Original Article
Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis

https://doi.org/10.1016/S0016-5107(03)02863-3Get rights and content

Abstract

Background

The immediate assistance of a cytologist during EUS-guided FNA is not universal. The optimal number of fine needle passes during EUS-guided FNA has not been determined in a prospective study. The aim of this study was to determine the optimal number of passes required to obtain a correct diagnosis.

Methods

Seven or more passes were made with a fine needle into a variety of lesions during EUS-guided FNA. Adequacy of the aspirate, diagnosis, and a “certainty score” were recorded after each pass and interpreted sequentially by a cytopathologist. Surgical histopathology and 1-year clinical follow-up were used as reference standards. The percentage of correctly diagnosed cases was calculated and stratified according to organ, disease group, and EUS characteristics of the lesion.

Results

Lesions from 95 patients were categorized into the following locations: pancreas, lymph node, and miscellaneous. The sensitivity and specificity for 7 passes from the pancreas and miscellaneous lesion groups were, respectively, 83% and 100%. The sensitivity and specificity for 5 passes from the lymph node group were, respectively, 77% and 100%.

Conclusions

During EUS-guided FNA, at least 7 passes with a fine needle into pancreatic and miscellaneous lesions, and 5 passes into lymph nodes are needed to ensure a high degree of certainty for making a correct diagnosis.

Section snippets

Study design

This prospective study was performed at a tertiary referral center. The study cohort consisted of consecutive patients who presented for EUS-FNA of a lesion suspected to be malignant. The following data were collected for each patient: demographic information; symptoms; medical, surgical, social, and family history; indication for EUS; and results of previous pertinent diagnostic tests. In our experience, between one and 6 EUS-guided fine needle passes are required to make a diagnosis of

Results

Over a 6-month period, 95 consecutive patients (50 men, 45 women; mean age 62 years, range 16-92 years) underwent EUS-FNA, for diagnosis or staging, of 95 sites: pancreas (33), lymph node (43), and miscellaneous (19) (Table 1). The miscellaneous group included lesions of the mediastinum, esophagus, stomach, duodenum, adrenal gland, periportal region, porta hepatis, spleen, and rectum. There were no aspirations of ascitic fluid, pleural fluid, or liver. The median number of FNA passes required

Discussion

The aim of the present study was to determine the optimal number of EUS-guided fine needle passes required to reach a diagnosis with certainty. An optimal number would be particularly useful in institutions in which the assistance of a cytopathologist or cytotechnician is not available during EUS-FNA. FNA of lesions arising in the breast, the thyroid, and the lung is non-diagnostic in up to 32% of cases because of scant cellularity when on-site interpretation is unavailable. These specimens, in

Cited by (256)

View all citing articles on Scopus
View full text