EUS-SOS

Abstract

Purpose: Bronchoscopy with transbronchial FNA, mediastinoscopy, CT guided bx and laparoscopy are accepted techniques for tissue sampling of intrathoracic and intra-abdominal masses. We report our experience with EUS FNA/Trucut bx (EUS FNA/TCB) as a rescue procedure in patients (pts.) who previously failed or were refused by other bx techniques. Aim: To evaluate the accuracy of EUS FNA in pts with malignant disease and a previously failed bx procedure. Methods: Retrospective analysis of EUS FNA/TCB results in all pts. referred for pancreatic or mediastinal bx from 10/03 to 4/05. Pts. who failed or were refused by other bx modalities and had a final diagnosis of malignancy were included. A positive diagnosis of malignancy by EUS FNA/TCB was considered true positive. All procedures were performed only with linear array EUS by a single endosonographer. No on-site cytopathology was done. FNA was performed in all pts. and TCB was added at the discretion of the endosonographer. Results: A total of 160 pts. were referred for pancreatic or mediastinal bx for solid masses. Thirty-nine pts. (24%) met the inclusion criteria. The mean age was 67 years (18 F and 21 M). There were 26 pancreatic masses and 13 mediastinal masses. In the mediastinal group, 11 failed bronchoscopy with transbronchial FNA, one failed mediastinoscopy, and one was turned down for CT guided bx. In the pancreatic group, sixteen failed CT guided bx, six failed laparoscopy, three were turned down for CT guided bx and one failed prior EUS FNA/TCB. The sensitivity of EUS FNA/TCB for detecting malignancy in 39 pts. was 85%. In the mediastinal and pancreatic subgroups sensitivities were: 100% and 77% respectively. The mean number of FNA passes was 6 (range 3–10), Trucut was used in 19 pts., mean number of passes of 2.4 (range 2–5). All six pts. with pancreatic cancer missed by EUS FNA did not undergo additional EUS TCB due to technical reasons (uncinate process lesions). Four of the six pts. with pancreatic cancer missed by EUS FNA, had at least two prior failed biopsies by CT FNA. Conclusions: In pts. who have failed other bx procedures, EUS FNA/TCB should still be considered an accurate and safe modality to detect malignancy. Addition of TCB to FNA appears safe and should be considered in the absence of on-site cytopathology review.