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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Accuracy of endoscopic ultrasound-guided tissue acquisition in the evaluation of lymph nodes enlargement in the absence of on-site pathologist
Yung Ka Chin, Julio Iglesias-Garcia, Daniel de la Iglesia, Jose Lariño-Noia, Ihab Abdulkader-Nallib, Hector Lázare, Susana Rebolledo Olmedo, J Enrique Dominguez-Muñoz
Yung Ka Chin, Julio Iglesias-Garcia, Daniel de la Iglesia, Jose Lariño-Noia, Susana Rebolledo Olmedo, J Enrique Dominguez-Muñoz, Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
Julio Iglesias-Garcia, Daniel de la Iglesia, Jose Lariño-Noia, Susana Rebolledo Olmedo, J Enrique Dominguez-Muñoz, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
Ihab Abdulkader-Nallib, Hector Lázare, Department of Pathology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
Author contributions: Chin YK designed and performed the research and wrote the manuscript; Iglesias-Garcia J designed the research and supervised the report; de la Iglesia D, Lariño-Noia J and Abdulkader-Nallib I contributed to the analysis and supervised the report; Lázare H and Rebolledo Olmedo S assisted with data acquisition; and Dominguez-Muñoz JE supervised the report and overall study supervision.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Informed consent statement: The authors of this paper guarantee that all study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Julio Iglesias-Garcia, MD, PhD, Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain. julio.iglesias.garcia@sergas.es
Telephone: +34-98-1951364 Fax: +34-98-1955100
Received: April 9, 2017
Peer-review started: April 10, 2017
First decision: June 1, 2017
Revised: June 15, 2017
Accepted: June 18, 2017
Article in press: June 19, 2017
Published online: August 21, 2017
AIM
To evaluate factors that influence the diagnostic accuracy of endoscopic ultrasound (EUS)-guided tissue acquisition for lymph node enlargement in the absence of an on-site pathologist.
METHODS
A retrospective analysis of patients who underwent EUS-guided tissue acquisition for the pathological diagnosis of lymph node enlargement between April 2012 and June 2015 is reported. Tissue acquisition was performed with both cytology and biopsy needles of different calibers. The variables evaluated were lymph node location and size, number of passes and type of needle used. Final diagnosis was based on surgical histopathology or, in non-operated cases, on EUS-guided tissue acquisition and imaging assessment with a minimum clinical follow-up of 6 mo.
RESULTS
During the study period, 168 lymph nodes with a median size of 20.3 mm (range 12.5-27) were sampled from 152 patients. Ninety lymph nodes (53.6%) were located at mediastinum, and 105 (62.5%) were acquired with biopsy needles. The final diagnosis was benign/reactive origin in 87 cases (51.8%), malignant in 65 cases (38.7%), and lymphoma in 16 cases (9.5%). The sensitivity, specificity, positive predictive value and negative predictive value for the detection of malignancy were 74.1%, 100%, 100% and 80.6%, respectively. The overall accuracy was 87.5% (95%CI: 81.7-91.7). No variables were independently associated with a correct final diagnosis according to the multivariate analysis.
CONCLUSION
EUS-guided tissue acquisition is a highly accurate technique for assessing lymph node enlargement. None of the variables evaluated were associated with diagnostic accuracy.
Core tip: This study shows that the accuracy of endoscopic ultrasound-guided tissue acquisition in enlarged lymph nodes is not affected by the type of needle used, the number of needle passes, or the location or characteristics of the enlarged lymph nodes. Histological specimens are essential for establishing the diagnosis of lymphoproliferative disease. Employing complementary imaging techniques, such as contrast enhancement and elastography, might help improve the diagnostic yield.
