Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy utilizing linear array and radial scanning endosonography: Results of diagnostic accuracy and complications

F. Gress, S. Ikenberry, R. Hawes, T. Savides, Glen Lehman

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Abstract

INTRODUCTION: EUS accurately stages GI malignancies, but is unable to differentiate between neoplastic and inflammatory processes. EUS directed FNA has been reported to be useful in obtaining tissue diagnosis in suspected malignant GI lesions. We report our experience with EUS directed FNA using both radial and linear array endosonography. METHODS: 179 consecutive pts. (91M/88F) mean age 61 yrs.(range 16-87) referred for EUS evaluation of unknown masses or suspected malignancies underwent EUS directed FNA. EUS guided FNA was performed with the radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) echoendoscopes (EE) utilizing a 23 gauge, 4 cm FNA needle (Wilson-Cooke) or a 22 guage, 10 cm needle (GIP/Mediglobe). Data collected included lesion types sampled, the # of passes performed, complications and diagnostic accuracy of FNA. RESULTS: 191 lesions were targeted with a total of 444 FNA passes (mean 3.2 passes). We had immediate complications in 4/179 pts or 2%. This consisted of bleeding in 2 pts and 2 episodes of pancreatitis. In 6 cases (5%) the procedure was limited or terminated due to FNA needle malfunction which in 4 cases was responsible for scope perforation. Needle malfunctions were a direct result of early design flaws. Type of Lesion # pts. Mean Lesion size # Passes Cytology Diagnostic hanged Therapy 1. Mediastinal LN 43 2.3 × 1.6 cm 3.2 41/43 = 95% 37/43 = 86% 2. Pane. Mass 102 3.4 × 3.3 cm 3.4 83/102 = 83% 80/102 = 78% 3. Submucosal masses 23 2.8 × 2.7 cm 3.8 18/23 = 78% 15/23 = 65% 4. Intraabdominal LN 8 2.9 × 2.8 cm 3.0 6/8 = 75% 4/8=50% Table 2 Olympus UM 20 vs.Pentax FNA Results OLYMPUS FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 22 2.5 × 2.1 cm 3.4 35 Min 19/22 = 85% Pancreatic Mass 26 3.4 × 3.5 cm 2.7 76 Min. 20/26 = 77% PENTAX FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 21 1.8 × 1.6 cm 3.0 40 Min. 18/21 = 86% Pancreatic Mass 76 3.2 × 3.0 cm 3.8 100 Min. 60/76 = 79% EUS FNA had diagnostic cytology in 84% (151/179). EUS FNA had a sensitivity of 89% and a specificity of 100% for diagnosing malignant involvement. The FNA results changed management in 65% (116/179). Both EUS Systems had similar FNA results. CONCLUSIONS: EUS directed FNA appears to: 1) be technically feasible, safe and accurate for obtaining diagnostic tissue of suspicious GI lesions or mediastinal LN. 2) provide important preop information which affects management in 65% principally by directing patients away from surgery-when there is no hope for a cure.

Original languageEnglish
Pages (from-to)421
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Fine Needle Biopsy
Needles
Cell Biology
Neoplastic Processes

