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Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses

World Journal of Gastroenterology 2014年第28期20卷 9451-9457页

作者： Julio Iglesias-Garcia Jose Lario-Noia ihab abdulkader J Enrique Domínguez-Muoz Department of Gastroenterology and Hepatology Foundation for Research in Digestive DiseasesUniversity Hospital of Santiago de Compostela Department of Pathology University Hospital of Santiago de Compostela

Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, differential diagnosis remains a clinical challenge. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting. EUS-guided FNA and FNB, by obtaining cytological and/or histological samples, are able to diagnose pancreatic lesions with high sensitivity and specificity. In this context, several methodological features, trying to increase the diagnostic yield of EUS-guided FNA and FNB, have been evaluated. In this review, we focus on the role of rapid on-site evaluation (ROSE). From data reported in the literature, ROSE may increase diagnostic yield of EUS-FNA specimens by 10%-30%, and thus, diagnostic accuracy. However, we should point out that many recent studies have reported adequacy rates of > 90% without ROSE, indicating that, perhaps, at high-volume centers, ROSE may not be indispensable to achieve excellent results. The use of ROSE can be considered important during the learning curve of EUS-FNA, and also in hospital with diagnostic accuracy rates < 90%.

关键词： Endoscopic-ultrasound-guided fine-needle aspiration Rapid on-site evaluation Solid pancreatic tumors Diagnostic accuracy

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Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

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World Journal of Gastroenterology 2007年第2期13卷 289-293页

作者： Julio Iglesias-Garcia Enrique Dominguez-Munoz Antonio Lozano-Leon ihab abdulkader Jose Larino-Noia Jose Antunez Jeronimo Forteza Gastroenterology Department University Hospital Santiago de Compostela Spain Foundation for Research in Digestive Diseases Santiago de Compostela Spain Foundation for Research in Digestive Diseases Santiago de Compostela Spain Pathology Department University Hospital Santiago de Compostela Spain

AIM： To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound （EUS）-guided fine needle aspiration （FNA） material in the differential diagnosis of pancreatic solid masses. METHODS： Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs （22G needle） were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Haterials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS： Length of the core specimen obtained for histological analysis was 6.5±5.3 mm （range 1-22 mm）. Cytological and histological samples were considered as adequate in 51 （82.3%） and 52 cases （83.9%）, respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Conbary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases （90.3%）, with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION： Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

关键词： Endoscopic ultrasound Fine needle aspiration Cytology Biopsy Pancreatic cancer

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Accuracy of endoscopic ultrasound-guided tissue acquisition in the evaluation of lymph nodes enlargement in the absence of on-site pathologist

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World Journal of Gastroenterology 2017年第31期23卷 5755-5763页

作者： Yung Ka Chin Julio Iglesias-Garcia Daniel de la Iglesia Jose Larino-Noia ihab abdulkader-Nallib Hector Lázare Susana Rebolledo Olmedo J Enrique Dominguez-Munoz Department of Gastroenterology and Hepatology University Hospital of Santiago de Compostela Health Research Institute of Santiago de Compostela (IDIS) University Hospital of Santiago de Compostela Department of Pathology University Hospital of Santiago de Compostela

To evaluate factors that influence the diagnostic accuracy of endoscopic ultrasound (EUS)-guided tissue acquisition for lymph node enlargement in the absence of an on-site pathologist. METHODSA retrospective analysis of patients who underwent EUS-guided tissue acquisition for the pathological diagnosis of lymph node enlargement between April 2012 and June 2015 is reported. Tissue acquisition was performed with both cytology and biopsy needles of different calibers. The variables evaluated were lymph node location and size, number of passes and type of needle used. Final diagnosis was based on surgical histopathology or, in non-operated cases, on EUS-guided tissue acquisition and imaging assessment with a minimum clinical follow-up of 6 mo. RESULTSDuring the study period, 168 lymph nodes with a median size of 20.3 mm (range 12.5-27) were sampled from 152 patients. Ninety lymph nodes (53.6%) were located at mediastinum, and 105 (62.5%) were acquired with biopsy needles. The final diagnosis was benign/reactive origin in 87 cases (51.8%), malignant in 65 cases (38.7%), and lymphoma in 16 cases (9.5%). The sensitivity, specificity, positive predictive value and negative predictive value for the detection of malignancy were 74.1%, 100%, 100% and 80.6%, respectively. The overall accuracy was 87.5% (95%CI: 81.7-91.7). No variables were independently associated with a correct final diagnosis according to the multivariate analysis. CONCLUSIONEUS-guided tissue acquisition is a highly accurate technique for assessing lymph node enlargement. None of the variables evaluated were associated with diagnostic accuracy.

关键词： Lymph node Endoscopic ultrasound Fine-needle aspiration Fine-needle biopsy Accuracy

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