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Endoscopic ultrasound fine needle aspiration vs fine needle biopsy in solid lesions:A multi-center analysis

World Journal of Clinical Cases 2021年第34期9卷 10507-10517页

作者： Diogo Turiani Hourneaux Moura Thomas R McCarty Pichamol Jirapinyo Igor Braga Ribeiro Galileu Ferreira Ayala Farias Antonio Coutinho Madruga-Neto Marvin Ryou Christopher C Thompson Gastrointestinal Endoscopy Unit University of Sao Paulo School of MedicineSão PauloSP 05403-010Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Division of Gastrointestinal Endoscopy University of São Paulo Medical SchoolSão PauloSP 01246-903Brazil

BACKGROUND While endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)is considered a preferred technique for tissue sampling for solid lesions,fine needle biopsy(FNB)has recently been developed.AIM To compare the accuracy of FNB vs FNA in determining the diagnosis of solid lesions.METHODS A retrospective,multi-center study of EUS-guided tissue sampling using FNA vs FNB needles.Measured outcomes included diagnostic test characteristics(i.e.,sensitivity,specificity,accuracy),use of rapid on-site evaluation(ROSE),and adverse events.Subgroup analyses were performed by type of lesion and diagnostic yield with or without ROSE.A multivariable logistic regression was also performed.RESULTS A total of 1168 patients with solid lesions(n=468 FNA;n=700 FNB)underwent EUS-guided sampling.Mean age was 65.02±12.13 years.Overall,sensitivity,specificity and accuracy were superior for FNB vs FNA(84.70%vs 74.53%;99.29%vs 96.62%;and 87.62%vs 81.55%,respectively;P0.05).Multivariate analysis showed no significant predictor for better accuracy.On subgroup analyses,FNB was superior to FNA for non-pancreatic lesions;however,there was no difference between the techniques among pancreatic lesions.One adverse event was reported in each group.CONCLUSION FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA+ROSE in the diagnosis of non-pancreatic solid lesions.Our results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.

关键词： Endoscopic ultrasound-guided tissue acquisition fine needle aspiration fine needle biopsy Solid lesions Endoscopic ultrasound Cancer

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Contrast-enhanced guided endoscopic ultrasound procedures

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World Journal of Gastroenterology 2024年第17期30卷 2311-2320页

作者： Marcel Ioan Gheorghiu Andrada Seicean Cristina Pojoga Claudia Hagiu Radu Seicean Zeno Sparchez Department of Gastroenterology “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and Hepatology"Iuliu Hatieganu"University of Medicine and PharmacyCluj-Napoca 400162ClujRomania Department of Clinical Psychology and Psychotherapy International Institute for Advanced Study of Psychotherapy and Applied Mental HealthBabeș-Bolyai UniversityCluj-Napoca 400375ClujRomania The First Surgical Clinic "Iuliu Hatieganu"University of Medicine and PharmacyCluj Napoca 400006ClujRomania

Contrast-enhanced endoscopic ultrasound(CH-EUS)can overcome the limi-tations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours.Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions,further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS.This review details the knowledge based on the available data on contrast-guided procedures.The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions,which occur in select cases.Additionally,the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage,and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented.Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours,in which case CH-EUS can be used to reveal the incomplete tumour destruction.

关键词： Endosonography Contrast-enhanced endoscopic ultrasound Tissue acquisition fine needle aspiration fine needle biopsy Drainage Pancreatic fluid collections biopsy Pancreas

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Improved diagnostic yield of endoscopic ultrasound-fine needle biopsy with histology specimen processing

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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 212-219页

作者： Lawrence Ku Mohammad A Shahshahan Linda A Hou Viktor E Eysselein Sofiya Reicher Department of Medicine Division of Gastroenterology and HepatologyHarbor-UCLA Medical CenterTorranceCA 90509United States

