Endoscopic ultrasound-guided fine-needle aspiration for suspected malignancies adjacent to the gastrointestinal tract

Table 1 Different anatomical localizations for the 1019 lesions in which endoscopic ultrasound-guided fine-needle aspiration was employed with the 431 surgical procedures adopted

Macroscopic (> 1 cm) (n = 932)	Surgical procedures (n = 393)
512 pancreatic masses	201 pancreatic resections
135 mediastinal lymphadenopathy	44 pneumonectomy, 12 lobectomy, 14 wedge resection
107 enlarged abdominal lymph nodes	11 Debulking, 19 nephrectomy, 6 splenectomy
23 lung cancer adjacent to the esophagus	11 pneumonectomy, 2 wedge resection
21 perirectal masses	6 low anterior resection, 5 Miles’procedures
18 cancer of the extrahepatic bile duct	4 bile duct resections, 2 hepatic resections
18 perigastric masses	7 gastrectomy, 2 wedge resections
15 mediastinal masses	9 pneumonectomy
12 perirectal node	7 transanal rectal resection
13 pleural thickening and pleural effusion	7 pleurectomy, decortication
10 masses of the retroperitoneum/	3 retroperitoneal debulking
10 peritoneal thickening and ascites	4 peritonectomy
10 left lobe of the liver	3 liver resection
9 left adrenal gland	5 adrenalectomy
8 prostate nodules with rectal involvement	4 prostatectomy and rectal resection
6 ovarian cyst	5 salpingo-oophorectomy
3 thyroid	3 thyroidectomy
1 spleen	1 splenectomy
1 cyst of CBD	1 biliary duct resection
Microscopic (< 1 cm submucosal) (n = 87)	Surgical procedures (n = 23)
49 gastric	12 gastrectomy, 1 sleeve gastrectomy
14 esophageal	2 esophagectomy
13 rectal	4 low rectal ant resection
8 duodenal	2 DCP
3 colorectal anastomoses	2 redo surgery for anastomotic recurrence

CBD: Common bile duct; DCP: Duodenocephalopancreatectomy.

Table 2 Cytological findings and final diagnoses of cancer n (%)

Cytology	Positive	Negative	Inconclusive (treated/untreated)	Patients (n)
Final diagnosis
D+	515	16 (FN)	85 (55/30)	616 (TP)
D-	0 (FP)	359	44 (0/44)	403 (TN)
	515 (50.5)	375 (36.8)	129 (55/74) (12.7)	1019

D+ patients with positive final cytological diagnosis, D- patients with negative final cytological diagnosis, true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Inconclusive tests are splitted into 2 groups: those that were treated (with surgery, or with chemo-radio-therapy) or those left untreated.

Table 3 Accuracy and efficiency and quality assessment n (%)

	MRS1 (n = 312)	MRS2 (n = 276)	MRS3 (n = 431)	Overall (n = 1019)
AC: (TP+TN)/N	0.97	0.87	1	0.95
ST: TP/N (D+)	0.85	0.79	0.99	0.93
SP: TP/N (D-)	1	1	1	1
PPV: TP/N (T+)	1	1	1	1
NPV: TN/N (T-)	0.97	0.76	0.95	0.90
+LR (ST/1-SP)	0	0	0	0
-LR (SP/1-ST)	6.6	4.7	100	4.2
TP	36 (3.5)	109 (10.6)	370 (36)	616 (60.4)
TN	231 (22.6)	101 (9.9)	26 (2.5)	403 (39.5)
IT	39 (12.5)	55 (19.9)	35 (8.1)	129 (12.6)
TDCD mean days (range)	25.4 (8-32)c	16.2 (11-24)a	12.4 (10-21)a	16.3 (8-32)
Patients TP treated with surgery or CRT	36 (3.5)c	109 (10.7)a	370 (36.3)a	515 (50.5)
Patients with inconclusive tests treated (surgery-CRT)	16 (9-7)	21 (12-9)	18 (13-5)	55 (34-21)

Calculation of accuracy (AC), sensitivity (ST), specificity (SP), and positive (PPV) and negative (NPV) predictive values for malignant risk score (MRS)-1, MRS-2 and MRS-3, likelihood ratios for positive and negative test (+LR, -LR) for different groups of patients. D+: Number of patients with positive final diagnosis; D-: Number of patients with negative final diagnosis; IT: Inconclusive test; TDCD: Time to definitive cytological diagnosis; CRT: Chemo-Radio-Therapy.

^aP < 0.05 vs MRS1;

^cP < 0.05 vs MRS3 according to the Scheffépost-hoc test.