Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy

Michael B. Wallace, Timothy Kennedy, Valerie Durkalski, Mohamed A. Eloubeidi, Robert Etamad, Koji Matsuda, David Lewin, Annette Van Velse, Winnie Hennesey, Robert H. Hawes, Brenda J. Hoffman

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

Background: EUS-guided fine needle aspiration (EUS-FNA) is a highly accurate method of detecting malignant lymphadenopathy. The optimal methods for performing EUS-FNA to maximize sensitivity and to minimize the number of needle passes necessary are unknown. This is a report of the results of a prospective randomized controlled trial to determine the effect of suction, the site of FNA (edge or center of lymph node), and the method of preparation of cytologic specimens on accuracy, number of needle passes needed, and specimen quality. Methods: Consecutive patients with lymphadenopathy detected by EUS underwent FNA. Each lymph node was sampled with or without suction and from the edge or center in a 2 × 2 factorial design. The samples were expressed onto slides for cytology, and the residual material in the needle was analyzed by the cytospin-cellblock technique. Each aspirate was individually characterized for a diagnosis of malignancy, cellularity, and bloodiness. Results: Forty-three patients with a total of 46 lymph nodes were evaluated. The final lymph node diagnosis was benign in 22 (48%), "suspicious for malignancy" in 6 (13%), and malignant in 18 (39%). The use of suction was associated with an increase in the cellularity of the specimen, but did not improve the likelihood of obtaining a correct diagnosis (OR 1.52: 95% Cl [0.81, 2.85]). Samples obtained with suction were of worse quality because of excessive bloodiness (OR 4.7: 95% Cl [1.99, 11.24]). Aspiration from the edge of the lymph node (compared with the center) did not increase the likelihood of a correct diagnosis (OR 1.16: 95% Cl [0.42, 3.21]). For 78% of malignant lymph nodes, the correct diagnosis was obtained on the first needle pass and for 100% by the third pass. Cytospin-cellblock methods did not add any additional diagnostic information compared with direct smear cytology. Conclusions: The traditional method of applying suction during EUS-FNA does not improve diagnostic accuracy and worsens specimen bloodiness compared with FNA without suction. The site of FNA within the lymph node does not affect accuracy. When EUS-FNA is necessary, our recommendation is up to 3 FNAs without suction from the most convenient and safe location within abnormal-appearing lymph nodes.

Original languageEnglish (US)
Pages (from-to)441-447
Number of pages7
JournalGastrointestinal Endoscopy
Volume54
Issue number4
DOIs
StatePublished - Oct 2001
Externally publishedYes

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Fine Needle Biopsy
Suction
Randomized Controlled Trials
Lymph Nodes
Needles
Cell Biology
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Lymphadenopathy
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wallace, M. B., Kennedy, T., Durkalski, V., Eloubeidi, M. A., Etamad, R., Matsuda, K., ... Hoffman, B. J. (2001). Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy. Gastrointestinal Endoscopy, 54(4), 441-447. https://doi.org/10.1067/mge.2001.117764

Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy. / Wallace, Michael B.; Kennedy, Timothy; Durkalski, Valerie; Eloubeidi, Mohamed A.; Etamad, Robert; Matsuda, Koji; Lewin, David; Van Velse, Annette; Hennesey, Winnie; Hawes, Robert H.; Hoffman, Brenda J.

In: Gastrointestinal Endoscopy, Vol. 54, No. 4, 10.2001, p. 441-447.

Research output: Contribution to journalArticle

Wallace, MB, Kennedy, T, Durkalski, V, Eloubeidi, MA, Etamad, R, Matsuda, K, Lewin, D, Van Velse, A, Hennesey, W, Hawes, RH & Hoffman, BJ 2001, 'Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy', Gastrointestinal Endoscopy, vol. 54, no. 4, pp. 441-447. https://doi.org/10.1067/mge.2001.117764
Wallace, Michael B. ; Kennedy, Timothy ; Durkalski, Valerie ; Eloubeidi, Mohamed A. ; Etamad, Robert ; Matsuda, Koji ; Lewin, David ; Van Velse, Annette ; Hennesey, Winnie ; Hawes, Robert H. ; Hoffman, Brenda J. / Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy. In: Gastrointestinal Endoscopy. 2001 ; Vol. 54, No. 4. pp. 441-447.
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abstract = "Background: EUS-guided fine needle aspiration (EUS-FNA) is a highly accurate method of detecting malignant lymphadenopathy. The optimal methods for performing EUS-FNA to maximize sensitivity and to minimize the number of needle passes necessary are unknown. This is a report of the results of a prospective randomized controlled trial to determine the effect of suction, the site of FNA (edge or center of lymph node), and the method of preparation of cytologic specimens on accuracy, number of needle passes needed, and specimen quality. Methods: Consecutive patients with lymphadenopathy detected by EUS underwent FNA. Each lymph node was sampled with or without suction and from the edge or center in a 2 × 2 factorial design. The samples were expressed onto slides for cytology, and the residual material in the needle was analyzed by the cytospin-cellblock technique. Each aspirate was individually characterized for a diagnosis of malignancy, cellularity, and bloodiness. Results: Forty-three patients with a total of 46 lymph nodes were evaluated. The final lymph node diagnosis was benign in 22 (48{\%}), {"}suspicious for malignancy{"} in 6 (13{\%}), and malignant in 18 (39{\%}). The use of suction was associated with an increase in the cellularity of the specimen, but did not improve the likelihood of obtaining a correct diagnosis (OR 1.52: 95{\%} Cl [0.81, 2.85]). Samples obtained with suction were of worse quality because of excessive bloodiness (OR 4.7: 95{\%} Cl [1.99, 11.24]). Aspiration from the edge of the lymph node (compared with the center) did not increase the likelihood of a correct diagnosis (OR 1.16: 95{\%} Cl [0.42, 3.21]). For 78{\%} of malignant lymph nodes, the correct diagnosis was obtained on the first needle pass and for 100{\%} by the third pass. Cytospin-cellblock methods did not add any additional diagnostic information compared with direct smear cytology. Conclusions: The traditional method of applying suction during EUS-FNA does not improve diagnostic accuracy and worsens specimen bloodiness compared with FNA without suction. The site of FNA within the lymph node does not affect accuracy. When EUS-FNA is necessary, our recommendation is up to 3 FNAs without suction from the most convenient and safe location within abnormal-appearing lymph nodes.",
author = "Wallace, {Michael B.} and Timothy Kennedy and Valerie Durkalski and Eloubeidi, {Mohamed A.} and Robert Etamad and Koji Matsuda and David Lewin and {Van Velse}, Annette and Winnie Hennesey and Hawes, {Robert H.} and Hoffman, {Brenda J.}",
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T1 - Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy

