CYTOLOGICAL DIFFERENTIATION OF MEDIASTINA L AND PARAPANCREATIC MASS LESIONS BY ENDOSONOGRAPHICALLY GUIDED FINE-NEEDLE ASPIRATION PUNCTURE

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.