Je. Baier et M. Wegener, CYTOLOGICAL DIFFERENTIATION OF MEDIASTINA L AND PARAPANCREATIC MASS LESIONS BY ENDOSONOGRAPHICALLY GUIDED FINE-NEEDLE ASPIRATION PUNCTURE, Tumordiagnostik & Therapie, 17(4), 1996, pp. 122-128
Mass lesions adjacent to the gastroesophageal wall can be visualized i
n detail by endoscopic ultrasonography. However, in many patients tiss
ue diagnosis of these mass lesions is urgently required. We evaluated
the efficiency of transmural fine-needle aspiration puncture guided by
endosonography for cytological confirmation of such mass lesions. End
osonographically guided transmural fine-needle aspiration (EUS-guided
FNA) puncture was performed in 33 patients with extrinsic mass lesions
adjacent to the gastro-esophageal wall. 14 patients performed with me
diastinal and 19 patients with paraesophageal lesions. In 17 patients
a malignant tumor and in 15 patients a benign lesion was identified by
EUS-guided FNA puncture. Only in one patient cytological classificati
on of PAP I was not correct, as the patient turned out to have a squam
ous cell carcinoma. No complications were observed. The cytological re
sult of a malignant lesion was confirmed either by resection of tumor
metastasis, by autopsy, or by demonstration of a local recurrence of a
previously histopathologically diagnosed carcinoma, while the benign
cytological results were confirmed by a follow-up period of at least 1
3 months and appropriate diagnostic tests. It is concluded that EUS-gu
ided FNA puncture is an efficient diagnostic technique for the assessm
ent of malignancy and tissue diagnosis of extrinsic paraduodeno-gastro
-esophageal mass lesions. An important precondition for the successful
performance of transmural EUS-guided FNA puncture is the application
of endosonographic transducers with longitudinal scanning in the axis
of the endoscope and a special needle device, which can be deeply adva
nced into the adjacent tissue.