Intest Res.  2015 Apr;13(2):135-144. 10.5217/ir.2015.13.2.135.

The Clinical Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy for Rectal and Perirectal Lesions

• Soh JS
• Lee HS
• Lee S
• Bae J
• Lee HJ
• Park SH
• Yang DH
• Kim KJ
• Ye BD
• Myung SJ
• Yang SK
• Kim JH
• Byeon JS

• KMID: 2284880
• DOI: http://doi.org/10.5217/ir.2015.13.2.135

Abstract

BACKGROUND/AIMS
Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle.
METHODS
From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy.
RESULTS
Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B.
CONCLUSIONS
The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.

Keyword

Endoscopic ultrasound-guided fine needle aspiration; Biopsy, fine needle; Rectum; Perirectum

MeSH Terms

Biopsy*
Biopsy, Fine-Needle
Diagnosis
Endoscopic Ultrasound-Guided Fine Needle Aspiration*
Fever
Gastrointestinal Stromal Tumors
Gastrointestinal Tract
Humans
Lymphoma
Needles
Pneumoperitoneum
Rectum

Figure

• 

  Fig. 1 A 61-year-old man (no. 4). (A) Colonoscopy showing a subepithelial tumor ~3 cm in diameter in the distal rectum. (B) MRI scan showing a well-defined mass with an internal high-density component ~6 cm in diameter in the distal rectum. (C) EUS showing a well-demarcated hypoechoic mass with central heterogeneous echogenicity approximately 5.0×4.3 cm in size in the rectum, which displaced the prostate. (D) Histological examination of the EUS-fine needle biopsy specimen showing spindle cells (H&E, ×200) that were positive for CD117 and CD34, but negative for smooth muscle actin and S-100 by immunohistochemistry (×200). This profile was diagnostic of a gastrointestinal stromal tumor. SMA, smooth-muscle actin.

• 

  Fig. 2 An 81-year-old man (no. 16) with a history of Hodgkin's lymphoma. (A) CT showing a well-defined nodule ~1 cm in diameter near the upper rectum. (B) Linear EUS showing a round hypoechoic lymph node ~1.2 cm in diameter located near the upper rectum. The 22-gauge ProCore needle was inserted into the lesion. (C) Histological examination of a sample obtained upon the first EUS-fine needle aspiration using a 22-gauge aspiration needle showed atypical cells (H&E, ×200) but was insufficient for a definitive diagnosis. (D) Histological examination of a specimen obtained upon the second EUS-fine needle biopsy using 22-gauge ProCore needle showing atypical lymphoid cells (H&E, ×200) that were positive for CD30 and CD15 by immunohistochemistry (×200). This profile was diagnostic of recurrent Hodgkin's lymphoma.

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