Pereira, S.P.; Falzon, M.; Kocjan, G.; Novelli, M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA26
Academic Journal
Background: EUS-FNA of mediastinal and gastrointestinal mass lesions is sensitive for diagnosing malignancy and has a Iow complication rate. However, EUS-FNA ideally requires an on-site cytopathologist to ensure adequate sampling, and the diagnosis of certain neoplasms is difficult based on cytology alone. A 19G trucut needle (Quick-Core, Wilson-Cook) has been recently developed for EUS, but there are no prospective data on its safety or accuracy. Aim: To compare the sens/spec of EUS-FNA with EUS-TNB in patients with suspected mediastinal or gastrointestinal mass lesions. Methods: Over a 10 week period, 12 patients (10M, 2F; mean age 68 year, range 43-82 year) underwent combined 22G EUS-FNA (median 3 passes, range 1-4) and 19G EUS-TNB (2 passes, range 1-3) of suspected mediastinal n = 2) or pancreaticobiliary mass lesions (transgastric approach in 4, transduodenal in 6). Pathologic samples were assessed independently by two pathologists, neither of whom attended the EUS. Patients were contacted 24-48 h later to assess complications. Results: The median size of the lesions biopsied was 2 cm (range 0.6-7 cra). The final diagnoses were benign disease in 6 and malignancy in 6 (adenocarcinoma in 4, lymphoma in 1, gastrinoma in 1). In two patients, EUS-TNB allowed additional characterisation of the tumour not provided by cytology. There were two false negative results for EUS-FNA (1 'highly suspicious', 1 inadequate), and two needle failures during attempted transduodenal EUS-TNB, but the accuracy of the combined tests in detecting malignancy was 100%. One patient reported mild abdominal discomfort for < 24 h after the procedure. Conclusions: Combined EUS-FNA and EUS-TNB appears to be safe and to have a high diagnostic yield. EUS-TN8 from the second part of the duodenum is associated with a high technical failure rate. Large prospective studies are needed to determine in what situations EUS-TNB may improve on the accuracy of EUS-FNA.


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