Endoscopic ultrasound guided fine needle aspiration of non-pancreatic lesions: an institutional experience

Abstract

Background: Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) has proven to be an effective diagnostic modality for the detection and staging of pancreatic malignancies. In recent years EUS-FNA has also been used to diagnose lesions of non-pancreatic sites such as structures in close proximity to the gut wall within the mediastinum, abdomen, pelvis and retro-peritoneum. Aims: To evaluate experience with EUS-FNA of non-pancreatic sites at a large university medical centre. Methods: The study cohort included 234 patients who underwent EUS-FNA of 246 lesions in non-pancreatic sites (122 peri-pancreatic and coeliac lymph nodes; 9 peri-pancreatic masses; other sites: mediastinum 12, gastric 25, liver 27, oesophagus 17, duodenum/colon/rectum 15, retro-peritoneum 8, lung 7, miscellaneous 4). Results: The cytology diagnoses were classified as non-neoplastic/reactive in 82 (33%), atypical/suspicious for malignancy in 25 (10%), malignant in 86 (35%) and non-diagnostic in 53 (22%) cases. Surgical pathology follow-up was available in 75 (31%) cases. Excluding the non-diagnostic cases there were 7 false negative and 3 false positive cases. The sensitivity, specificity and positive predictive value of EUS-FNA in the diagnosis of lesions of non-pancreatic sites was 92%, 98% and 97%, respectively. Conclusions: EUS-FNA can be effectively used as a diagnostic modality in the diagnosis of lesions from nonpancreatic sites.

Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology of Porta Hepatis Lesions: A Retrospective Study

“…The lower rate of porta hepatis lymph node surgical biopsy may reflect a lower clinical suspicion of malignancy, with the majority of cases without additional surgical biopsy having had a benign FNA result. This percentage is similar to that reported (31%) in a study evaluating the performance of EUS-FNA at multiple anatomic sites [5]. …”

“…In all cases, the final surgical diagnosis confirmed the FNA diagnosis. The high sensitivity, specificity and positive predictive value of EUS-FNA are similar to what was reported across a range of nonpancreatic anatomic locations with values of 92, 98 and 97%, respectively [5]. …”

Primary squamous cell carcinoma of pancreas diagnosed by EUS-FNA: A case report

“…A glandular component should also be sought when noting atypical squamous carcinoma cells, as adenosquamous carcinoma is more common than the pure squamous cell type [3] . Squamous cell contaminants could also contribute to diagnostic uncertainty; although transgastric and transduodenal routes for EUS-FNA should not produce many of these cells, however, they appear to have been noted in our case ( Figure 2C) [25] . In this patient, diagnosis of primary squamous cell carcinoma of the pancreas with liver metastasis was confirmed, as EUS-FNA obtained the same type of cancer cells from both pancreatic and liver lesions, and CT and upper endoscopy did not identify other possible primary squamous cell malignancy.…”

Utility of EUS-guided biopsy of extramural pelvic masses

“…Although a few case reports have described the use of EUS or EUS-guided FNA (EUS-FNA) in the diagnosis of pelvic lesions, 1,2,[7][8][9] there have been few larger studies evaluating the role of EUS in these patients. 10,11 Furthermore, the accuracies of EUS-FNA and EUS-guided Tru-cut biopsy (EUS-TCB) in pelvic masses have not been described. The aim of this study was to assess the utility and complications of EUS-FNA and EUS-TCB in patients with extramural pelvic masses.…”