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Background <p>Early diagnosis of extraluminal locoregional recurrence (LRR) near the anastomosis after surgery for gastrointestinal malignancies is challenging. This study evaluated the diagnostic performance of endoscopic ultrasound (EUS), EUS-guided fine-needle aspiration (EUS-FNA), and an integrated diagnostic pathway in this context.</p> Methods <p>We retrospectively analyzed patients who underwent EUS at our hospital between April 2014 and April 2025 for suspected extraluminal LRR. We collected clinical, procedural, and pathological data. Each patient had at least 6&#xa0;months of clinical-imaging follow-up. The final diagnosis was based on pathology (surgical or EUS-FNA) or confirmed disease progression and served as the reference standard for calculating diagnostic performance.</p> Results <p>Seventy-seven patients were included. EUS identified suspicious extraluminal lesions in 37 patients; 35 of these underwent EUS-FNA. EUS alone demonstrated a sensitivity of 94.6% (95% CI 81.8–99.3%), specificity of 95.0% (95% CI 83.1–99.4%), and accuracy of 94.8%. The corresponding values for EUS-FNA were 93.9% (95% CI 79.8–99.3%), 100.0% (95% CI 15.8–100.0%), and 94.3%, respectively, while the integrated diagnostic strategy achieved 89.2% (95% CI 74.6–97.0%), 100.0% (95% CI 91.2–100.0%), and 94.8%, respectively. The subgroup analysis showed the high sensitivity of EUS-FNA in all recurrence patterns, tumor types, and anastomotic sites (≥ 83.3%). According to the surgical pathological findings of the primary tumor, the recurrence rate was significantly higher in patients with elevated-risk (57.1% vs 23.8%; OR 4.27, 95% CI 1.38–13.2; P = 0.011), but EUS-FNA still achieved a sensitivity of 92.9%.</p> Conclusions <p>Combining EUS with selective EUS-FNA provides an accurate and safe strategy for detecting extraluminal LRR. This approach uses EUS’s high sensitivity for lesions and definitive pathology from EUS-FNA, significantly enhancing the accuracy of postoperative surveillance for extraluminal anastomotic LRR.</p> Graphical abstract <p></p>

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EUS-FNA improves diagnosis of extraluminal anastomotic recurrence after surgery

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Huiyuan Yu,
  • Mingtang Li,
  • Yanjie Che,
  • Jing Zhao,
  • Sha Li,
  • Longjiang Xu,
  • Guilian Cheng,
  • Liming Xu,
  • Wei Wu,
  • Run Bao,
  • Yirui Zhang,
  • Mingjie Qian,
  • Duanmin Hu

摘要

Background

Early diagnosis of extraluminal locoregional recurrence (LRR) near the anastomosis after surgery for gastrointestinal malignancies is challenging. This study evaluated the diagnostic performance of endoscopic ultrasound (EUS), EUS-guided fine-needle aspiration (EUS-FNA), and an integrated diagnostic pathway in this context.

Methods

We retrospectively analyzed patients who underwent EUS at our hospital between April 2014 and April 2025 for suspected extraluminal LRR. We collected clinical, procedural, and pathological data. Each patient had at least 6 months of clinical-imaging follow-up. The final diagnosis was based on pathology (surgical or EUS-FNA) or confirmed disease progression and served as the reference standard for calculating diagnostic performance.

Results

Seventy-seven patients were included. EUS identified suspicious extraluminal lesions in 37 patients; 35 of these underwent EUS-FNA. EUS alone demonstrated a sensitivity of 94.6% (95% CI 81.8–99.3%), specificity of 95.0% (95% CI 83.1–99.4%), and accuracy of 94.8%. The corresponding values for EUS-FNA were 93.9% (95% CI 79.8–99.3%), 100.0% (95% CI 15.8–100.0%), and 94.3%, respectively, while the integrated diagnostic strategy achieved 89.2% (95% CI 74.6–97.0%), 100.0% (95% CI 91.2–100.0%), and 94.8%, respectively. The subgroup analysis showed the high sensitivity of EUS-FNA in all recurrence patterns, tumor types, and anastomotic sites (≥ 83.3%). According to the surgical pathological findings of the primary tumor, the recurrence rate was significantly higher in patients with elevated-risk (57.1% vs 23.8%; OR 4.27, 95% CI 1.38–13.2; P = 0.011), but EUS-FNA still achieved a sensitivity of 92.9%.

Conclusions

Combining EUS with selective EUS-FNA provides an accurate and safe strategy for detecting extraluminal LRR. This approach uses EUS’s high sensitivity for lesions and definitive pathology from EUS-FNA, significantly enhancing the accuracy of postoperative surveillance for extraluminal anastomotic LRR.

Graphical abstract