Undiagnosed significant gastrointestinal wall thickening or hypertrophy, can endoscopic ultrasound and endoscopic ultrasound-fine needle aspiration help?

BACKGROUND AND OBJECTIVES: Many gastrointestinal tumors as diffuse circumferential malignancies as signet ring cell carcinoma and lymphoma may involve mainly the submucosal layer and hence are difficult to diagnose as they frequently yield negative endoscopic biopsies. This main aim of this study is to evaluate the accuracy of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of diffuse gastrointestinal (GI) lesions with inconclusive endoscopic biopsies. PATIENTS AND METHODS: This prospective study included 102 patients with diffuse or circumferential GI lesions with nonconclusive biopsies that were taken during upper or lower endoscopy. EUS and EUS-FNA were performed to all patients with cytopathological examination. RESULTS: This study included 65 males (64%) and 37 females (36%), with the mean age of 54.6 years; 80 cases (78.4%) were proved to have malignant lesions; 22 cases (21.6%) were proved to be benign. EUS had a sensitivity of 95%, specificity of 65%, positive predictive value (PPV) of 91%, negative predictive value (NPV) of 45% with P < 0.0001 in diagnosing malignant lesions. EUS-FNA had a sensitivity of 83%, specificity of 100%, PPV of 100%, NPV of 62%, with P < 0.0001. CONCLUSION: EUS with EUS-FNA is an accurate procedure in the diagnosis of endoscopic biopsy negative diffuse or circumferential GI lesions.