BACKGROUND Endoscopic ultrasound-guided fine needle biopsy(EUS-FNB)has emerged as a safe,efficacious alternative to fine needle aspiration(FNA)for tissue acquisition.EUS-FNB is reported to have higher diagnostic yield while preserving specimen tissue architecture.However,data on the optimal method of EUS-FNB specimen processing is limited.AIM To evaluate EUS-FNB with specimen processing as histology vs EUS-FNA cytology with regards to diagnostic yield and specimen adequacy.METHODS All EUS-FNA and EUS-FNB performed at our institution from July 1,2016,to January 31,2018,were retrospectively analyzed.We collected data on demographics,EUS findings,pathology,clinical outcomes,and procedural complications in two periods,July 2016 through March 2017,and April 2017 through January 2018,with predominant use of FNB in the second data collection time period.FNA specimens were processed as cytology with cell block technique and reviewed by a cytopathologist;FNB specimens were fixed in formalin,processed for histopathologic analysis and immunohistochemical staining,and reviewed by an anatomic pathologist.Final diagnosis was based on surgical pathology when available,repeat biopsy or imaging,and length of clinical follow up.RESULTS One hundred six EUS-FNA and EUS-FNB procedures were performed.FNA alone was performed in 17 patients;in 56 patients,FNB alone was done;and in 33 patients,both FNA and FNB were performed.For all indications,diagnostic yield was 47.1%(8/17)in FNA alone cases,85.7%(48/56)in FNB alone cases,and 84.8%(28/33)in cases where both FNA and FNB were performed(P=0.0039).Specimens were adequate for pathologic evaluation in 52.9%(9/17)of FNA alone cases,in 89.3%(50/56)of FNB alone cases,and 84.8%(28/33)in cases where FNA with FNB were performed(P=0.0049).Tissue could not be aspirated for cytology in 10.0%(5/50)of cases where FNA was done,while in 3.4%(3/89)of FNB cases,tissue could not be obtained for histology.In patients who underwent FNA with FNB,there was a statistically significant difference in both specime

关键词： fine needle biopsy Endoscopic ultrasound fine needle aspiration Pancreatic cancer Histology Cytopathology

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Peripancreatic paraganglioma:Lesson from a round table

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World Journal of Gastroenterology 2022年第21期28卷 2396-2402页

作者： Federica Petrelli Geri Fratini Andrea Sbrozzi-Vanni Andrea Giusti Raffele Manta Claudio Vignali Gabriella Nesi Andrea Amorosi Andrea Cavazzana Marco Arganini Maria Raffaella Ambrosio Pathology Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Surgery Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Endoscopic Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Endoscopic Unit Santa Maria Misericordia HospitalPerugia 06122Italy Interventional Radiology Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Department of Health Sciences University of FlorenceFlorence 50139Italy Pathology Unit UniversitàMagna GraeciaCatanzaro 88100Italy

We described the case of a peripancreatic paraganglioma(PGL)misdiagnosed as pancreatic lesion.Surgical exploration revealed an unremarkable pancreas and a large well-defined cystic mass originating at the mesocolon root.Radical enucleation of the mass was performed,preserving the pancreatic tail.Histologically,a diagnosis of PGL was rendered.Interestingly,two previously unreported mutations,one affecting the KDR gene in exon 7 and another on the JAK3 gene in exon 4 were detected.Both mutations are known to be pathogenetic.Imaging and cytologic findings were blindly reviewed by an expert panel of clinicians,radiologists,and pathologists to identify possible causes of the misdiagnosis.The major issue was lack of evidence of a cleavage plane from the pancreas at imaging,which prompted radiologists to establish an intraparenchymal origin.The blinded revision shifted the diagnosis towards an extrapancreatic lesion,as the pancreatic parenchyma showed no structural alterations and no dislocation of the Wirsung duct.Ex post,the identified biases were the emergency setting of the radiologic examination and the very thin mesocolon sheet,which hindered clear definition of the lesion borders.Original endoscopic ultrasonography diagnosis was confirmed,emphasizing the intrinsic limit of this technique in detecting large masses.Finally,pathologic review favored a diagnosis of PGL due to the morphological features and immonohistochemical profile.Eighteen months after tumor excision,the patient is asymptomatic with no disease relapse evident by either radiology or laboratory tests.Our report strongly highlights the difficulties in rendering an accurate preoperative diagnosis of PGL.

关键词： Peripancreatic paraganglioma Pancreatic neuroendocrine tumor Solid pseudopapillary neoplasm S100 Succinate dehydrogenase subunit B gene and expression fine needle biopsy

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Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions

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World Journal of Methodology 2023年第4期13卷 287-295页

作者： Hussein Hassan Okasha Hanane Delsa Abdelmoneim Alsawaf Ahmed Morad Hashim Hani M Khattab Dalia Abdelfatah Abeer Abdellatef Amr Albitar Department of Internal Medicine Division of Gastroenterology and HepatologyKasr Al-Aini School of MedicineCairo UniversityCairo 11451Egypt Department of Gastroenterology and Hepatology Cheikh Khalifa International University HospitalMohammed VI University of Sciences and HealthCasablanca 82403Morocco Research Unit Mohammed VI Center for Research and InnovationRabat 10100Morocco Department of Gastroenterology Barnsley NHS Foundation TrustBarnsley S752EPUnited Kingdom Department of Pathology Kasr Al-Aini School of MedicineCairo UniversityCairo 11451Egypt Department of Cancer Epidemiology and Biostatistics National Cancer InstituteCairo UniversityCairo 11451Egypt

