Evaluation the diagnostic value of endoscopic ultrasound guided fine needle aspiration for the lesions with suspicious lymph nodes metastasis around the upper digestive tract and pancreas

Objective: To evaluate the clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in upper digestive tract and pancreatic diseases accompanied with peripheral suspicious lymph nodes as metastasis on differenzial diagnosis between benign and malignant lesions.

Methods: Between January 2010 and June 2010, 15 patients have been enrolled randomized in our hospital suspected as esophageal, gastric, pancreatic, and duodenal inflammatory diseases or cancers. EUS-guided FNA was performed when lymph nodes were considered to be metastasis (oval shape, hypoechogenicity, distinct margins, diameter >5mm). All EUS-FNA were performed with 22 gauge needles. The accuracy and safety of EUS-FNA were evaluated based on the final diagnosis from cytological and histological results.

Results: 13 patients received postoperative diagnosis, the sensitivity of EUS-FNA was 86.7%. 3 patients had surgical follow-up, the lymph node diagnosis were consistent with EUS-FNA smears or pathological results, coincidence rate was 100%. Two cases were negative for lymph node biopsy. Nevertheless pathological examination confirmed pancreatic cancer with peripheral lymph node metastasis. All patients have not severe complications.

Conclusion: EUS-FNA is a safe and effective procedure, which can be used routinely in diagnosis of peripheral dubious lymph nodes around pancreas and upper gastrointestinal tract, especially to make a differenzial diagnosis between benign and malignant lesions. For some cystic lesions and those lesions presented with severe necrosis, which were unable or quiet difficult to obtain cells or tissue enough to make differentiation. It is recommended to do puncture in time with EUS-FNA for those periphery suspicious lymph nodes to make the diagnosis more accurately and quickly by the results of cytology or pathology, in order to avoid the high incidence of complications such as bleeding, infection, perforation caused by repeated punctures for those lesions within the pancreas or upper GI tract. The results of this study also demonstrate the remarkable clinical significance for shortening operation time, and increasing the tolerance of patients as well.