Endoscopic ultrasound-guided fine needle aspiration for gastrointestinal lesions with inconclusive endoscopic biopsies

Objective To determine the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for gastrointestinal lesions with inconclusive endoscopic biopsies. Methods A retrospective analysis was performed in 65 patients who were found to have gastrointestinal lesions with inconclusive endoscopic biopsies and underwent EUS-FNA in Drum Tower Hospital. Diagnostic value of EUS-FNA was determined by comparing with surgical histopathology and follow-up results. Results This study included 41 males (63%) and 24 females (37%) with median age of 60 years. The most common lesion was diffuse infiltrative lesions (37, 56.9%), followed by submucosal protrusion types (17, 26.2%). Fifty-four cases (83.1%) were malignant lesions, and 11 cases (16.9%) were benign. The overall sensitivity, specificity, and accuracy of EUS-FNA for gastrointestinal lesions with inconclusive biopsies were 76.8% (95%CI: 65.7%-87.8%), 100.0% (95%CI: 66.4%-100.0%), and 80.0% (95%CI: 70.3%-89.7%), respectively. Sub-group analysis showed the sensitivity, specificity, and accuracy of EUS-FNA for diffuse infiltrative lesions were 70.6% (95%CI: 55.3%-85.9%, 100.0% (95%CI: 29.2%-100.0%), and 73.0% (95%CI: 58.7%-87.3%), respectively. For submucosal protrusions, the sensitivity, specificity, and accuracy of EUS-FNA were 68.8% (95%CI: 46.0%-91.5%), 100.0% (95%CI: 2.5%-100.0%), and 70.6% (95%CI: 44.0%-89.7%), respectively. Conclusion EUS-FNA has moderate diagnostic value for endoscopic biopsy-inconclusive gastrointestinal lesions. It can be an alternative option when standard methods, such as endoscopic mucosal forceps biopsy, fail to provide a definitive diagnosis. Key words: Biopsy, fine-needle; Ultrasonography; Endoscopy, gastrointestinal; Diagnosis