Background: Endoscopic ultrasound (EUS) accurately stages gastrointest
inal malignancies but is less able to differentiate between neoplastic
and inflammatory processes. EUS-guided fine-needle aspiration (EUS FN
A) has been reported useful for obtaining a diagnosis in suspected gas
trointestinal lesions. We report our entire experience with EUS FNA us
ing both radial and linear array endosonography, including our diagnos
tic accuracy and complication rate. Methods: Two hundred eight consecu
tive patients (119 men, 89 women) referred for EUS evaluation of suspe
cted gastrointestinal or mediastinal masses underwent EUS-guided FNA.
We performed EUS FNA using radial scanning or linear array endosonogra
phy and a 23 gauge, 4 cm needle or a 22 guage, 12 cm needle. Data coll
ected included lesion types, number of passes, complications, and diag
nostic accuracy. Results: Two hundred eight lesions were targeted, wit
h a total of 705 FNA passes (mean 3.39 passes/patient). Overall diagno
stic accuracy for our study population was 87% with a 89% sensitivity
and 100% specificity. The diagnostic accuracy for each subgroup was 95
% for mediastinal lymph node, 85% for intra-abdominal lymph node, 85%
for pancreatic, 84% for submucosal, and 100% for perirectal masses. EU
S FNA provided an adequate specimen in 90% of patients. The FNA result
s were similar for both types of endosonography. We observed immediate
complications in 2% (4 of 208) of patients. All complications occurre
d with EUS FNA of pancreatic lesions and consisted of bleeding and pan
creatitis in 2 patients each. For EUS FNA of pancreatic masses there w
as a 1.2% (2 of 121) risk of pancreatitis, 1% (1/121) risk of severe b
leeding, and risk of death in less than 1%. Conclusions: EUS-guided FN
A appears to be technically feasible, safe, and accurate for obtaining
diagnostic tissue of suspicious gastrointestinal and mediastinal lesi
ons and provides important preoperative information.