EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study

• Published in: Gastrointestinal endoscopy Vol. 74; no. 3; pp. 504 - 510
• Main Authors: Larghi, Alberto, MD, PhD, Verna, Elizabeth C., MD, Ricci, Riccardo, MD, Seerden, Tom C., MD, PhD, Galasso, Domenico, MD, Carnuccio, Antonella, MD, PhD, Uchida, Naohito, MD, Rindi, Guido, MD, PhD, Costamagna, Guido, MD, FACG
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.09.2011; Elsevier
• Subjects: Adenocarcinoma - pathology; Aged; Biological and medical sciences; Biopsy, Fine-Needle - instrumentation; Carcinoma, Squamous Cell - pathology; Digestive System Neoplasms - pathology; Digestive system. Abdomen; Endoscopy; False Negative Reactions; False Positive Reactions; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Lymph Nodes - pathology; Lymphoma - pathology; Male; Mediastinal Diseases - pathology; Medical sciences; Middle Aged; Needles; Pancreatitis - pathology; Predictive Value of Tests; Prospective Studies; Ultrasonography, Interventional; EUS-guided fine-needle tissue acquisition; upper quartile; LQ; EUS-TCB; EUS-FNA; EUS-guided Tru-Cut biopsy needle; conventional linear array; FV; lower quartile; forward-viewing; CLA; EUS-guided fine-needle aspiration; UQ; EUS-FNTA; Sonography; Human; Fine needle; Endoscopic route; Endoscopic ultrasonography; Echography
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.05.014

Background The ability to obtain tissue samples for histological examination during EUS has theoretical advantages over cytology alone. Objective To prospectively evaluate the feasibility and yield of EUS-guided fine-needle tissue acquisition (EUS-FNTA) with a large-gauge needle in patients in whom we expected histology to be more useful than cytology to reach a definitive diagnosis. Design Prospective cohort study. Setting Tertiary care academic medical center. Patients Consecutive patients with subepithelial lesions, esophagogastric wall thickening, mediastinal and abdominal masses/lymphadenopathy of unknown origin, or pancreatic lesions after nondiagnostic FNA. Interventions EUS-FNTA with a 19-gauge needle. Main Outcome Measurements Feasibility and yield of EUS-FNTA. Results A total of 120 patients with a mean age of 61 ± 14.6 years and mean lesion size of 38 ± 25 mm (range 8-140 mm) were enrolled. FNTA was successfully performed in all but 1 patient (98.9%), and adequate samples for histological examination were obtained in 116 of the 119 patients (97.5%) in whom EUS-FNTA was technically successful. A mean of 2.8 ± 0.8 passes per patient were performed. At the time of current follow-up, a definitive diagnosis was available in 117 of the 120 patients (97.5%), with only 8 false-negative results. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNTA in the 117 patients with a definitive diagnosis were 91.8%, 100%, 100%, 71.4%, and 93.2%, respectively. Limitations Single-center study with limited power. Conclusions EUS-FNTA by using a large-gauge needle has a high yield and promising diagnostic accuracy and could be used when histology may be more useful than cytology to reach a definitive diagnosis.