BACKGROUND Endoscopic ultrasonography(EUS)has become an established method in diagnostic and therapeutic procedures in gastroenterology;however,it has recently gained a growing role in hepatology.AIM To evaluate the role of EUS features,strain elastography(SE),and EUS-tissue acquisition in diagnosing hepatic focal lesions(HFLs)that could affect further management.METHODS This cross-sectional study included 215 patients with pancreatic,biliary,or gastrointestinal malignancies referred for EUS examination.HFLs were identified in 43 patients(20%),and EUSguided tissue acquisition was performed from these lesions.RESULTS EUS features were highly sensitive(100%)but much less specific(57%)in diagnosing HFLs;the overall accuracy was 94%.Real-time elastography was also very sensitive(97%)but less specific(67%)in diagnosing HFLs;however,the overall accuracy was 92%.EUS tissue acquisition was extremely sensitive(100%)and specific(100%),with a 100%overall diagnostic accuracy.CONCLUSION The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs.EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.

关键词： Endoscopic ultrasonography Hepatic focal lesions fine needle aspiration fine needle biopsy Elastography

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Two Cases of Primary Intraocular Lymphoma:fine needle Aspiration Diagnosis and Intravitreal Methotrexate Treatment

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2011年第1期31卷 142-144页

作者：赵坦泰李云琴唐罗生魏欣朱小华 Department of Ophthalmology the Second Xiangya HospitalCentral South University Department of Ophthalmology the Second People's Hospital of Yunnan Province

We described clinical process of two cases of intraocular lymphoma in aspects of early diagnosis by fine needle aspiration（FNA） and biopsy and treatment by intravitreal methotrexate（MTX）.Two patients were suspected to have primary intraocular lymphoma（PIOL） with geographic yellow-white infiltrates and vitreous opacity.FNA confirmed malignant intraocular lymphoma in one patient and failed in the other patient due to complication of vitreous hemorrhage.Subsequent vitreous biopsy confirmed malignant intraocular lymphoma in the other patient.Both patients were treated by intravitreal methotrexate.In case 1 the tumor had complete remission and follow-up of 12 months had not found any signs of recurrence.In case 2 the patient died of brain metastasis 22 months after the ocular biopsy.Our findings demonstrate that although cytological examination of vitrectomy specimens remains the gold standard in diagnosis of PIOL,examination of FNA and biopsy increases the reliability of early diagnosing or excluding a PIOL.Individualized intravitreal methotrexate can be used to effectively treat PIOL.More effective integrated program treating primary central nervous system lymphoma/PIOL is worthy of looking forward to.

关键词： primary intraocular lymphoma fine needle biopsy vitrectomy intravitreal injection methotrexate

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Endoscopic ultrasound-fine needle biopsies of pancreatic lesions: Prospective study of histology quality using Franseen needle

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World Journal of Gastroenterology 2020年第37期26卷 5693-5704页

作者： Petros Stathopoulos Anika Pehl Lutz Philipp Breitling Christian Bauer Tobias Grote Thomas Mathias Gress Carsten Denkert Ulrike Walburga Denzer Department of Gastroenterology EndocrinologyMetabolism and Clinical InfectiologyUniversity Hospital MarburgMarburg 35043HessenGermany Institute of pathology University Hospital MarburgMarburg 35043HessenGermany

BACKGROUND The introduction of fine needle biopsies(FNB)to clinical practice presents a changing trend towards histology in the endoscopic ultrasound-guided tissue acquisition(EUS-TA).AIM To evaluate the clinical performance of a new FNB needle,the 22-gauge(22G)Franseen needle,when sampling pancreatic solid lesions.METHODS Consecutive patients with an indication for EUS-TA for the assessment of pancreatic solid lesions were included in this prospective,single-center,singlearm trial.Each patient underwent a puncture of the lesion two times using the 22G Franseen needle and the obtained samples were directly placed into formalin for histological analysis.The primary study endpoint was the rate of high-quality obtained specimen.Secondary endpoints included the length and diameter of the core specimen,the diagnostic accuracy and the complication rate.RESULTS From June 2017 to December 2018,forty patients with pancreatic solid lesions(22 females;mean age 67.2 years)were enrolled.Tissue acquisition was achieved in all cases.High-quality histology,rated with Payne score 3,was obtained in 37/40 cases(92.5%)after two needle passes.The mean size of the acquired histological core tissue was 1.54 mm×0.39 mm.The diagnostic accuracy for the correct diagnosis was 85%(34/40).Only one adverse event was occurred,consisting of a self-limiting bleeding in the puncture site.CONCLUSION The 22G Franseen needle achieved according to our standardized protocol a high rate of histological core procurement,and a high diagnostic accuracy,with one minor adverse event reported.

