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Diagnostic and Therapeutic Endoscopy
Volume 2012 (2012), Article ID 139563, 7 pages
http://dx.doi.org/10.1155/2012/139563
Research Article

Accuracy and Quality Assessment of EUS-FNA: A Single-Center Large Cohort of Biopsies

1Technion-Israel Institute of Technology, The Bruce and Ruth Rappaport Faculty of Medicine, Israel
2Technion-Israel Institute of Technology and EUS Service, The Bruce and Ruth Rappaport Faculty of Medicine, Rambam Healthcare Campus, Haifa, Israel
3Departments of Gastroenterology and Community Medicine, Rambam Health Care Campus, Haifa, Israel
4Oncology Ambulatory Care, Rambam Healthcare Campus, Haifa, Israel

Received 23 May 2012; Accepted 28 August 2012

Academic Editor: Arthur Hoffman

Copyright © 2012 Benjamin Ephraim Bluen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Thorough quality control (QC) study with systemic monitoring and evaluation is crucial to optimizing the effectiveness of EUS-FNA. Methods. Retrospective analysis was composed of investigating consecutive patient files that underwent EUS-FNA. QC specifically focused on diagnostic accuracy, impacts on preexisting diagnoses, and case management. Results. 268 patient files were evaluated. EUS-FNA cytology helped establish accurate diagnoses in 92.54% (248/268) of patients. Sensitivity, specificity, PPV, NPV, and accuracy were 83%, 100%, 100%, 91.6%, and 94%, respectively. The most common biopsy site was the pancreas (68%). The most accurate location for EUS-FNA was the esophagus, 13/13 (100%), followed by the pancreas (89.6%). EUS-FNA was least informative for abdominal lymph nodes (70.5%). After FNA and followup, eight false negatives for tumors were found (3%), while 7.5% of samples still lacked a definitive diagnosis. Discussion. QC suggests that the diagnostic accuracy of EUS-FNA might be improved further by (1) taking more FNA passes from suspected lesions, (2) optimizing needle selection (3) having an experienced echo-endoscopist available during the learning curve, and (4) having a cytologist present during the procedure. QC also identified remediable reporting errors. In conclusion, QC study is valuable in identifying weaknesses and thereby augmenting the effectiveness of EUS-FNA.