Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Intramural and Extraintestinal Mass Lesions: Diagnostic Accuracy, Complication Assessment, and Impact on Management

Background and Study Aims: The aims of this study were: firstly, to determine the usefulness of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in obtaining tissue diagnosis of intramural and extraintestinal lesions; secondly, to assess the immediate, acute, and 30-day complications in these patients; and thirdly, to assess the impact of the tissue diagnoses on patient management.
Patients and Methods: All EUS-FNAs of extraintestinal mass lesions and intramural gastrointestinal tumors over a 26-month period were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 20), repeat imaging (n = 12), clinical follow-up (n = 4), or death from disease (n = 2). Four patients were lost to follow-up.
Results: Forty-two consecutive patients (24 men, 18 women; mean age 59.7 years) underwent EUS-FNA of extraintestinal mass lesions and intramural gastrointestinal tumors. Previous attempts at tissue diagnosis had failed in 52.4 % of the patients. The EUS-FNA cytological diagnoses included: 17 gastrointestinal stromal tumors, five esophageal cancers, five rectal cancers, one bronchogenic cyst, one foregut duplication cyst, and 13 other miscellaneous diagnoses. The mean number of passes needed to reach a diagnosis was 3.9 (± 2.2). The mean follow-up period was 13.1 months. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA of extraintestinal and intramural tumors were 97 %, 100 %, 100 %, 90 %, and 98 %, respectively. No major complications were encountered.
Conclusions: EUS-FNA is a safe and accurate method that can provide a tissue diagnosis in intramural and extraintestinal mass lesions, especially when other modalities have failed. EUS-FNA significantly affects the management of patients by allowing them to be allocated to appropriate treatment and by avoiding the need for more invasive procedures to obtain tissue diagnosis.

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