Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in non-gastrointestinal (GI) disorders: A multicenter assessment on accuracy and therapeutic guidance

EUS guided FNA has increased the diagnostic capability of endosonography with respect to GI pathology. The role of FNA in non-GI disorders using EUS guidance has received little attention in the literature in limited numbers. AIM: To evaluate the diagnostic accuracy and impact on Rx of EUS guided FNA in a variety of non-GI disorders. METHODS: 142 pts (85M, 57F, age 27-81) underwent EUS guided FNA at 10 tertiary centers. Final diagnosis was available in all pts using EUS FNA, "other" biopsy method, surgery, and long-term f/u. EUS guided FNA was classified under 8 disease categories: 1) Mediastinal lymph (LN) node (primary pulmonary process), 1A-benign/ infections, 1B-malignant pulmonary, 1C-malignant mediastinal (lymphoma, mets, etc); 2) Mediastinal mass (thymoma, thyroid, etc.); 3) Prostate; 4) Ovarian; 5) Adrenal; 6) Kidney; 7) Intra-abdominal mass (non-GI); 8) Intra-abdominal LN (non-GI). Indications for EUS guided FNA included abnormal x-ray 56, LN staging of known malignancy (lung, ovarian, etc.) 61, unexplained symptoms 5. RESULTS: EUS FNA was successful in establishing a tissue diagnosis in 123 of 142 pts (87%). It was helpful in directing subsequent Rx and/or guiding further testing in 116 of 142 pts (82%). Number of FNA passes/pt ranged from 1-9 (mean 3.6). Complications were rare and included 2 episodes of infection Rx with antibiotics and 1 chest pain. DISEASE CATEGORY (No.) EUS FNA RESULTS FINAL DX ESTABLISHED ACCURACY EUS No. (%) EUS FNA ON RX IMPACT BEN MALIG INAD SUSP FNA OTHER SURG F/U 1A - (9) 7 0 2 0 5 2 2 0 7 (78) 7 1B - (88) 29 55 1 3 75 5 8 0 80 (91) 78 1C - (9) 3 6 0 0 6 1 1 1 7 (78) 6 2 - (5) 3 1 1 0 4 0 0 1 4 (80) 3 3 - (4) 1 3 0 0 4 0 0 0 4 (100) 4 4 - (2) 2 0 0 0 2 0 0 0 2 (100) 2 5 - (3) 1 2 0 0 3 0 0 0 3 (100) 3 6 - (4) 0 4 0 0 4 0 0 0 4 (100) 4 7 - (16) 6 7 0 3 12 0 3 1 10 (63) 9 8 - (2) 1 0 0 1 0 1 1 0 0 0 CONCLUSIONS: EUS guided FNA in a variety of non-GI disease is accurate, safe and assists in guiding subsequent Rx in the vast majority of cases. Promising areas include FNA of mediastinal LN/masses in primary pulmonary disease and intra-abdominal lesions, particularly perirectal disease.