M.S. Burdyukov1,2, A.M. Nechipay2, E.E. Kudryavitskiy1, O.V. Chistyakova1, E.A. Moroz1, I.N. Yurichev1,2, B.I. Dolgushin1, I.B. Perfilev1
1N.N. Blokhin Russian Cancer Research Center, Moscow
2Russian Medical Academy of Postgraduate Education, Moscow
Burdyukov M.S. ― Cand. Med. Sc., senior researcher of N.N. Blokhin Russian Cancer Research Center, Associate Professor of Endoscopy Department of the Russian Medical Academy of Postgraduate Education
23 Kashirskoe highway, Moscow, Russian Fedration, 115478, e-mail: email@example.com
EUS-guided fine needle biopsy is high-tech method of obtaining tissue samples for morphologic verification of diagnosis. However, pathology reports of tissue samples obtained using this method are not always informative. In this article researchers summarize and analyze non-informative reports obtained during more than 10 years.
Objective ― to establish diagnostic effectiveness of EUS-FNA after tissue samples with non-conclusive pathology reports are re-read by pathology experts.
Material and methods. 523 patients who underwent EUS-FNA of masses of mediastinum and upper abdomen from 2005 through 2016 with the aim of making a pathology diagnosis and staging were included in the study. Cytology reports were found indetermined in 43 (8,2%) patients with histology pathology reports being indetermined in 4 patients (8,4%).
Results. After non-conclusive cytology reports of 43 patients were re-read by pathology experts 7 cases of benign lymphadenopathy, 1 case of adrenal adenoma and 1 case of suspicious on adenocarcinoma and adenocarcinoma were diagnosed. After 44 of non-conclusive histologic reports were re-read by pathology experts 3 conclusive diagnoses were made – 1 case of spindle-cell tumor and 1 case of adenocarcinoma. As a result effectiveness of EUS-FNA in obtaining good quality tissues sample enough to make a conclusive cytology diagnosis increased from 91,8 to 93,7% and effectiveness of EUS-FNA in obtaining good quality tissues sample to make a conclusive histologic diagnosis increased from 76,7 to 78,3%. As the effectiveness of EUS-FNA increased minimally after biopsy tissue samples were re-read by experts we analyze the history of obtaining tissue samples that were found inconclusive. We found that the vast majority of non-diagnostic cytology and histology samples were obtained if EUS-FNA was attempted only once 29-67,4% and 30-68,3% accordingly.
Conclusion. Considering low negative predictive value in case of non- informative pathology report it is prudent to perform repeated biopsy. Opportunity of immediate tissue sample assessment by pathologist during procedure or performing EUS-FNA 3 times during one procedure session increase the chance of obtaining informative sample. Adequate wording of cytology and histology reports including cases of observed non-malignant changes (for example benign lymphadenopathy) is helpful in establishing correct diagnosis and possibly can decrease the number of unnecessary repeated EUS-FNA. Immediate tissue sample assessment by pathologist during procedure and/or performing EUS-FNA 3 times during one procedure session increase the chance of obtaining a diagnostic tissue sample and potentially decrease the need for unnecessary repeated procedures.
Key words: EUS-FNA, verification pit-falls.