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{6dd5e1e739914e7689162ef290434618,
title = "Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy utilizing linear array and radial scanning endosonography: Results of diagnostic accuracy and complications",
abstract = "INTRODUCTION: EUS accurately stages GI malignancies, but is unable to differentiate between neoplastic and inflammatory processes. EUS directed FNA has been reported to be useful in obtaining tissue diagnosis in suspected malignant GI lesions. We report our experience with EUS directed FNA using both radial and linear array endosonography. METHODS: 179 consecutive pts. (91M/88F) mean age 61 yrs.(range 16-87) referred for EUS evaluation of unknown masses or suspected malignancies underwent EUS directed FNA. EUS guided FNA was performed with the radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) echoendoscopes (EE) utilizing a 23 gauge, 4 cm FNA needle (Wilson-Cooke) or a 22 guage, 10 cm needle (GIP/Mediglobe). Data collected included lesion types sampled, the # of passes performed, complications and diagnostic accuracy of FNA. RESULTS: 191 lesions were targeted with a total of 444 FNA passes (mean 3.2 passes). We had immediate complications in 4/179 pts or 2{\%}. This consisted of bleeding in 2 pts and 2 episodes of pancreatitis. In 6 cases (5{\%}) the procedure was limited or terminated due to FNA needle malfunction which in 4 cases was responsible for scope perforation. Needle malfunctions were a direct result of early design flaws. Type of Lesion # pts. Mean Lesion size # Passes Cytology Diagnostic hanged Therapy 1. Mediastinal LN 43 2.3 × 1.6 cm 3.2 41/43 = 95{\%} 37/43 = 86{\%} 2. Pane. Mass 102 3.4 × 3.3 cm 3.4 83/102 = 83{\%} 80/102 = 78{\%} 3. Submucosal masses 23 2.8 × 2.7 cm 3.8 18/23 = 78{\%} 15/23 = 65{\%} 4. Intraabdominal LN 8 2.9 × 2.8 cm 3.0 6/8 = 75{\%} 4/8=50{\%} Table 2 Olympus UM 20 vs.Pentax FNA Results OLYMPUS FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 22 2.5 × 2.1 cm 3.4 35 Min 19/22 = 85{\%} Pancreatic Mass 26 3.4 × 3.5 cm 2.7 76 Min. 20/26 = 77{\%} PENTAX FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 21 1.8 × 1.6 cm 3.0 40 Min. 18/21 = 86{\%} Pancreatic Mass 76 3.2 × 3.0 cm 3.8 100 Min. 60/76 = 79{\%} EUS FNA had diagnostic cytology in 84{\%} (151/179). EUS FNA had a sensitivity of 89{\%} and a specificity of 100{\%} for diagnosing malignant involvement. The FNA results changed management in 65{\%} (116/179). Both EUS Systems had similar FNA results. CONCLUSIONS: EUS directed FNA appears to: 1) be technically feasible, safe and accurate for obtaining diagnostic tissue of suspicious GI lesions or mediastinal LN. 2) provide important preop information which affects management in 65{\%} principally by directing patients away from surgery-when there is no hope for a cure.",
author = "F. Gress and S. Ikenberry and R. Hawes and T. Savides and Glen Lehman",
year = "1996",
language = "English",
volume = "43",
pages = "421",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy utilizing linear array and radial scanning endosonography

T2 - Results of diagnostic accuracy and complications

AU - Gress, F.

AU - Ikenberry, S.

AU - Hawes, R.

AU - Savides, T.

AU - Lehman, Glen

PY - 1996

Y1 - 1996

N2 - INTRODUCTION: EUS accurately stages GI malignancies, but is unable to differentiate between neoplastic and inflammatory processes. EUS directed FNA has been reported to be useful in obtaining tissue diagnosis in suspected malignant GI lesions. We report our experience with EUS directed FNA using both radial and linear array endosonography. METHODS: 179 consecutive pts. (91M/88F) mean age 61 yrs.(range 16-87) referred for EUS evaluation of unknown masses or suspected malignancies underwent EUS directed FNA. EUS guided FNA was performed with the radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) echoendoscopes (EE) utilizing a 23 gauge, 4 cm FNA needle (Wilson-Cooke) or a 22 guage, 10 cm needle (GIP/Mediglobe). Data collected included lesion types sampled, the # of passes performed, complications and diagnostic accuracy of FNA. RESULTS: 191 lesions were targeted with a total of 444 FNA passes (mean 3.2 passes). We had immediate complications in 4/179 pts or 2%. This consisted of bleeding in 2 pts and 2 episodes of pancreatitis. In 6 cases (5%) the procedure was limited or terminated due to FNA needle malfunction which in 4 cases was responsible for scope perforation. Needle malfunctions were a direct result of early design flaws. Type of Lesion # pts. Mean Lesion size # Passes Cytology Diagnostic hanged Therapy 1. Mediastinal LN 43 2.3 × 1.6 cm 3.2 41/43 = 95% 37/43 = 86% 2. Pane. Mass 102 3.4 × 3.3 cm 3.4 83/102 = 83% 80/102 = 78% 3. Submucosal masses 23 2.8 × 2.7 cm 3.8 18/23 = 78% 15/23 = 65% 4. Intraabdominal LN 8 2.9 × 2.8 cm 3.0 6/8 = 75% 4/8=50% Table 2 Olympus UM 20 vs.Pentax FNA Results OLYMPUS FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 22 2.5 × 2.1 cm 3.4 35 Min 19/22 = 85% Pancreatic Mass 26 3.4 × 3.5 cm 2.7 76 Min. 20/26 = 77% PENTAX FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 21 1.8 × 1.6 cm 3.0 40 Min. 18/21 = 86% Pancreatic Mass 76 3.2 × 3.0 cm 3.8 100 Min. 60/76 = 79% EUS FNA had diagnostic cytology in 84% (151/179). EUS FNA had a sensitivity of 89% and a specificity of 100% for diagnosing malignant involvement. The FNA results changed management in 65% (116/179). Both EUS Systems had similar FNA results. CONCLUSIONS: EUS directed FNA appears to: 1) be technically feasible, safe and accurate for obtaining diagnostic tissue of suspicious GI lesions or mediastinal LN. 2) provide important preop information which affects management in 65% principally by directing patients away from surgery-when there is no hope for a cure.

