Abstract
The aim of this study was to evaluate the impact of the EUS-guided biopsy in the diagnostic approach and the therapeutic decision. Patients and methods: From January 1992 to November 1997, 522 patients (317 men and 205 women) with a mean age of 68.7 years (range: 15-78 years) underwent an EUS-guided biopsy for mediastinal mass or lymph nodes in 119 cases, sus mesocolic lymph nodes in 72 cases, peri-rectal or peri-colonic lymph nodes or masses in 40 cases, pancreatic tumors in 186 cases, large gastric folds with negative endoscopic biopsy in 31 cases, small liver metastasis in 33 cases, sub-mucosal tumors in 16 cases, adrenal metastasis in 6 cases, ascitis and pleura| effusion in 15 cases and gallbladder tumors in 4 cases. The EUS endoscopes used are the FG 32UA, the FG-36X, the EG-36-30 and the FG 38-X manufactured by Pentax. Results. Patient tolerance was excellent, Five complications (0.9%) were observed: 3 episodes of fever disappearing with antibiotics, 2 acute pancreatitis without complications. The sensitivity, the specificity, the positive predictive value, the negative predictive value and the accuracy of the EUS-guided biopsy for the diagnosis of malignancy were 83.2%, 99.1%, 99.7%, 62.8% and 87.7% respectively. With regards to the diagnostic approach, the EUS-guided biopsy has allowed to make a diagnosis without having recourse to an invasive technique (mediastinoscopy or laparotomy) in 208 cases (39.8%). For the therapeutic attitude, the EUS-guided biopsy reassessed the stage of the esophageal, gastric, pancreatic and rectal tumor in 65 cases. Moreover, the EUS-guided biopsy has modified the treatment of pancreatic tumor in 19 cases showing a neuroendocrine lesion. Conclusion: in this study, the EUS-guided biopsy has modified the diagnostic and the therapeutic approach in 292/522 cases (55.9%) especially for the isolated mediastinal or abdominal lymph nodes or masses, the pancreatic tumor and for the distant lymph nodes staging of GI cancer.
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