUS-FNA can effectively detect a curable malignant lesions at an earlier time and at a higher rate in patients with a higher cancer risk that were evaluated using MTE.
authors.affiliation: Pietro Gambitta, Antonio Armellino, Edoardo Forti, Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca' Granda, 20162 Milano, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gambitta
authors.affiliation: Pietro Gambitta, Antonio Armellino, Edoardo Forti, Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca' Granda, 20162 Milano, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Armellino
authors.affiliation: Pietro Gambitta, Antonio Armellino, Edoardo Forti, Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca' Granda, 20162 Milano, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Forti
authors.affiliation: Pietro Gambitta, Antonio Armellino, Edoardo Forti, Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca' Granda, 20162 Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vertemati
authors.affiliation: Pietro Gambitta, Antonio Armellino, Edoardo Forti, Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca' Granda, 20162 Milano, Italy.
authors.forename: Paola Enrica
authors.initials: PE
authors.lastname: Colombo
authors.affiliation: Pietro Gambitta, Antonio Armellino, Edoardo Forti, Unità di Chirurgia Endoscopica ed Ecoendoscopia Ospedale Niguarda Ca' Granda, 20162 Milano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Aseni
mesh_terms: D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Clinical decision support system; Clinical scoring system; Endoscopic ultrasonography; Fine needle aspiration; Gastrointestinal neoplasm