Factors affecting the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA) for upper gastrointestinal submucosal or extraluminal solid mass lesions

Aim: A number of potential variables are associated with the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA). The aim of this study was to evaluate factors affecting the diagnostic accuracy of EUS‐FNA for upper gastrointestinal submucosal or extraluminal solid lesions. Methods: Patients with such lesions who underwent EUS‐FNA between January 2009 and December 2010 were studied retrospectively. Needles of 22, 25 and 19 gauge were used. The associations between the EUS‐FNA results and factors such as mass location, mass size, needle size, number of needle passes, combined histologic‐cytologic analysis and final diagnosis were analyzed. Results: A total of 170 EUS‐FNA procedures were performed in 158 patients with upper gastrointestinal submucosal or extraluminal solid lesions. The overall accuracy of EUS‐FNA was 86.5% (147/170). The diagnostic accuracy with three or more needle passes was higher than with less than 3.0 needle passes (90.0%, 108/120 vs 78.0%, 39/50; P < 0.05). Mass location, mass size, and final diagnosis were not associated with EUS‐FNA accuracy. Combined cytologic‐histologic analysis had significantly higher diagnostic accuracy than either cytologic or histologic analysis alone (P < 0.001). In a subgroup of 90 patients, both 22 and 25 gauge needles were used for EUS‐FNA. The overall diagnostic accuracy was similar for 25 gauge needles and 22 gauge needles (80.0% vs 78.9% P = 1.000) in this subgroup. Conclusion: Overall, 25 and 22 gauge needles have a similar diagnostic accuracy. Our results suggest that 3.0 or more needle passes and combined cytologic‐histologic analysis enhance the diagnostic accuracy of EUS‐FNA.     

Prospective evaluation of the optimal number of 25‐gauge needle passes for endoscopic ultrasound‐guided fine‐needle aspiration biopsy of solid pancreatic lesions in the absence of an onsite cytopathologist

Introduction: A prior study with 22‐gauge needles recommended more than seven needle passes for endoscopic ultrasound‐guided fine‐needle aspiration biopsy (EUS‐FNA) of solid pancreatic lesions (SPL) without onsite cytopathology for optimal acquisition of cytopathological diagnosis. The feasibility of this recommendation should be re‐evaluated considering the later development and popularity of 25‐gauge EUS‐FNA needles. We aimed to determine the optimal number of needle passes for cytopathological specimen acquisition with 25‐gauge needles for EUS‐FNA of SPL. Methods: A preliminary prospective study of 22 patients with an onsite cytopathology technician showed a sensitivity of 93.3% and a specificity of 100% with four needle passes that was not statistically different from five needle passes. Based on our preliminary study, we fixed the number of needle passes to four (Group A). As a control group, we carried out sampling in consecutive patients using 25‐gauge needles with an onsite cytopathologist (Group B). Sampling rate, diagnostic value and complications were evaluated. Results: We enrolled 20 patients in each group. Sampling rate was higher in Group B (20/20, 100%) than in Group A (19/20, 95%), but there was no statistical difference between them (P‐value = 0.31). In Group A, sensitivity, specificity and accuracy were 100% among 19. In Group B, sensitivity was 94.1%, specificity 100%, accuracy 95%. There were also no statistical differences between the groups. No complications were seen. Conclusion: Our study suggests that four needle passes using a 25‐gauge needle may be sufficient for EUS‐FNA of SPL where onsite cytology is not available.     

Endoscopic ultrasound‐guided fine‐needle aspiration of solid lesions on clopidogrel may not be a high‐risk procedure for bleeding: A case series

The major gastrointestinal endoscopy society guidelines list endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) as a high‐risk procedure for bleeding. However, there are no studies evaluating the risk of bleeding for EUS‐FNA of solid organs while patients continue to take clopidogrel. The aim of the present case series was to evaluate the rate of bleeding in a cohort of patients who underwent EUS‐FNA for solid lesions while on clopidogrel. Bleeding was measured at the time of the procedure by bleeding seen on EUS, endoscopic visualization of blood, or drop in hemoglobin after the procedure. From 2013 to 2015, 10 patients were identified for this case series. Lesions that underwent EUS‐FNA included gastric and rectal subepithelial lesions, pancreas masses, and liver masses. No immediate or delayed bleeding was observed in any of the patients. EUS‐FNA of solid lesions on clopidogrel may not be a high‐risk procedure for bleeding. Larger studies are needed to confirm this finding.     

Tips for endoscopic ultrasound‐guided fine needle aspiration of various pancreatic lesions

Endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) is a well‐established procedure for diagnosis of pancreatic solid masses. This technique is highly accurate and safe and can be performed uneventfully in most cases. However, factors such as unstable scope position, inappropriate location of the lesion, lesion mobility, and lesion characteristics may complicate the procedure. To overcome such difficulties, it is necessary to select the most suitable needle and consider several technical points according to each situation. We introduce our standard technique for EUS‐FNA and provide several tips for ensuring a successful procedure.