Endoscopic Ultrasound-Guided Fine Needle Aspiration:From the Past to the Future

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained throughaspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosaltumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung,etc. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is superiorto computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possibleto avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for locoregionalstaging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detectionof malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist duringEUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently theprocedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though theEUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discoveryand performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potentialmolecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosisof solid pancreatic masses.