Which Needle Is Better for Diagnosing Subepithelial Lesions?

the diagnostic process for subepithelial lesions (SELs). Location of the mass within the gut wall, internal echogenicity, outer margins of the mass, and its relation to extramural structures can all be determined using EUS. Careful examination may provide a definitive diagnosis such as cyst or lipoma when these characteristic EUS findings are observed. Alternately, narrowing the differential diagnosis is possible by an 'educated guess' based on the information obtained from EUS examination. 1 However, the accuracy of EUS in the diagnosis of SEL is not absolute and a microscopic tissue examination is still necessary to obtain a definitive diagnosis of SEL. There are many methods available for tissue acquisition for diagnosing SEL. 2 EUS-guided tissue acquisition is regarded as a safe and accurate method and EUS-guided fine needle aspiration (EUS-FNA) is a widely-used approach. Nevertheless, reported diagnostic accuracy of EUS-FNA for SEL varies broadly from 60% to 98% 3,4 as results are easily influenced by various factors such as the availability of an on-site cytopathologist, experience of endosonographer, location and size of lesion, equipment used, technique used, and deviated data interpretation.