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Endoscopic ultrasound guided fine needle aspiration of non-pancreatic lesions: an institutional experience

¹ Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
² Department of Medicine, Gastroenterology Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA

Correspondence to:
Dr Zubair W Baloch, Department of Pathology and Laboratory Medicine, 6 Founders Pavilion, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA; baloch{at}mail.med.upenn.edu

Background: Endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) has proven to be an effective diagnostic modality for the detection and staging of pancreatic malignancies. In recent years EUS-FNA has also been used to diagnose lesions of non-pancreatic sites such as structures in close proximity to the gut wall within the mediastinum, abdomen, pelvis and retro-peritoneum.

Aims: To evaluate experience with EUS-FNA of non-pancreatic sites at a large university medical centre.

Methods: The study cohort included 234 patients who underwent EUS-FNA of 246 lesions in non-pancreatic sites (122 peri-pancreatic and coeliac lymph nodes; 9 peri-pancreatic masses; other sites: mediastinum 12, gastric 25, liver 27, oesophagus 17, duodenum/colon/rectum 15, retro-peritoneum 8, lung 7, miscellaneous 4).

Results: The cytology diagnoses were classified as non-neoplastic/reactive in 82 (33%), atypical/suspicious for malignancy in 25 (10%), malignant in 86 (35%) and non-diagnostic in 53 (22%) cases. Surgical pathology follow-up was available in 75 (31%) cases. Excluding the non-diagnostic cases there were 7 false negative and 3 false positive cases. The sensitivity, specificity and positive predictive value of EUS-FNA in the diagnosis of lesions of non-pancreatic sites was 92%, 98% and 97%, respectively.

Conclusions: EUS-FNA can be effectively used as a diagnostic modality in the diagnosis of lesions from non-pancreatic sites.

Abbreviations: EUS, endoscopic ultrasound; FNA, fine needle aspiration; GI, gastrointestinal; GIST, gastrointestinal stromal tumour

Keywords: endoscopy; ultrasound; fine needle biopsy