ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION BIOPSY USING LINEAR-ARRAY AND RADIAL SCANNING ENDOSONOGRAPHY

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.