Endoscopic Ultrasound Guided Fine Needle Aspiration as a Diagnostic and Staging Tool for Rectal and Perirectal Lesions – An Institutional Experience
Khalid Amin, Mojtaba Olyaee, Ossama Tawfik, Patricia Thomas, Fang Fan. Kansas University Medical Center, Kansas City, KS
Background: The role of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) in evaluating lesions adjacent to the upper gastrointestinal tract wall is well established. However, this tool is under-utilized in evaluating rectal and perirectal lesions, possibly due to insufficient experience and under recognized value of this procedure. In this study, we report our institutional experience with EUS-FNA as a diagnostic and staging tool for rectal and peri-rectal lesions.
Design: A retrospective chart review was performed and a cohort of 36 patients who underwent rectal EUS-FNA (39 specimens) at our institution between January 2002- July 2011 was retrieved. The cytology diagnoses were compared to the concurrent or follow up histologic and clinical diagnoses.
Results: Among the total 39 cases, rectal EUS-FNA was performed as a diagnostic procedure in 21 (54%) and a staging procedure in 18 (46%) cases. On cytology examination, 15 (39%) cases were diagnosed as malignant, 1 (2%) as atypical/suspicious for malignancy, 3 (8%) as benign neoplastic, 14 (36%) as benign reactive and 6 (15%) as non-diagnostic. Malignant cases included 11 colorectal/anal, 1 cervical, 1 endometrial, 1 urothelial, 1 hematopoietic and 1 unknown primary cancers. Concurrent or follow-up histological diagnoses were available in 19 (48%) cases, 18 of them had concordant cytological/histological diagnoses (10 benign, 8 malignant). One perirectal lymph node with negative cytology diagnosis was found to be positive on histologic examination, probably due to sampling error on cytology. The sensitivity and specificity of EUS-FNA for rectal/perirectal lesions in this study was 90% and 100% respectively.
Conclusions: EUS-FNA is a useful diagnostic tool for rectal/perirectal lesions; it confirms or excludes malignancy for lesions with high or low clinical suspicions. It serves as a reliable staging method to identify patients for proper clinical management. The prevailing non-diagnostic rate may be further reduced as more experience is gained with this procedure.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 81, Wednesday Afternoon