Indications for EUS and FNA

At our institution, approximately 60 to 70% of all EUS cases result in FNA. EUS-guided FNA is used for the following indications in decreasing frequency:

1. Pancreatic tumors

2. Lymph nodes

3. Cystic lesions

4. Submucosal lesions

5. Ascites or pleural effusion

6. Liver lesions

7. Biliary lesions

8. Mediastinal tumors

We routinely obtain consent from every EUS patient for the possibility of FNA. We find this maximizes efficiency and avoids a second procedure and sedation. This approach, however, makes room time less predictable and scheduling more challenging. During an EUS examination, the decision to perform an FNA is based on whether obtaining a tissue diagnosis of the lesion in question will make a difference in the clinical decision making, management, or prognosis of the patient. For this reason, it is important to discuss with the patient and his/her physician team the algorithm of possible management scenarios in the context of a positive or negative FNA. If the algorithm is unaffected by the result of the FNA, then it should not be performed, unless there is a need for further diagnostic or prognostic confirmation.

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