Routine diagnostic: Indications and results of endosonography-guided fine-needle aspiration cytology

The usefulness and clinical utility of routine EUS-guided fine needle aspir ation cytology (FNA) in the diagnosis of lesions adjacent to the upper gast rointestinal tract was prospectively studied. Methods: EUS/FNA was performed in 122 patients for 125 lesions: Mediastinal lymph nodes (n = 56), pancreatic lesions (n = 45), paragastric masses (n = 12), submucosal tumors (n = 4) and small hepatic lesions (n = 2) were succ essfully punctured for cytological diagnosis. Results: Adequate material was gained in 119 out of 125 punctures (95%). Ov erall sensitivity, specifity, positive and negative predictive value were 9 0%, 98%, 98% and 89%. Results of EUS/FNA in mediastinal lymph nodes were su perior (95%, 100%, 100%, 90%) to those in pancreatic lesions (80%, 100%, 10 0%? 80%). In paragastric masses sensitivity was 100% whereas specifity was only 67% - due to one false-positive result. Out of four submucosal tumors diagnosis was revealed in three. Two liver metastasis were successfully pun ctured. 35 out of 56 mediastinal nodes showed malignancy. 27 metastases of lung, three of gastric-, two of renal cancer and three Non-Hodgkins's lymph oma were diagnosed. The cytological results of 45 pancreatic lesions showed cancer in 19 and chronic inflammation in 21, two abscesses and three benig n cysts. There were no complications. 37 patients were treated on outpatien t's basis. Conclusions: EUS-guided FNA is an accurate and safe technique to sample cyt ology from lesions adjacent to the wall of the upper gastrointestinal tract . New indications may be established for the diagnosis of lung cancer or me tastases of other spreading out into the mediastinum or the celiac axis.