Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study

Background EUS-guided FNA is an efficacious technique for sampling intraintestinal and extraintestinal mass lesions. However, cytology has limitations to its final yield and accuracy, which may be overcome if histological specimens are provided to the pathologist. Objective To evaluate feasibility,...

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Published in:Gastrointestinal endoscopy 2011-06, Vol.73 (6), p.1189-1196
Main Authors: Iglesias-Garcia, Julio, MD, Poley, Jan-Werner, MD, Larghi, Alberto, MD, PhD, Giovannini, Marc, MD, PhD, Petrone, Maria Chiara, MD, Abdulkader, Ihab, MD, PhD, Monges, Genevieve, MD, PhD, Costamagna, Guido, MD, PhD, Arcidiacono, Paolo, MD, Biermann, Katharina, MD, PhD, Rindi, Guido, MD, PhD, Bories, Erwan, MD, Dogloni, Claudio, MD, PhD, Bruno, Marco, MD, PhD, Dominguez-Muñoz, J. Enrique, MD, PhD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy, Fine-Needle - instrumentation
Cohort Studies
Digestive system. Abdomen
Endoscopy
Feasibility Studies
Female
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Investigative techniques, diagnostic techniques (general aspects)
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Male
Medical sciences
Middle Aged
Needles
Neoplasms - diagnostic imaging
Neoplasms - pathology
Predictive Value of Tests
Sensitivity and Specificity
Ultrasonography, Interventional
Young Adult
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Summary:Background EUS-guided FNA is an efficacious technique for sampling intraintestinal and extraintestinal mass lesions. However, cytology has limitations to its final yield and accuracy, which may be overcome if histological specimens are provided to the pathologist. Objective To evaluate feasibility, yield, and diagnostic accuracy of a newly developed 19-gauge, fine-needle biopsy (FNB) device. Design Multicenter, pooled, cohort study. Setting Five medical centers. Patients This study involved 109 consecutive patients with 114 intraintestinal or extraintestinal mass lesions and/or peri-intestinal lymph nodes. Intervention EUS-guided FNB (EUS-FNB) with a newly developed, 19-gauge, FNB device. Main Outcome Measurements Percentage of cases in which pathologists classified the sample quality as optimal for histological evaluation and the overall diagnostic accuracy compared with a composite criterion-standard diagnosis. Results We evaluated 114 lesions (mean [± standard deviation] size 35.1 ± 18.7 mm; 84 malignant [73.7%] and 30 [26.3%] benign). EUS-FNB was technically feasible in 112 lesions (98.24%). Sample quality was adequate for full histological assessment in 102 lesions (89.47%). In 98 cases (85.96%), diagnosis proved to be correct according to criterion-standard diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for diagnosis of malignancy were 90.2%, 100%, 100%, 78.9%, and 92.9%, respectively. Limitations Use of a surrogate criterion-standard diagnosis, including clinical follow-up when no surgical specimens were available, mainly in benign diagnoses. Conclusion Performing an EUS-FNB with a new 19-gauge histology needle is feasible for histopathology diagnosis of intraintestinal and extraintestinal mass lesions, offering the possibility of obtaining a core sample for histological evaluation in the majority of cases, with an overall diagnostic accuracy of over 85%.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2011.01.053