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Endoscopic Ultrasound-Guided Fine-Needle Aspiration Highly Effective in Diagnostic and Staging Tool: Presented at ASCP

By Lexa W. Lee

NEW ORLEANS, LA -- October 25, 2007 -- Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) significantly improves evaluation of lesions in many organs and reduces the need for more invasive diagnostic and staging procedures, according to study findings presented here at the annual meeting of the American Society of Clinical Pathology (ASCP).

EUS-FNA is gradually replacing older methods used for the diagnosis, staging, and treatment of tumours. Its high degree of accuracy for staging tumours of the oesophagus, stomach, pancreas, rectum, and mediastinum has been reported in many studies. In addition, new developments in FNA biopsy needles and brushes have made it possible to obtain sufficient material for sampling of intramural and cystic masses.

Songlin Zhang, MD, Cytopathologist, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois, United States, and colleagues conducted their study to assess the past 5 years of samples collected by EUS-FNA at their institution and compare the findings with those in the current literature. A total of 951 EUS-FNA cases from 2002 to 2006 were reviewed for cytological-histological correlations, and causes for discrepancies were documented by reviewing both cytology and surgical slides.

The EUS-FNA cases included 465 pancreatic lesions, 249 lymph nodes, 111 submucosal lesions, 32 liver lesions, and 94 other lesions. There were 3 false negative cases and no false positives. The cytologic diagnoses included 30.9% malignant cases, 3.8% atypical, 12.9% neoplastic, 37.9% negative, 10.2% unsatisfactory, 4.3% 'other' (descriptive) cases.

Overall, 37.5% of the cases had surgical follow-up. Lymph nodes, mainly examined for staging, had the lowest unsatisfactory rate, at 5.6%; pancreatic cystic lesions had the highest unsatisfactory rate, at 23.8%. Counting 'malignant' and 'atypical' as positive diagnoses in cytology and all others as negative, sensitivity was 91.6%, specificity 96.6%, and accuracy 93.2%.

The findings showed pancreatic lesions to be the most common targets at Northwestern for EUS-FNA (48%), followed by lymph nodes (26%). The overall sensitivity of EUS-FNA was 85% to 95%, specificity 95% to 100%, and accuracy 85% to 95%, depending on the location and nature of the lesions (ie, sensitivity is higher for solid lesions in the pancreas, at 95% vs cystic, at 47%).

As reported in previous studies, the ability to obtain an adequate specimen depends on the experience of the specialist.

Dr. Zhang concluded, "EUS-FNA is a powerful tool for diagnosis and staging. We achieved a very high sensitivity, specificity, and accuracy."


[Presentation title: EUS-FNA: Five Years' Experience at Northwestern Memorial Hospital. Poster 92]

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