Safety and utility of endoscopic ultrasound-guided fine-needle aspiration of focal splenic lesions: a retrospective analysis

BACKGROUND Fine-needle aspiration (FNA) of focal splenic lesions (FSL) is usually done under ultrasound (US) or computed tomography guidance. Endoscopic US (EUS), because of its ability to provide high-resolution images, can be used for aspirating FSL. We studied the safety and efficacy of EUS-guided FNA of FSL. METHODS We performed a retrospective analysis of patients with FSL undergoing EUS-guided FNA over the last six years. RESULTS EUS-guided FNA was performed in 16 patients (age: 28-43 years; male: 11). A 22-G needle was used in 13 patients, a 25-G needle in 2 patients, and a 19-G needle in 1 patient. All patients had abdominal pain, with 6 patients also having fever. On EUS, 8 patients had focal hypoechoic lesion/lesions, whereas 8 patients had focal cystic lesion/lesions. The size of the focal lesions ranged from 0.8-10 cm. EUS-guided aspiration was performed successfully in all patients. The cytology was adequate in all patients and a diagnosis was established in 13 (81%) patients. The final diagnosis in patients with hypoechoic lesions was tuberculosis in 6 patients and sarcoidosis in 2 patients. The final diagnosis in patients with cystic lesions was pseudocyst in 5 patients and simple cyst in 3 patients. One patient with splenic pseudocyst had a massive hemorrhage from a splenic artery pseudoaneurysm 7 days after FNA. No other major complication was encountered. CONCLUSION EUS-guided FNA of FSL is safe and provides adequate material for cytological examination, even in the case of small lesions.