Endoscopic ultrasonography-guided fine needle aspiration: Relatively low sensitivity in the endosonographer population

Table 1 Characteristics of survey respondents n (%)

Male gender (Nr = 92)	66 (71.7)
Age (yr) (Nr = 92)	43.1 ± 8.0
Years of endoscopy practice (Nr = 92)	12.5 ± 7.8
Years of EUS practice (Nr = 91)	4.8 ± 4.1
Number of respondents practicing in Western Europe (Nr = 89)	67 (75.3)
Proportion of EUS with FNA or drainage (Nr = 92)
< 20%	35 (38)
20%-40%	36 (39.1)
40%-60%	18 (19.6)
60%-80%	3 (3.3)
> 80%	0
EUS-FNA annual hospital caseload (Nr = 92)
< 50	32 (34.8)
50-100	26 (28.3)
100-200	25 (27.2)
> 200	9 (9.8)
Sensitivity of EUS-FNA for the diagnosis of solid mass lesions (Nr = 61)
< 40%	1 (1.6)
40%-60%	14 (23.0)
60%-80%	23 (37.7)
> 80%	23 (37.7)

Numbers are means ± SD except where stated otherwise. N_r: Number of respondents for each question; ERCP: Endoscopic retrograde cholangio-pancreatography; EUS: Endoscopic ultrasonography; EUS-FNA: Endoscopic ultrasonography-guided fine needle aspiration; FNA: Fine needle aspiration.

Table 2 Practice of endoscopic ultrasonography-guided fine needle aspiration n (%)

Diameter of the needle used for lesions located
In the esophagus/stomach (Nr = 88)
19G	12 (13.6)
22G	70 (79.5)
25G	6 (6.8)
In the head of the pancreas (Nr = 86)
19G	5 (5.8)
22G	64 (74.4)
25G	17 (19.8)
ROSE available (Nr = 86)
Routinely	24 (27.9)
In selected cases	13 (15.1)
Never	49 (56.9)
Number of needle passes
Pancreatic mass < 25 mm (Nr = 84)
≤ 3	41 (48.8)
5-7	19 (22.6)
> 7 or based on ROSE	24 (28.6)
Pancreatic mass > 25 mm (Nr = 83)
≤ 3	37 (44.6)
5-7	21 (25.3)
> 7 or based on ROSE	25 (30.1)
Lymphadenopathy (Nr = 87)
≤ 3	51 (58.6)
5-7	14 (16.1)
> 7 or based on ROSE	22 (25.3)
Paraffin-embedded blocks prepared for histopathological analysis (Nr = 86)
Yes	48 (55.8)
No	12 (13.9)
Do not know	26 (30.2)
Pathologist making routine diagnosis for EUS-FNA samples (Nr = 85)
Dedicated digestive cytopathologist	25 (29.4)
General cytopathologist	47 (55.3)
Digestive pathologist not specialized in cytology	13 (15.3)
Attitude if EUS-FNA is repeated after a first inconclusive EUS-FNA (Nr = 85)
Change in the procedure (2 answers allowed)	48 (56.5)
Higher number of needle passes	42 (87.5)
Larger needle	19 (39.6)
Addition of ROSE	12 (25.0)
Tru-Cut needle in the esophagus and rectum	7 (14.6)
Repetition of identical procedure	30 (35.3)
Referral to another endosonographer	7 (8.2)

N_r: Number of respondents for each question; EUS-FNA: Endoscopic ultrasonography-guided fine needle aspiration; G: Gauge; ROSE: Rapid on-site cytopathological evaluation.

Table 3 Univariate analysis of variables potentially associated with an endoscopic ultrasonography-guided fine needle aspiration sensitivity > 80% for the diagnosis of solid mass lesions

	Pvalue
Number of needle passes based on ROSE or > 7 (small pancreatic lesions)	< 0.0001
Number of needle passes based on ROSE or > 7 (large pancreatic lesions)	0.0002
ROSE available	0.0017
Number of needle passes based on ROSE or > 7 (lymphadenopathy)	0.0019
High annual hospital caseload	0.0242
Routine isolation of microcores	0.0422
Method of sample preservation	0.1198
Years of EUS practice	0.6475

EUS: Endoscopic ultrasonography; ROSE: Rapid on-site cytopathological evaluation.