关键词： Endosonography fine needle biopsy Histology Pancreatic lesions Franseen needle

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Tunneled biopsy is an underutilised,simple,safe and efficient method for tissue acquisition from subepithelial tumours

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World Journal of Clinical Cases 2021年第21期9卷 5822-5829页

作者： Andreas Koutsoumpas Ruwan Perera Adele Melton Jonathan Kuker Tilak Ghosh Barbara Braden Translational Gastroenterology Unit Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom Senior School Magdalen College SchoolOxford OX40DZUnited Kingdom Translational Gastroenterology Unit Oxford University Hospital NHS Foundation TrustOxford OX39DUUnited Kingdom

BACKGROUND Tissue acquisition from subepithelial lesions is often attempted by endoscopic ultrasound(EUS)-sampling as conventional endoscopic biopsy usually fails to reach deeper layers of the gastrointestinal wall.AIM To investigate the utilisation,safety and diagnostic yield of an intensified“biteon-bite”tunnel biopsy technique.METHODS In this retrospective cohort study,all patients presenting with subepithelial masses in the upper gastrointestinal tract from March 2013 to July 2019 were included.Data were analysed for size and location of the subepithelial mass,use of intensified tunnel biopsy protocol(more than 10 double bite-on-bite biopsies)or superficial conventional biopsies,histology and imaging results,occurrence of readmission and adverse events after endoscopy.RESULTS Two hundred and twenty-nine patients with subepithelial lesions were included.Superficial conventional biopsies were taken in 117 patients and were diagnostic only in one lipoma(0.9%).Tunnel biopsies taken in 112/229(48.9%)patients were significantly more likely to provide histological diagnosis(53.6%;Pbiopsy is a simple,safe and efficient but underutilised diagnostic modality for tissue acquisition in subepithelial masses.It should be routinely attempted at the initial endoscopy.

关键词： Gastrointestinal stromal tumour fine needle biopsy Lipoma Immunohistology Neuroendocrine tumours fine needle biopsy

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Comparison of the reverse bevel versus Franseen type endoscopic ultrasound needle

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World Journal of Gastrointestinal Endoscopy 2020年第9期12卷 266-275页

作者： Chi Wing Chow Syeda Asma Haider Krish Ragunath Guruprasad P Aithal Martin W James Jacobo Ortiz-Fernandez-Sordo Aloysious Dominic Aravinthan Suresh Vasan Venkatachalapathy National Institute for Health Research Nottingham Biomedical Research Centre Nottingham University Hospitals National Health Service Trust and University of NottinghamNottingham NG72UHUnited Kingdom Department of Pathology Nottingham University Hospitals National Health Service TrustNottingham NG72UHUnited Kingdom Nottingham Digestive Diseases Centre School of MedicineUniversity of NottinghamNottingham NG72RDUnited Kingdom National Institute for Health Research Nottingham Biomedical Research Centre Nottingham University Hospitals National Health Service Trust and University of NottinghamNottingham NG27UHUnited Kingdom

BACKGROUND Reverse bevel(RB)needle is widely used for endoscopic ultrasound fine needle biopsy(EUS-FNB).A 3-plane symmetrical needle with Franseen geometry(FG)has recently become available.AIM To compare the clinical efficacy of FG to that of RB needle.METHODS A retrospective cohort study of all adult patients who underwent EUS-FNB for solid and mixed lesions either with 22G RB needle or 22G FG needle between January 2016 and February 2019 was undertaken.All cytology slides were reviewed by an independent gastrointestinal cytopathologist blinded to the needle used and the initial cytology report.The primary and secondary outcomes were to assess the sample adequacy using Euro-cytology criteria and the number of cell clusters,respectively.RESULTS Two hundred and twenty six procedures were included in the study.RB needle was used in 128 procedures and FG needle in 98 procedures.The baseline characteristics of both groups were comparable.On multivariable analysis,FG needle(P=0.02)and location of the lesion(Pneedle(P=0.04)and the size of the lesion(P=0.02)were independently associated with acquisition of increased number of cell clusters.CONCLUSION FG needle is superior to RB needle in acquiring adequate tissue and attaining higher number of cell clusters for solid and mixed lesions.

关键词： Endoscopic ultrasound fine needle aspiration fine needle biopsy Reverse bevel Franseen geometry Tissue acquisition

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