Diagnostic Ability and Factors Influencing the Accuracy of Endoscopic Ultrasonography-guided Fine-needle Aspiration for Solid Lesions In and Adjacent to the Gastrointestinal Tract

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has become a safe and accurate diagnostic tool for lesions arising from organs adjacent to the gastrointestinal tract, as well as those arising from the gastrointestinal wall. To improve diagnostic accuracy, devices such as needles with side ports have been developed, but studies evaluating the clinical usefulness of such enhancements remain scant. To explore the factors potentially influencing the diagnostic accuracy of endoscopic ultrasonography-guided fine–needle aspiration (EUS–FNA) for solid masses located in and adjacent to the gastrointestinal tract. Totally 484 consecutive patients who underwent diagnostic EUS-FNA for solid lesions in or adjacent to the gastrointestinal tract from January 2008 to December 2012 were reviewed retrospectively. The overall diagnostic accuracy was 87.0% (442/508). The diagnostic accuracy of combined cytologic/histologic analyses was significantly higher compared with either cytologic or histologic analysis alone. Three and/or more needle passes (p<0.01 compared with less than 3 needle passes; OR=4.01, 95% CI: 2.27-7.07) and larger lesions of >2 cm in diameter (p<0.01 compared with masses <2 cm; odds ratio [OR]=3.20, 95% confidence interval [CI]: 1.68-6.09) were associated with higher diagnostic accuracy. Gauge size (22and 25-gauge) and side port (with or without) of needle were independent factors for the overall diagnostic accuracy of EUS-FNA. Conclusion: Lesions ≥2 cm, combined cytologic-histologic analysis and 3 or more needle passes, irrespective of the needle gauge or a side port of needles, were suggested to improve the diagnostic accuracy of EUS-FNA.