Endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy in the diagnosis of gastrointestinal lymphomas

Introduction: The role of endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy (EUS-FNA/B) in the clinical management of gastrointestinal lymphoma has not been extensively studied. This study investigates the use of EUS-FNA/B in the diagnosis of first-time and recurrent gastrointestinal lymphomas at a large academic institution.

Materials and methods: A total of 40 patients who had final diagnosis of lymphoma according to the World Health Organization (WHO) classification of tumors of hematopoietic lymphoid tissues who underwent EUS-FNA/B were included in the study. Cases with concurrent forceps mucosal biopsies or lost to clinical follow-up were excluded. The diagnostic accuracy and clinical use of EUS-FNA/B was investigated by comparing EUS-FNA/B diagnosis with the final diagnosis.

Results: EUS-FNA/B diagnoses were concordant with the final WHO diagnosis for as high as 72.5% of the cases. Of the remaining 27.5%, 17.5% had enough cytologic features for lymphoma diagnosis with incomplete phenotyping, while the remaining 10.0% showed features suspicious for lymphoma. Cell block and flow cytometry quality significantly affected diagnostic accuracy. Number of passes between 1 and 5 yielded better diagnostic accuracy than 6 or more passes during FNA; however, no difference was identified during procedures that used FNB alone or combined with FNA. There is no significant difference in onsite adequacy diagnostic performance of EUS-FNA performed by cytopathologists or cytotechnologists.

Conclusions: EUS-FNA/B with concurrent ancillary studies such as immunocytochemistry in cell block and flow cytometry can be helpful in efficient first and recurrent diagnoses of gastrointestinal lymphomas.