AU - Wallace, Michael B.

AU - Kennedy, Timothy

AU - Durkalski, Valerie

AU - Eloubeidi, Mohamed A.

AU - Etamad, Robert

AU - Matsuda, Koji

AU - Lewin, David

AU - Van Velse, Annette

AU - Hennesey, Winnie

AU - Hawes, Robert H.

AU - Hoffman, Brenda J.

PY - 2001/10

Y1 - 2001/10

N2 - Background: EUS-guided fine needle aspiration (EUS-FNA) is a highly accurate method of detecting malignant lymphadenopathy. The optimal methods for performing EUS-FNA to maximize sensitivity and to minimize the number of needle passes necessary are unknown. This is a report of the results of a prospective randomized controlled trial to determine the effect of suction, the site of FNA (edge or center of lymph node), and the method of preparation of cytologic specimens on accuracy, number of needle passes needed, and specimen quality. Methods: Consecutive patients with lymphadenopathy detected by EUS underwent FNA. Each lymph node was sampled with or without suction and from the edge or center in a 2 × 2 factorial design. The samples were expressed onto slides for cytology, and the residual material in the needle was analyzed by the cytospin-cellblock technique. Each aspirate was individually characterized for a diagnosis of malignancy, cellularity, and bloodiness. Results: Forty-three patients with a total of 46 lymph nodes were evaluated. The final lymph node diagnosis was benign in 22 (48%), "suspicious for malignancy" in 6 (13%), and malignant in 18 (39%). The use of suction was associated with an increase in the cellularity of the specimen, but did not improve the likelihood of obtaining a correct diagnosis (OR 1.52: 95% Cl [0.81, 2.85]). Samples obtained with suction were of worse quality because of excessive bloodiness (OR 4.7: 95% Cl [1.99, 11.24]). Aspiration from the edge of the lymph node (compared with the center) did not increase the likelihood of a correct diagnosis (OR 1.16: 95% Cl [0.42, 3.21]). For 78% of malignant lymph nodes, the correct diagnosis was obtained on the first needle pass and for 100% by the third pass. Cytospin-cellblock methods did not add any additional diagnostic information compared with direct smear cytology. Conclusions: The traditional method of applying suction during EUS-FNA does not improve diagnostic accuracy and worsens specimen bloodiness compared with FNA without suction. The site of FNA within the lymph node does not affect accuracy. When EUS-FNA is necessary, our recommendation is up to 3 FNAs without suction from the most convenient and safe location within abnormal-appearing lymph nodes.

AB - Background: EUS-guided fine needle aspiration (EUS-FNA) is a highly accurate method of detecting malignant lymphadenopathy. The optimal methods for performing EUS-FNA to maximize sensitivity and to minimize the number of needle passes necessary are unknown. This is a report of the results of a prospective randomized controlled trial to determine the effect of suction, the site of FNA (edge or center of lymph node), and the method of preparation of cytologic specimens on accuracy, number of needle passes needed, and specimen quality. Methods: Consecutive patients with lymphadenopathy detected by EUS underwent FNA. Each lymph node was sampled with or without suction and from the edge or center in a 2 × 2 factorial design. The samples were expressed onto slides for cytology, and the residual material in the needle was analyzed by the cytospin-cellblock technique. Each aspirate was individually characterized for a diagnosis of malignancy, cellularity, and bloodiness. Results: Forty-three patients with a total of 46 lymph nodes were evaluated. The final lymph node diagnosis was benign in 22 (48%), "suspicious for malignancy" in 6 (13%), and malignant in 18 (39%). The use of suction was associated with an increase in the cellularity of the specimen, but did not improve the likelihood of obtaining a correct diagnosis (OR 1.52: 95% Cl [0.81, 2.85]). Samples obtained with suction were of worse quality because of excessive bloodiness (OR 4.7: 95% Cl [1.99, 11.24]). Aspiration from the edge of the lymph node (compared with the center) did not increase the likelihood of a correct diagnosis (OR 1.16: 95% Cl [0.42, 3.21]). For 78% of malignant lymph nodes, the correct diagnosis was obtained on the first needle pass and for 100% by the third pass. Cytospin-cellblock methods did not add any additional diagnostic information compared with direct smear cytology. Conclusions: The traditional method of applying suction during EUS-FNA does not improve diagnostic accuracy and worsens specimen bloodiness compared with FNA without suction. The site of FNA within the lymph node does not affect accuracy. When EUS-FNA is necessary, our recommendation is up to 3 FNAs without suction from the most convenient and safe location within abnormal-appearing lymph nodes.

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