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Pitfalls in endoscopic ultrasound-guided fine-needle aspiration and how to avoid them

Edward B Stelow1, Ricardo H Bardales, Michael W Stanley

  • 1Department of Pathology, University of Virginia, Charlottesville, Virginia 22908, USA. edstelow@yahoo.com

Advances in Anatomic Pathology
|February 26, 2005
PubMed

Insights

This review highlights common diagnostic pitfalls in endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for pancreatic, gastrointestinal, and thoracic pathologies. It guides cytopathologists in interpreting challenging EUS-FNA samples for accurate diagnoses.

Area of Science:

  • Gastroenterology
  • Pathology
  • Oncology

Background:

  • Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is crucial for diagnosing various abdominal pathologies.
  • Cytopathologists face recurring challenges with specific sample types and cytomorphologic features in EUS-FNA.
  • Accurate interpretation of EUS-FNA samples is vital for patient management and treatment decisions.

Purpose of the Study:

  • To review common diagnostic pitfalls encountered in EUS-guided FNA procedures.
  • To provide guidance on the cytomorphologic interpretation of challenging EUS-FNA specimens.
  • To enhance diagnostic accuracy for pancreatic, gastrointestinal, and thoracic conditions sampled via EUS-FNA.

Main Methods:

  • Review of cytopathologic findings from EUS-guided FNA procedures.
  • Discussion of diagnostic challenges associated with specific tumor types and lesions.
  • Focus on key differential diagnoses for common EUS-FNA sample types.

Main Results:

  • Identification of recurring difficulties in EUS-FNA interpretation, particularly for pancreatic lesions.
  • Detailed discussion on differentiating pancreatic ductal adenocarcinoma, endocrine neoplasms, solid pseudopapillary tumors, and acinar cell carcinomas.
  • Analysis of diagnostic considerations for pancreatic cystic neoplasms (IPMNs, MCNs) and gastrointestinal mesenchymal tumors (GISTs).
  • Emphasis on the interpretation of lymph node aspirates in the context of EUS-FNA.

Conclusions:

  • Cytopathologists must be aware of specific pitfalls in EUS-FNA to ensure accurate diagnoses.
  • Understanding the cytomorphology of various pancreatic and gastrointestinal neoplasms is essential.
  • This review serves as a practical guide for improving diagnostic outcomes from EUS-FNA procedures.

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