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

Abstract

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective technique for qualitative diagnosis of space occupying lesions in and around the wall of the digestive tract. At present, there are many studies on EUS-FNA via the upper gastrointestinal route, while there are few studies on EUS-FNA via the lower gastrointestinal route, especially for Chinese patients with pelvic mass. Therefore, this study sought to evaluate the value of transrectal EUS-FNA in the qualitative diagnosis of pelvic masses in Chinese patients. Methods:The clinical data of 35 patients with pelvic masses who underwent EUS-FNA at our hospital were collected from September 2014 to December 2021. Among these patients, 10 underwent surgical treatment after EUS-FNA, and a diagnosis was made based on a pathologic evaluation. The EUS-FNA biopsy results were compared to the final diagnostic results to calculate the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS-FNA in the diagnosis of malignant pelvic mass. For the 10 patients who underwent surgery, the final diagnoses were based on the pathologic findings of surgical specimens, and for the 25 patients who did not undergo surgery, the final diagnoses were based on the malignant pathological results of EUS-FNA or clinical follow-up results.Results: Among the 35 patients, 12 had benign lesions, including pelvic abscesses, cysts, and inflammatory masses, and 23 had malignant lesions, including mesenchymal tumors, leiomyosarcomas, teratomas, and malignant tumors with pelvic metastases. There were no complications resulting from the biopsy punctures.The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNAs for the diagnosis of malignant pelvic masses were 91.3% (21/23), 100.0% (12/12), 100.0% (21/21), 85.7% (12/14), and 94.3% (33/35), respectively.Conclusions: EUS-FNA is a safe and effective method for the qualitative diagnosis of pelvic masses, and has good clinical application value.

The Role of Endoscopic Ultrasound-guided Fine-needle Aspiration of Pelvic Lesions

“…Quality was evaluated as high in 17 studies 1,4,5,9–11,14–23 . The details of the quality assessment of the included studies are shown in Supplementary Table 1, Supplemental Digital Content 1, http://links.lww.com/JCG/B49.…”

“…CT or magnetic resonance imaging provides important clues for the diagnosis of malignant pelvic masses but cannot provide a qualitative diagnosis, which is usually achieved through pathologic evaluation. Owing to the high risk to tissue structures that block the puncture path, and puncture complications, percutaneous biopsy may be difficult to perform in this anatomic area 1 . Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a diagnostic technique that includes monitoring using a linear array echo endoscope to avoid blood vessels around the lesion and accurately inserting a needle through the wall of the digestive tract into the target lesion.…”

“…Owing to the high risk to tissue structures that block the puncture path, and puncture complications, percutaneous biopsy may be difficult to perform in this anatomic area. 1 Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a diagnostic technique that includes monitoring using a linear array echo endoscope to avoid blood vessels around the lesion and accurately inserting a needle through the wall of the digestive tract into the target lesion. EUS-FNA is now a mature minimally invasive endoscopic technique, with unique advantages in diagnosing pelvic diseases.…”

Rectovaginal endometriosis with nodular smooth muscle metaplasia diagnosed via transrectal ultrasound‐guided fine‐needle aspiration cytology: An underused minimally invasive diagnostic technique?

“…These include but are not limited to primary and metastatic carcinomas, endometrial stromal tumors, gastrointestinal stromal tumor (GIST), pelvic mesenchymal tumors, cysts and abscesses. 23 TRUS-FNA is a minimally invasive technique that can provide an accu- Regarding treatment, there is general agreement to avoid surgical intervention in asymptomatic patients who do not exhibit enlargement of endometriotic nodules. 13 However, the management of symptomatic patients is more controversial.…”

“…Several benign and malignant neoplasms can present as a pelvic/perirectal mass on imaging and be sampled with TRUS‐FNA. These include but are not limited to primary and metastatic carcinomas, endometrial stromal tumors, gastrointestinal stromal tumor (GIST), pelvic mesenchymal tumors, cysts and abscesses 23 . TRUS‐FNA is a minimally invasive technique that can provide an accurate diagnosis.…”