EUS‐FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions

• Published in: Diagnostic cytopathology 2020-11, Vol.48 (11), p.1058-1066
• Main Authors: Saqib, Muhammad, Maruf, Maheen, Bashir, Sehar, Mehmood, Shafqat, Akhter, Noreen, Yusuf, Muhammed Aasim, Loya, Asif
• Format: Article
• Language: English
• Subjects: Abdomen; ancillary studies; endoscopic ultrasound‐guided fine‐needle aspiration; rapid on‐site evaluation
• ISSN: 8755-1039; 1097-0339
• DOI: 10.1002/dc.24523

Background Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) is an important modality to obtain tissue diagnosis from mediastinal, pancreatic, and intra‐abdominal lesions in close proximity to the pulmonary and gastrointestinal tract. It is considered to be a relatively safe, rapid, and minimally invasive technique with low complication rates. Aims To determine the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and outcome of EUS‐FNA, with histological correlation where applicable. Methods Data of all 1059 consecutive patients who underwent EUS‐FNA from 1 January 2005 to 31 December 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore was reviewed in this retrospective study. The major sites that were targeted for EUS‐FNA were pancreatic (423), mediastinal (376), and other abdominal lesions (260). Results The average number of passes per patient was 2.22. Rapid on‐site evaluation (ROSE) was adequate in 969 patients (91.4%). Concordance between ROSE and final cytology was 99.5%. Follow‐up was available in 810 patients (76.4%). The overall diagnostic yield was 94.3%. Ancillary studies, including immunohistochemical stains and flow cytometry, helped to increase the diagnostic yield from 78.1% to 94.3%. The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy for EUS‐FNA were 94.8%, 98.6%, 99.9%, 65.5%, and 95.1%, respectively. Seven of 1059 patients (0.6%) developed complications. Conclusion EUS‐FNA is a very sensitive and specific diagnostic tool with a minimal complication rate. Ancillary studies helped to increase the sensitivity, as well as the diagnostic yield.