Comparison of endoscopic ultrasound‐guided fine needle aspiration cytology versus endoscopic biopsy for the diagnosis of subepithelial lesions of the upper and lower gastrointestinal tract: A 10‐year retrospective single institution analysis

Abstract

Background The aim of this study is to compare the diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) versus endoscopic biopsy for the diagnosis of gastrointestinal (GI) subepithelial lesions (SELs) using surgical resection as the gold standard. Methods All patients who underwent EUS‐FNA of upper and lower GI SELs over a 10‐year period (2010 through 2019) were retrospectively reviewed. The medical records of all patients were reviewed and data extracted from the endoscopy, pathology, and surgical reports were analyzed. Results In total, 283 patients with ages ranging from 21 to 92 years underwent EUS‐FNA for evaluation of GI SELs, 117 (41%) patients underwent endoscopic biopsy and 82 (29%) patients had concurrent surgical resection specimen. EUS‐FNA was obtained from the stomach in 167 (59%) patients, duodenum in 51 (18%) patients, esophagus in 38 (13%) patients, and colorectum in 27 (10%) patients. It was found that the largest percentage of lesions originated in the muscularis propria (36%), followed by the submucosa (26%), deep mucosa (13%), and not specified in 21%. The concordance between EUS‐FNA and endoscopic biopsy was good (correlation coefficient of 0.631, p < .001). EUS‐FNA versus endoscopic biopsy in resected cases showed sensitivity and specificity of 78% versus 68% and 84% versus 100%, respectively. The EUS‐FNA has an accuracy of 80% compared to 74% in biopsy. The diagnostic yield of EUS‐FNA and endoscopic biopsy was 64% versus 55%. Conclusion EUS‐FNA is more sensitive and more accurate than endoscopic biopsy for diagnosing GI SELs with a good concordance between the two techniques.

Diagnosis by Endoscopic Ultrasonography-Guided Sampling through the Lower Gastrointestinal Tract

“…Although a previous study confirmed that mucosal incision-assisted biopsy is superior to ultrasound-guided fine-needle aspiration biopsy in diagnosing small lesions in the upper and lower layers of the stomach [ 18 ], EUS-guided aspiration biopsy may still be preferred in the colon, especially when space-occupying lesions make mucosal resection difficult. Moreover, the pathological results for the EUS-guided sampling and endoscopic resection of lesions are highly consistent, and fewer complications are associated with EUS-guided sampling [ 19 , 20 ]. When diagnosing subepithelial lesions, EUS-FNB often requires fewer passes than EUS-FNA [ 21 ].…”