Lower Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Useful Diagnostic Tool for Perirectal and Intraluminal Lesions: A Large Series in a Single Tertiary Referral Hospital

2014
Introduction: Lower Endoscopic Ultrasound-Guided Fine-Needle Aspiration (LEUS-FNA) of perirectal lesions is a safe, minimally invasive, and well tolerated procedure that provides valuable information which affects patient management. Herein, we presented our experience of LEUS -FNA to evaluate perirectal lesions. Materials and Methods: LEUS-FNAs were retrieved from the cytopathologyarchives of our University Hospital, from 2001February, 2014. The cytopathologyreports, corresponding histology, immunohistochemistry when available, and clinical data were collected. The sensitivity and specificity of EUS-FNA were calculated in a subset of patients with available surgical pathology. Results: 114 specimens were retrieved. Masses measured 5e100 mm (mean: 27.5 mm) in diameter. Recurrent cancer was clinically suspected in 46% of cases (nZ53). For 37 cases histopatholgic material was available. The aspirated material showed malignant (n Z 48), benign (n Z 41), atypical/suspicious (nZ6) and nondiagnostic cytology(nZ 19). Malignant cases were adenocarcinoma (24), neuroendocrine tumor(3), squamous cell carcinoma (5), urothelial carcinoma (2), positive for malignant cells (12), gastrointestinal stromal tumor(1) and non Hodgkin lymphoma (1). The primary site of the tumors included colorectal, anal, urinary bladder, prostate, pancreas, ovary, and female lower genital tract. The benign cytologycases were negative for malignant cells (32), schwannoma (1), and 8 non neoplastic lesions including: abscess (3), endometriosis (2), hematoma (1), malacoplakia(1) and mucinous cyst (1). Histology confirmed 11/12 negative cytology; one false negative cytologyof lymph node. Statistical analysis for LEUS-FNA showed 91% sensitivity, 100% specificity, diagnostic accuracy of 95%, and a positive predictive value of 100% and a negative predictive value of 88%. Discrepancies were likely due to cytology sampling errors. Conclusion: Lower EUS-FNA allows cytologicalexamination and ancillary studies (immunohistochemistry, flow cytometry) of suspicious pelvic lesions in the gut wall and surrounding tissues. LEUS-FNA can detect local recurrences and also improve the staging accuracy of colorectal adenocarcinomaby proving nodal metastasis.
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