Endoscopy 2001; 33(6): 478-483
DOI: 10.1055/s-2001-14966
Original Article

© Georg Thieme Verlag Stuttgart · New York

Clinical Impact of Endoscopic Ultrasound-Guided Fine Needle Aspiration Biopsy in Patients with Upper Gastrointestinal Tract Malignancies. A Prospective Study

M. B. Mortensen, T. Pless, J. Durup, A. P. Ainsworth, G. J. Plagborg, C. Hovendal
  • Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Background and Study Aims: Several studies have evaluated the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) in the upper gastrointestinal tract, but so far no studies have specifically evaluated the clinical impact of EUS-FNAB in upper gastrointestinal tract cancer patients. In this consecutive and prospective study, EUS-FNAB was only performed if a positive malignant finding would change the therapeutic strategy.

Patients and Methods: Between 1997 and 1999, 307 consecutive patients were referred for EUS with a diagnosis or strong suspicion of esophageal, gastric or pancreatic cancer; 274 patients were potential candidates for surgical treatment and had EUS. According to predefined impact criteria, 27 % (75/274) of the patients had EUS-FNAB for staging or diagnostic reasons.

Results: The overall clinical impact of EUS-FNAB was 13 %, 14 %, and 30 % in esophageal, gastric, and pancreatic cancer, respectively. The staging-related clinical impact was similar for all three types of cancer (11 - 12.5 %), whereas the diagnosis-related impact was highest in pancreatic cancer patients (86 %). EUS-FNAB was inadequate in 13 % and gave false-negative results in 5 %. The overall sensitivity, specificity and accuracy for EUS-FNAB were 80 %, 78 % and 80 %, respectively. No complications related to the biopsy procedure were seen.

Conclusions: If EUS-FNAB was performed only in cases where a positive malignant result would change patient management, then approximately one out of four patients with upper gastrointestinal tract cancer would require a biopsy. With this approach the actual clinical impact of EUS-FNAB ranged from 13 % in esophageal cancer to 30 % in pancreatic cancer. EUS-FNAB plays a limited, but very important clinical role in the assessment of upper gastrointestinal tract cancer.

References

 M. B. Mortensen, M.D., PhD

Department of Surgical Gastroenterology
Odense University Hospital

5000 Odense C
Denmark


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