Endoscopic ultrasound-guided fine-needle aspiration with on-site cytopathology versus core biopsy: a comparison of both techniques performed at the same endoscopic session

 

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Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) with bedside cytopathology is the gold standard for assessment of pancreatic, subepithelial, and other lesions in close proximity to the gastrointestinal tract, but it is time-consuming, has certain diagnostic limitations, and bedside cytopathology is not widely available.

Aims: The goal of this study is to compare the diagnostic yield of EUS-guided FNA with on-site cytopathology and EUS-guided core biopsy.

Methods: Twenty-six patients with gastrointestinal mass lesions requiring biopsy at a tertiary medical center were included in this retrospective analysis of a prospective cohort. Two core biopsies were taken using a 22 gauge needle followed by FNA guided by a bedside cytopathologist at the same endoscopic session. The diagnostic yield and test characteristics of EUS core biopsy and EUS FNA with bedside cytopathology were examined.

Results: The mean number of passes was 3.2 for FNA, and the mean procedure time was 39.4 minutes. The final diagnosis was malignant in 92.3 %. Sensitivity and specificity were 83 % and 100 %, respectively, for FNA, and 91.7 % and 100 %, respectively, for core biopsy. Diagnostic accuracy was 92.3 % for FNA and 84.6 % for core biopsy. The two approaches were in agreement in 88.4 % with a kappa statistic of 0.66 (95 % confidence interval 0.33 – 0.99).

Conclusions: An approach using two passes with a core biopsy needle is comparable to the current gold standard of FNA with bedside cytopathology. The performance of two core biopsies is time-efficient and could represent a good alternative to FNA with bedside cytopathology.

• References

• 1 Vander Noot 3rd MR, Eloubeidi MA, Chen VK et al. Diagnosis of gastrointestinal lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 2004; 102: 157-163
  CrossrefPubMedGoogle Scholar
• 2 Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine-needle aspiration of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management. Endoscopy 2005; 27: 984-989
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Wiersema MJ, Vilmann P, Giovannini M et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997; 112: 1087-1095
  CrossrefPubMedGoogle Scholar
• 4 Yoshinaga S, Suzuki H, Oda I et al. Role of endoscopic ultrasound-guided fine needle aspiration for diagnosis of solid pancreatic masses. Dig Endosc 2011; 23: 29-33
  CrossrefPubMedGoogle Scholar
• 5 Kramer H, Sandes J, Post WJ et al. Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration. Cancer 2006; 108: 206-211
  CrossrefPubMedGoogle Scholar
• 6 Watson RR, Binmoeller KF, Hamerski CM et al. Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stroma tumors. Dig Dis Sci 2011; 56: 1757-1762
  CrossrefPubMedGoogle Scholar
• 7 Chang KJ, Wiersema M, Giovannini M et al. Multi-center experience with endoscopic ultrasound guided fine needle aspiration of the pancreas. Gastrointest Endosc 1996; 43: S49 (abstract)
  CrossrefPubMedGoogle Scholar
• 8 Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. Am J Gastroenterol 2011; 106: 1705-1710
  CrossrefPubMedGoogle Scholar
• 9 Klapman JB, Logrono R, Dye CE et al. Clinical impact of on-site cytopathology interpretation of endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 2003; 98: 1289-1294
  CrossrefPubMedGoogle Scholar
• 10 Jhala NC, Jhala DN, Chhieng DC et al. Endoscopic ultrasound-guided fine needle aspiration: a cytopathologist’s perspective. Am J Clin Pathol 2003; 120: 351-367
  CrossrefPubMedGoogle Scholar
• 11 Ribeiro A, Vazquez-Sequeiros E, Wiersema LM et al. EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma. Gastrointest Endosc 2001; 53: 485-491
  CrossrefPubMedGoogle Scholar
• 12 Saftoiu A, Vilmann P, Guldhammer Skov B et al. Endoscopic ultrasound-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: a prospective study. Scand J Gastroenterol 2007; 42: 117-125
  CrossrefPubMedGoogle Scholar
• 13 Nasuti JF, Gupta PK, Baloch ZW. Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: review of 5,688 cases. Diagn Cytopathol 2002; 27: 1-4
  CrossrefPubMedGoogle Scholar
• 14 Larghi A, Verna EC, Ricci R et al. EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study. Gastrointest Endosc 2011; 74: 504-510
  CrossrefPubMedGoogle Scholar
• 15 Chhieng DC, Jhala D, Jhala N et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy: a study of 103 cases. Cancer 2002; 96: 232-239
  CrossrefPubMedGoogle Scholar
• 16 Wittmann J, Kocjan G, Sgouros SN et al. Endoscopic ultrasound-guided tissue sampling by combined fine needle aspiration and trucut needle biopsy: a prospective study. Cytopathology 2006; 17: 27-33
  PubMedGoogle Scholar
• 17 Varadarajulu S, Fraig M, Schmulewitz N et al. Comparison of EUS-guided 19-gauge trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 2004; 36: 397-401
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Storch I, Jorda M, Thurer R et al. Advantage of EUS trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc 2006; 64: 505-511
  CrossrefPubMedGoogle Scholar
• 19 Storch I, Shah M, Thurer R et al. Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in thoracic lesions: when tissue is the issue. Surg Endosc 2008; 22: 86-90
  CrossrefPubMedGoogle Scholar
• 20 Levy MJ, Wiersema MJ. EUS-guided trucut biopsy. Gastrointest Endosc 2005; 62: 417-426
  CrossrefPubMedGoogle Scholar
• 21 Iglesias-Garcia J, Poley JW, Larghi A et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
  CrossrefPubMedGoogle Scholar
• 22 Sakamoto H, Kitano M, Komaki T et al. Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol 2009; 24: 384-390
  CrossrefPubMedGoogle Scholar
• 23 Bang JY, Herbert-Magee S, Trevino J et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
  CrossrefPubMedGoogle Scholar
• 24 Berzosa M, Patel K, Vela S et al. Comparison of a novel EUS core needle vs. standard FNA for pancreatic lesions: what’s the verdict? [Abstract]. Am J Gastroenterol 2012; 107: 109-S110
  PubMedGoogle Scholar
• 25 Al-Haddad M, Wallace MB, Woodward TA et al. The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study. Endoscopy 2008; 40: 204-208
  Article in Thieme ConnectPubMedGoogle Scholar
• 26 Thomas T, Kaye PV, Ragunath K et al. Efficacy, safety, and predictive factors for a positive yield of EUS-guided trucut biopsy: a large tertiary referral center experience. Am J Gastroenterol 2009; 104: 584-591
  CrossrefPubMedGoogle Scholar