How good is fine needle aspiration? What results should you expect?

Abstract

Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.

Outcomes of endoscopic ultrasound‐guided pancreatic FNAC diagnosis for solid and cystic lesions at Manchester Royal Infirmary based upon the Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme

“…EUS‐FNAC has been shown to have a high level of diagnostic accuracy in the assessment of solid pancreatic lesions. In combination with EUS findings and cyst fluid biochemistry, it is also of significant diagnostic utility in the assessment of pancreatic cystic lesions …”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)

“…Standard aspiration needles were originally designed to obtain cellular material for cytopathological examinations [110,484,485]. The cytological yield and diagnostic accuracy, in studies using predominantly 22 G aspiration needles, are reported to be high for solid pancreatic lesions and metastatic lymph nodes, satisfactory for biliary mass lesions, but only moderate for gastrointestinal SETs and PCLs ( • " Table 3) [104,110,486,487]. Currently, the 22 G aspiration needle is most widely used, with increased utilization of 25 G aspiration needles particularly for sampling and cytopathological evaluation of pancreatic lesions and lymph nodes [149,488,489].…”

The diagnostic performance of novel torque technique for endoscopic ultrasound‐guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial

“…Endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (FNA) plays an essential role in making an accurate diagnosis and therapeutic plan for pancreatic solid mass with few major adverse events . However, the diagnostic yield, including sensitivity and specificity (75–92% and 82–100%, respectively), for pancreatic solid mass is limited especially considering the very low negative predictive value . To overcome this limitation, some attempts for the improvement of diagnostic outcomes in EUS‐guided tissue acquisition were conducted; these include the use of fanning technique, the use or elimination of suction, and the use or elimination of stylet .…”

“…1 However, the diagnostic yield, including sensitivity and specificity (75-92% and 82-100%, respectively), for pancreatic solid mass is limited especially considering the very low negative predictive value. 2,3 To overcome this limitation, some attempts for the improvement of diagnostic outcomes in EUS-guided tissue acquisition were conducted; these include the use of fanning technique, the use or elimination of suction, and the use or elimination of stylet. 4 Among these, the fanning technique was first introduced by Bang et al in 2013.…”