Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.

Abstract

Diagnosis of submucosal lesions, pancreatic tumors, and mediastinal or celiac lymph nodes or masses is possible using endoscopic ultrasonography (EUS), but histological confirmation to differentiate between benign and malignant lesions is still required. The aim of this study was to evaluate the efficacy of a new method of EUS-guided fine-needle aspiration biopsy of intramural and paramural lesions. From October 1991 to September 1994, EUS-guided fine-needle aspiration biopsy was carried out in 141 patients with findings of mediastinal masses (18 cases), mediastinal lymph nodes (24 cases), submucosal tumors (seven cases), celiac lymph nodes (26 cases), large gastric folds with negative endoscopic biopsy (13 cases), pancreatic tumors (43 cases), a small liver metastasis (five cases), retrorectal tumors (four cases), and an adrenal metastasis (one case). The EUS examination was performed using a Pentax-Hitachi FG 32-UA system. A malignant tumor was diagnosed in 110 of the 141 patients. EUS-guided fine-needle aspiration was positive in 85 cases. In 15 cases, an adequate specimen could not be obtained (10.6%). The sensitivity and specificity of the diagnosis of malignancy were 77.0% and 100%, respectively. Results were better for mediastinal masses (sensitivity 88%), mediastinal lymph nodes (81%), and celiac lymph nodes (80%) than for pancreatic tumors (75%) or submucosal tumors (60%). These results suggest that EUS-guided fine-needle biopsy using a curved-array transducer represents a step forward in the tissue diagnosis of gastrointestinal lesions.