Endoscopic ultrasound guided fine needle aspiration biopsy: a large singlecentre experience

Background-Endoscopic ultrasound guided fine needle aspiration biopsy (EUS- FNA) is a recent innovation in the evaluation of gastrointestinal and pulmo nary malignancies. Aims-To review the experience with EUS-FNA of a large single centre. Methods-333 consecutive patients underwent EUS-FNA. Follow up data were ava ilable on 327 lesions in 317 patients, including 160 lymph nodes, 144 pancr eatic lesions, 15 extraintestinal masses, and eight intramural tumours. Results-A primary diagnosis of malignancy was obtained by EUS-FNA in 62% of patients with clinically suspicious lesions. The overall accuracy of EUS-F NA for the diagnosis of malignancy was 86%, with sensitivity of 84% and spe cificity of 96%. With respect to lesion types, the sensitivity, specificity , and accuracy were 85%, 100%, and 89% for lymph nodes; 82%, 100%, and 85% for pancreatic lesions; 88%, 100%, and 90% for perirectal masses; and 50%, 25%, and 38% for intramural lesions, respectively. Compared with size and s onographic criteria, EUS-FNA in the evaluation of lymph nodes provided supe rior accuracy and specificity, without compromising sensitivity. Inadequate specimens were obtained from only six patients, including 3/5 with stromal tumors. Only one complication occurred. Conclusions-EUS-FNA is safe and can readily obtain tissue specimens adequat e for cytopathological diagnoses. Compared with size and sonographic criter ia, it is a superior modality for the detection of nodal metastases. While providing accurate diagnosis of pancreatic and perirectal malignancies, res ults suggest the technique is less useful for intramural lesions.