Clin Endosc.  2013 Nov;46(6):627-632.

Performance and Clinical Role of Endoscopic Ultrasound Fine Needle Aspiration for Diagnosing Gastrointestinal Intramural Lesions

• Sung HJ
• Cho YK
• Park EY
• Moon SJ
• Lim CH
• Kim JS
• Park JM
• Lee IS
• Kim SW
• Choi MG
• Choi KY

Abstract

BACKGROUND/AIMS
We evaluated the performance, clinical role, and diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in gastrointestinal intramural lesions.
METHODS
Procedural and pathologic data were reviewed from consecutive patients undergoing EUS-FNA for intramural lesions. Final diagnoses were determined by surgical histopathologic conformation and the diagnosis of malignancy, including clinical follow-up with repeat imaging.
RESULTS
Forty-six patients (mean age, 47 years; 24 males) underwent EUS-FNA. Lesions were located in the stomach (n=31), esophagus (n=5), and duodenum (n=10). The median lesion size was 2 cm (range, 1 to 20.6). Final diagnoses were obtained in 22 patients (48%). EUS-FNA was diagnostic in 40 patients (87%). The diagnostic accuracy of cytology for differentiating between benign and malignant lesions was 82%; diagnostic error occurred in three patients (6%). The cytologic results influenced clinical judgment in 78% cases. The primary reasons for negative or no clinical impact were false-negative results, misdirected patient management, and inconclusive cytology.
CONCLUSIONS
EUS-FNA exhibited an 87% diagnostic yield for gastrointestinal intramural lesions; the accuracy of cytology for differentiating malignancy was 82%. The limitations of EUS-FNA were primarily because of nondiagnostic sampling (9%) and probable diagnostic error (6%); these factors may influence the clinical role of EUS-FNA.

Keyword

Accuracy; Endoscopic ultrasound-guided fine needle aspiration; Extraintestinal mass; Intramural mass; Yield

MeSH Terms

Biopsy, Fine-Needle*
Diagnosis
Diagnostic Errors
Duodenum
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Esophagus
Follow-Up Studies
Humans
Judgment
Stomach
Ultrasonography*

Figure

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  Fig. 1 A subepithelial tumor exhibiting benign cytology that proved to be a neuroendocrine tumor. (A) A 2-cm subepithelial tumor of the duodenum. (B) Endoscopic ultrasound reveals a heterogenous hypoechoic mass containing multiple tiny cysts that originated from the submucosal layer. (C) Cytology was negative for malignancy. The final diagnosis after surgery was neuroendocrine tumor.

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