EUS is an established imaging modality for the evaluation of a variety of GI disorders. The emergence of EUS guided FNA has improved the diagnostic and therapeutic capability of EUS with the possibility of improving outcome. There are no current established practice guidelines regarding the indications for or preparation of FNA. METHOD: Ten tertiary centers for EUS guided FNA participated in a survey regarding organs biopsied, presence of cytopathologist (CP) at tissue harvesting, frequency of nondiagnostic biopsy, and complication per organ/lesion biopsied. A multi-item questionnaire was completed for all patients. Cases were classified into 4 primary GI categories: 1) lymph nodes (LN) in primary GI malignancy, 2) extra-intestinal (X-INT) mass (pancreas, liver), 3) cystic mass, 4) intramural mass (IM). Number of FNA passes per lesion for adequacy of tissue sampling in each category was recorded. The importance of CP present during FNA to analyze each needle pass sample was also observed. Each case sampling was classified as benign, malignant, "inadequate", or "suspicious" at final pathology. Number of inadequate or suspicious diagnoses for each category was compared to presence/absence of CP. Complication rate was assessed for each disease category, number of FNA passes/case and presence or absence of CP. RESULTS: Data was analyzed in 712 pts. CP was present in all cases at 7 of 10 centers. Table demonstrates Avg FNA passes/pt, # nondiagnostic FNA cases and complications in the presence (pres) or absence (abs) of CP for each disease category. Avg No Passes/Pt % Inadequate/Susp Complications Disease Category Total No. CP Pres CP Abs CP Pres CP Abs CP Pres CP Abs LN 280 3.5 4.5 2.5% 8.9% 0 0 X-INT 371 4.2 4.6 7.0% 10.7% 2 1 CYSTIC 16 3.2 3.8 0% 16.7% 1 2 IM 45 4.6 4.9 9.4% 23.1% 0 1 CONCLUSION'S: Number of FNA passes/case and nondiagnostic cases are significantly increased in the absence of a CP for all categories. Rate of complications is small and not correlated with number of passes but rather to certain disease categories (cystic mass). Presence of CP during tissue harvesting is essential for successful sampling. Assessment of X-INT and LN staging represent greater than 90% of FNA cases.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging