Original Articles
EUS-guided fine needle aspiration of idiopathic abdominal masses

https://doi.org/10.1067/mge.2002.122956Get rights and content

Abstract

Background: EUS-guided fine needle aspiration (EUS-FNA) has significantly increased the diagnostic capability of EUS. FNA can also be helpful in the diagnosis of non-GI disorders. The role of EUS-FNA in the diagnosis of idiopathic abdominal masses has not been determined. This study evaluated the diagnostic accuracy of EUS-FNA of abdominal masses of unknown cause and its impact on subsequent evaluation and therapy. Methods: Thirty-four patients from 5 tertiary referral centers (21 women, 13 men; mean age 54 years, range 27-72 years) with idiopathic abdominal masses underwent EUS-FNA. Presenting symptoms included the following: pain (29 patients), weight loss (15), altered bowel habits (7), nausea/vomiting (6), abnormal liver function tests (4), palpable mass (4), and urinary retention (1). Four patients had a history of intra-abdominal cancer (2 cervical, 1 ovarian, 1 colon). A final diagnosis by EUS-FNA, surgery, autopsy, or long-term follow-up was available in all patients. Abdominal masses were classified into 3 disease categories: infectious, benign/inflammatory, and malignant. Results: Final diagnosis included infectious (5), benign/inflammatory (6), and malignant (23) abdominal mass. Overall, EUS-FNA established a tissue diagnosis in 29 of 34 patients (85%) in all 3 categories (infectious, 80%; benign/inflammatory, 67%; malignant, 91%). EUS-FNA was instrumental in directing subsequent evaluation in 29 patients (85%) and therapy in 26 (77%). The number of fine needle passes for adequate tissue sampling was lower for nonmalignant (2.2-3.2) versus malignant diseases (4.6). One complication occurred (perirectal abscess) and was treated successfully with antibiotics. Conclusions: EUS-FNA of idiopathic abdominal masses is safe and accurate and helps to guide subsequent evaluation and therapy in the majority of patients. The most common and promising area seems to be EUS-FNA of malignant abdominal masses. Transluminal EUS-FNA provides minimally invasive tissue sampling and obviates the need for exploratory laparotomy. (Gastrointest Endosc 2002;55:854-8.)

Section snippets

Patients and methods

Thirty-four patients (21 women, 13 men: mean age 58 years, range 27-73 years) presenting with idiopathic abdominal masses were evaluated by EUS-FNA at 5 tertiary referral centers. Procedure reports, results of the cytopathologic evaluation of the specimens, and related medical records for EUS-FNA procedures performed between 1996 and 1998 were systematically reviewed at the participating centers, and summaries were provided to the data collection center (Milwaukee). All patients were referred

Results

Final diagnoses by disease category were infectious (5 patients), benign/inflammatory (6), and malignant (23) abdominal masses. Inclusive of all 3 categories, EUS-FNA resulted in a correct diagnosis in 29 of 34 patients (85%). With reference to the 3 specific disease categories EUS and FNA provided an accurate cytologic diagnosis in 4 of 5 patients with infectious (80%), 4 of 6 with benign/inflammatory (67%), and 21 of 23 patients with malignant masses (91%). Diagnosis in the first 2 categories

Discussion

Intra-abdominal masses arise from intraperitoneal (e.g., liver, spleen, stomach) and retroperitoneal (kidney, pancreas, spine, muscular elements) viscera. Before the advent of EUS, US-guided and CT-guided percutaneous tissue sampling were used for diagnosis, although in many cases laparotomy was still required.2 Many pathologic processes can lead to formation of an intra-abdominal mass and accurate noninvasive diagnosis is difficult because the origin or precise location of the mass is often

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