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

Abstract

Aims: 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. In this study we evaluated our experience with EUS-FNA of the non-pancreatic sites. Methods: The study cohort included 234 patients; 144 males and 90 females (mean age 64.3 yrs) who underwent EUS-FNA of 246 lesions in non-pancreatic sites. These included 122 peri-pancreatic and celiac lymph nodes, 9 peripancreatic masses, mediastinum 12, gastric 25, liver 27, esophagus 17, duodenum/colon/rectum 15, retro-peritoneum 8, lung 7, and 4 miscellaneous cases. Results: The cytology diagnoses were classified as non-neoplastic/reactive 82 (33%), atypical/suspicious for malignancy 25 (10%), malignant 86 (35%) and non-diagnostic 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.