Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower gastrointestinal tract approaches

Abstract

Background: Combining upper and lower gastrointestinal tract (GI) approaches allows expansion of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) indications for pelvic lesions. The upper GI approach has been used for pelvic lesions around the level of the aortoiliac bifurcation in our institution. The aim of this study is to evaluate the feasibility and safety of EUS-FNA for pelvic lesions via the upper and lower GI approaches. Methods: All consecutive patients who underwent EUS-FNA for the pelvic lesion between January 2008 and December 2018 were retrospectively analyzed. Pelvic lesions were defined as lesions located around and below the aortoiliac bifurcation level. The primary outcome was technical success rate, and the secondary outcomes were the diagnostic capability of EUS-FNA for malignancy and the safety.Results: EUS-FNA for pelvic lesions was performed in 49 patients: upper and lower GI approaches were used in 28 and 21 patients, respectively. The technical success rates were 91.8% (45/49) in all patients: 89.3% (25/28) and 95.2% (20/21) with the upper and lower GI approaches, respectively. Among patients who achieved technical success, the diagnostic accuracy for malignancy was 97.8% (44/45) in all patients:100% (25/25) and 95.0% (19/20) with the upper and lower GI approaches, respectively. One (2.0%) patient developed an adverse event of sigmoid colon perforation.Conclusions: EUS-FNA for pelvic lesions via the upper and lower GI approaches was a safe, feasible, and effective method, although careful endoscopic manipulation is required to avoid perforation, especially with the lower GI approach. Further large-scale, well-designed studies are needed to validate our findings.

Transrectal endoscopic ultrasound-guided fine-needle aspiration biopsy for qualitative diagnosis of pelvic space-occupying lesions: a diagnostic test

“…To date, many studies involving EUS-FNA have focused on applications in diagnosing space-occupying lesions in the pancreas, liver, and mediastinum. However, few studies have reported on the use and diagnostic accuracy of EUS-FNA in pelvic space-occupying lesions (11)(12)(13)(14). In the present study we retrospectively analyzed the medical records of 35 patients who underwent EUS-FNA for pelvic space-occupying lesions at our hospital over a 7-year period.…”

“…Another study of 21 patients with pelvic space-occupying lesions concluded that the diagnostic sensitivity of EUS-FNA via the lower digestive tract for malignant pelvic space-occupying lesions was 94.4%, the specificity was 100.0%, the positive predictive value was 100%, the negative predictive value was 66.7%, and the accuracy was 95.0% (12). A meta-analysis of 10 studies involving 246 patients with pelvic space-occupying lesions (13) showed that the diagnostic sensitivity of EUS-FNA for differentiating between benign and malignant lesions was 89.0%, the specificity was 93.0%, and the overall incidence of complications was 1.7% (there was 1 case of postpuncture bleeding and 2 cases of secondary abscesses after puncture of the cystic lesions) (13).…”

“…EUS-FNA is usually performed for the qualitative diagnosis of lesions via the upper digestive tract. However, several studies have examined the qualitative diagnosis of lesions occupying the digestive tract, pelvis, and nearby areas using EUS-FNA via the lower digestive tract (11)(12)(13)(14); although a meta-analysis was included in these studies, some of them had small sample sizes, and some of them excluded occupying lesions in the digestive wall. Moreover, there was a lack of comprehensive pathological diagnosis types of EUS-FNA, and the subjects were mainly European or American patients.…”

Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study

“…Nevertheless, CLA probes have an oblique endoscopic view that makes deep insertion into the colon technically challenging and potentially risky due to complex anatomical factors and colonic angulations that discourage its use beyond the rectosigmoid colon. 5,6 However, the diagnostic and therapeutic uses of CLA-EUS in the…”

“…Infection and pneumoperitoneum have been reported after EUS-FNA of pelvic and rectosigmoid lesions. 6,9 Another concern about C-US FNA is the risk of neoplastic cell seeding. To the best of our knowledge, there are no current data on C-US FNA, and therefore, it should be considered only if performing FNA would be crucial to management decisions.…”