Pitfalls in EUS FNA

Although endoscopic ultrasound (EUS) fine-needle aspiration (FNA) is a safe and accurate procedure, the diagnostic yield varies. Factors contributing to the diagnostic accuracy of EUS FNA include endosonographer and cytopathologist experience, EUS image recognition, accurate FNA targeting of the lesion, proper specimen collection and handling, use of ancillary techniques, and accurate cytologic interpretation. Errors in performance or judgment made before, during, or after the procedure may affect the results of the EUS FNA. The authors discuss the potential pitfalls of EUS FNA and methods to avoid their occurrence to optimize the diagnostic yield, efficiency, and safety of the procedure.

Key points

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Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) should be performed only if the results will potentially impact patient care as determined by the patients’ multidisciplinary team.
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Direct communication between the endosonographer and cytotechnologist and cytopathologist is key to optimize the specimen adequacy and diagnostic accuracy.
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False-negative cytology most commonly results from sampling error caused by inaccurate sampling by the endosonographer, suboptimal characteristics of the target lesion, or misinterpretation of on-site cytology review.
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The presence of chronic pancreatitis negatively impacts both EUS imaging and FNA cytologic interpretation, thereby decreasing the diagnostic yield of EUS FNA.