Background and Objective
EUS-guided FNA is a sensitive method to obtain cytologic specimens from solid lesions
in close proximity to the GI tract. Although FNA provides cells for analysis, large-caliber
Tru-cut biopsy (EUS-TCB) needles obtain samples that can be used for additional histopathologic
analysis. We assessed the additional diagnostic yield of EUS-TCB in patients with
solid mediastinal lesions in whom EUS-FNA was performed.
Patients and Design
In the period from July 2003 to July 2007, all patients with mediastinal lesions accessible
to EUS-FNA and EUS-TCB were evaluated. In all patients, a mean of 3 passes of EUS-FNA
was followed by EUS-TCB. Cytologic and histologic specimens were evaluated by 2 pathologists
blinded for patient condition. A final diagnosis was obtained by combining all information
present (EUS-FNA and EUS-TCB results, mediastinoscopy, bronchoscopy [if performed],
and other investigations).
Results
The diagnostic accuracy of EUS-FNA, EUS-TCB, and the combination of both techniques
was 93%, 90%, and 98%, respectively (not significant). In EUS-FNA–negative patients,
EUS-TCB provided a final diagnosis in an additional 3 patients (5%). Malignant disease
found by EUS-FNA could be specified by EUS-TCB in 15 patients (25% of patients). The
granulomatous disease established by cytologic samples of clinically suspected tuberculosis
could be specified by EUS-TCB in 2 patients (3%). In 1 patient (2%), both FNA and
TCB were inconclusive.
Limitations
Retrospective study.
Conclusions
The diagnostic yield of EUS-FNA and EUS-TCB is comparable. We recommend limiting the
use of EUS-TCB to specific cases in which EUS-FNA is not conclusive.
Abbreviations:
EUS-TCB (EUS-guided Tru-cut biopsy), MRI (magnetic resonance imaging), PET (positron emission tomography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 27, 2009
Accepted:
September 17,
2008
Received:
March 13,
2008
Nieuwegein, The NetherlandsFootnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you want to chat with an author of this article, you may contact him at [email protected] or [email protected]
Identification
Copyright
© 2009 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
