Accuracy of endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of mediastinal and pancreatic pathology at King Hussein Medical Centre 2003-2006

Abstract EN

Objective: To evaluate the sensitivity, specificity and accuracy of endoscopic ultrasonography guided fine-needle aspiration biopsy (EUS-FNAB) of lymph nodes in mediastinal, intra abdominal and pancreatic lesions. Methods: Sixty-four consecutive patients with mediastinal lymphadenopathy, pancreatic lesions and intra abdominal lymphadenopathy were examined by EUS+FNA at King Hussein Medical Centre, Amman, Jordan between March 2003 and April 2006.

Twenty five patients were examined for mediastinal lymph nodes, 37 for pancreatic lesions and two for abdominal lymph nodes.

Our patients were 40 men and 24 women with average age between 40 and 70 year.

Five patients were excluded from the study; 4 men and 1 woman because of inadequate sample all of them from pancreatic lesion.

The study was performed to obtain primary diagnosis, final diagnosis was based on clinical follow up, cytology and/or surgical results. Results: The endoscopic ultrasound guided fine needle aspiration biopsy of mediastinal nodal and pancreatic lesions were highly sensitive and specific as primary diagnosis procedures, and to differentiate between benign and malignant lesions with overall accuracy of 91.5%, sensitivity of 85.3% and 100% specificity.

Regarding the lesion type; the sensitivity, specificity, accuracy, negative predictive value and positive predictive value were 92.8%, 100%, 96%, 91.6% and 100% for mediastinal lymph node; 80%, 100%, 88%, 77.7% and 100% for pancreatic lesion respectively.

Primary diagnosis of malignancy was obtained by endoscopic ultrasound guided fine-needle aspiration biopsy in 49% (29/59) of patients with clinically suspicious lesion.

The accuracy and sensitively for pancreatic lesion is lower than that for lymph node.

No complications were reported in our study (this could be due to small sample size). Conclusions: Endoscopic Ultrasound Guided Fine-Needle Aspiration Biopsy (EUS-FNAB) is safe, minimally invasive and can readily obtain adequate tissue specimens for cytopathological diagnosis, moreover it provides accurate diagnosis of mediastinum, pancreatic cancer and differentiate malignant from benign lesions.