Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: How many passes?

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is essential for diagnosing gastrointestinal cancers.
• Variations exist in the number of samples needed for diagnostic material from different lesions.
• The presence of a cytopathologist for rapid on-site evaluation (ROSE) influences sample acquisition.

Purpose of the Study:

• To review factors influencing diagnostic yield in EUS-FNA.
• To determine optimal needle pass numbers for various gastrointestinal lesions when ROSE is unavailable.
• To explore strategies for improving conclusive diagnoses from EUS-FNA.

Main Methods:

• Review of existing studies on EUS-FNA diagnostic yield.
• Analysis of factors affecting sample acquisition, including ROSE availability.
• Comparison of needle pass recommendations for different lesion types (pancreatic masses, lymph nodes, cysts).

Main Results:

• EUS-FNA with ROSE achieves diagnostic yields exceeding 90%.
• Recommended passes vary: 5-7 for pancreatic masses, 3 for lymph nodes, 1 for cysts when ROSE is absent.
• Core biopsy or 19-G needles may enhance histological yield.

Conclusions:

• Optimizing EUS-FNA technique, including needle passes and ROSE utilization, is key for accurate diagnosis.
• Centralizing care to high-volume centers with ROSE availability can improve patient outcomes.
• Further research may refine EUS-FNA protocols for diverse gastrointestinal lesions.