The effectiveness and factors that impact the value of biopsy sample
of EUS-FNA in morphological verification of abdominal and mediastinum lesions
Abstract Morphological verification of diagnosis in oncology patients is the essential factor for right treatment choice. Fine-needle aspiration under endososnography control (EUS-FNA) is one of the methods for obtaining biopsy samples of masses in mediastinum and upper level of abdominal cavity But obtaining informative sample using EUS-FNA, and other methods is not always successful. Objective. Investigate factors that impact the value of biopsy sample obtained using EUS-FNA, and choose most significant ones.
Population and methods. 312 were enrolled in to the study from 2005–2014. All the patients underwent EUS-FNA of masses in mediastinum and upper part of abdominal cavity for definitive morphological diagnosis. 74 patients subsequently were operated on that made it possible to compare morphology between samples obtained from EUS-FNA with samples obtained during surgery. We investigate the factors that could influence the value of information obtained using EUS-FNA: age, sex, object of EUS-FNA, site of tumor, needle diameter used for EUS-FNA, history of obtaining no informative biopsy sample, number of EUS-FNA attempts, tumor size and methods of EUS-FNA.
Results. Sensitivity, specificity and accuracy of EUS-FNA were 81.5; 88.9 and 82.4%, accordingly. The frequency of cytological and histological coincidence between samples obtained by EUS-FNA with samples obtained during surgery in the same patients populations were 83.8 и 90.9%, accordingly. The sensitivity of the test was 85.6% in cases when diagnosis was made with the first attempt of EUS-FNA . The sensitivity was 50% when EUS-FNA were performed more then one time to (p=0.005). The sensitivity of EUS-FNA was 68% in patients when other methods of obtaining diagnostic tissue sample failed and rose to 90% in patients without such previous attempts (p=0.029).
The discriminant analysis has found some significant factors that affects the percentage of diagnosis coincidence between EUS-FNA and surgery biopsy: presence of non-informative morphological results before EUS-FNA (p=0.004), needle diameter used for EUS-FNA (p=0.019) and total count of EUS-FNA attempts (p=0.05).
Discussion. Many factors impact usefulness of information obtained using EUS-FNA in our study number of attempts of EUS-FNA was the most important variable that predict the value of information obtained during biopsy (if the first puncture did not obtain sample taht was informative it is obvious that next attempts could not be informative as well. This statement is the case for other methods of obtaining biopsy samples. Diameter of needle used for EUS-FNA is another significant factor for quality of obtained sample
Comclusion. Irrespective of clinical scenario needle 22 g can be recommended for EUS-FNA as an optimal method for obtaining biopsy sample. For EUS-FNA in patients with high risk of obtaining non-informative sample it is advisable to do a few fine-needle punctures including use of a wider diameter needle (19G) during one session for obtaining samples for cytology and histology examinations.
Keywords:endoscopic ultrasonography, fine- needle aspiration, morphological verification
Clin. Experiment. Surg. Petrovsky J. 2015. № 4. Р. 73–84.
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