Author(s): Wittmann J, Kocjan G, Sgouros SN, Deheragoda M, Pereira SP
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Abstract BACKGROUND AND AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has a diagnostic accuracy of 70-90\%, depending on the site under evaluation. In order to improve EUS-guided tissue sampling a novel 19-gauge trucut-type needle has been designed to obtain core biopsies during EUS. We prospectively evaluated the safety and accuracy of EUS-FNA alone versus combined EUS-FNA and trucut needle biopsy (TNB) in patients referred to our Unit over a 3-year period. PATIENTS AND METHODS: A total of 159 patients underwent EUS-FNA alone (lesions<2 cm) or the combination of both sampling modalities (lesions>or=2 cm). The adequacy of sampling, sensitivity, specificity and overall accuracies of EUS-FNA or EUS-TNB alone and combined EUS-FNA/TNB were determined. RESULTS: Adequate samples were obtained by EUS-FNA, EUS-TNB and EUS-FNA/TNB in 91\%, 88\% and 97\% of patients, respectively. From the pancreas (n=83), adequate samples were obtained by FNA in 94\% and by TNB in 81\%, compared with 87\% and 92\% from non-pancreatic sites (n=76), respectively. The combination of both techniques resulted in more adequate samples from non-pancreatic cases than EUS-FNA alone (P=0.044). The specificity was 100\%. Overall accuracy for EUS-FNA alone was 77\%, for EUS-TNB alone 73\% and for EUS-FNA/TNB 91\% (P=0.008). For pancreatic sampling, the accuracy of EUS-FNA alone was 77\%, for EUS-TNB alone 56\% and for EUS-FNA/TNB 83\%. For non-pancreatic sampling, the accuracy for EUS-FNA alone was 78\%, for EUS-TNB alone 83\% and for EUS-FNA/TNB 95\% (P=0.006). The complication rate was 0.6\%. CONCLUSIONS: Combined EUS-FNA/TNB for lesions>or=2 cm improves adequacy of sampling and diagnostic accuracy compared with either technique alone and is safe.
This article was published in Cytopathology
and referenced in Journal of Gastrointestinal & Digestive System