AB - INTRODUCTION: EUS accurately stages GI malignancies, but is unable to differentiate between neoplastic and inflammatory processes. EUS directed FNA has been reported to be useful in obtaining tissue diagnosis in suspected malignant GI lesions. We report our experience with EUS directed FNA using both radial and linear array endosonography. METHODS: 179 consecutive pts. (91M/88F) mean age 61 yrs.(range 16-87) referred for EUS evaluation of unknown masses or suspected malignancies underwent EUS directed FNA. EUS guided FNA was performed with the radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) echoendoscopes (EE) utilizing a 23 gauge, 4 cm FNA needle (Wilson-Cooke) or a 22 guage, 10 cm needle (GIP/Mediglobe). Data collected included lesion types sampled, the # of passes performed, complications and diagnostic accuracy of FNA. RESULTS: 191 lesions were targeted with a total of 444 FNA passes (mean 3.2 passes). We had immediate complications in 4/179 pts or 2%. This consisted of bleeding in 2 pts and 2 episodes of pancreatitis. In 6 cases (5%) the procedure was limited or terminated due to FNA needle malfunction which in 4 cases was responsible for scope perforation. Needle malfunctions were a direct result of early design flaws. Type of Lesion # pts. Mean Lesion size # Passes Cytology Diagnostic hanged Therapy 1. Mediastinal LN 43 2.3 × 1.6 cm 3.2 41/43 = 95% 37/43 = 86% 2. Pane. Mass 102 3.4 × 3.3 cm 3.4 83/102 = 83% 80/102 = 78% 3. Submucosal masses 23 2.8 × 2.7 cm 3.8 18/23 = 78% 15/23 = 65% 4. Intraabdominal LN 8 2.9 × 2.8 cm 3.0 6/8 = 75% 4/8=50% Table 2 Olympus UM 20 vs.Pentax FNA Results OLYMPUS FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 22 2.5 × 2.1 cm 3.4 35 Min 19/22 = 85% Pancreatic Mass 26 3.4 × 3.5 cm 2.7 76 Min. 20/26 = 77% PENTAX FNA DATA Type of Lesion # pts. Mean Lesion Size # Passes Mean FNA Procedure Time Cytology Diagnostic Mediastinal LN 21 1.8 × 1.6 cm 3.0 40 Min. 18/21 = 86% Pancreatic Mass 76 3.2 × 3.0 cm 3.8 100 Min. 60/76 = 79% EUS FNA had diagnostic cytology in 84% (151/179). EUS FNA had a sensitivity of 89% and a specificity of 100% for diagnosing malignant involvement. The FNA results changed management in 65% (116/179). Both EUS Systems had similar FNA results. CONCLUSIONS: EUS directed FNA appears to: 1) be technically feasible, safe and accurate for obtaining diagnostic tissue of suspicious GI lesions or mediastinal LN. 2) provide important preop information which affects management in 65% principally by directing patients away from surgery-when there is no hope for a cure.

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