Lesion size determines diagnostic yield of EUS-FNA with onsite cytopathologic evaluation for upper gastrointestinal subepithelial lesions

Abstract

Background/Aims: The aim of this study was to determine the diagnostic yield and factors influencing the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for upper gastrointestinal (GI) subepithelial lesions (SELs) with rapid onsite cytopathologic evaluation. Materials and Methods: This is a single-center, retrospective study. Results: Among 22 patients who underwent EUS-FNA, a cytopathological diagnosis was reached in 16 (72.7\%) patients. The EUS-FNA results were as follows: seven GISTS (31.8\%), six leiomyomas (27.2\%), four non-diagnostics (18\%), two duplication cysts (9\%), two spindle cell tumor (9\%), and one ectopic pancreas (4.5\%). The long-axis size was >20 mm in 12 patients (average size: 31.3 +/- 9.3 mm) and <20 mm (average size: 16.6 +/- 2.5 mm) in 10 patients. Diagnostic accuracy of EUS-FNA from lesions <20 mm was 50\% (5/10 lesions), and of lesions >20 mm was 91.6\% (11/12 lesions) (Fisher's exact testp=0.028). Six patients underwent surgical resection. Surgical pathology results of five lesions (four GIST, one leiomyoma) were consistent with cytopathology results (83.3\%). Conclusion: The diagnostic yield of EUS-FNA of the upper GI SELs with an onsite cytopathologic interpretation was 72.7\%. Lesion size <2 cm significantly reduces the diagnostic yield of EUS-FNA for the upper GI SELs.