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Moretti A, Kovacevic B, Vilmann P, Annema JT, Korevaar DA. Performance of EUS-FNA and EUS-B-FNA for the diagnosis of left adrenal glands metastases in patients with lung cancer: A systematic review and meta-analysis. Lung Cancer 2023; 186:107391. [PMID: 37827042 DOI: 10.1016/j.lungcan.2023.107391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES For diagnosing left adrenal gland metastasis in lung cancer, clinical guidelines recommend to perform EUS, but EUS-B (EUS using an EBUS-scope) is increasingly being used. We evaluated the diagnostic performance of both procedures. MATERIALS AND METHODS We did a systematic review (PROSPERO, CRD42023416205) and searched MEDLINE and EMBASE on 04-July-2023 for studies evaluating EUS and/or EUS-B in diagnosing left adrenal gland metastases in adults with (suspected) lung cancer. Outcomes were: (1) ability to visualize the left adrenal gland, (2) ability to sample (in those with successful visualization and in whom sampling was attempted), (3) ability to obtain adequate material (in those with successful sampling), (4) malignancy detection rate (in those with successful sampling), and (5) remaining risk of malignancy (in those with a negative EUS(-B)-FNA and undergoing a reference standard). We performed random-effects meta-analyses. RESULTS We included 19 studies (EUS: n = 11, EUS-B: n = 6, both: n = 2), covering 1712 patients. All studies had high (n = 18) or unclear (n = 1) risk of bias (QUADAS-2). Average ability to visualize the left adrenal gland was 0.94 (95 %CI 0.82-0.98; n = 7 studies). Average ability to sample was 1.00 (95 %CI 0.99-1.00; n = 9). Average ability to obtain adequate material was 0.96 (95 %CI 0.93-0.98; n = 18). Average malignancy detection rate was 0.42 (95 %CI 0.34-0.49; n = 18). Remaining risk of malignancy was 0.07 (95 %CI 0.04-0.12; n = 8). Ability to visualize was slightly higher for EUS (0.99; 95 %CI 0.90-1.00) than EUS-B (0.84; 95 %CI 0.70-0.92; p = 0.025), but the other performance characteristics were similar. No major complications were reported. CONCLUSION Both EUS and EUS-B have good performance and are safe for left adrenal gland analysis in patients with lung cancer, but the number of high-quality studies is limited and further well-constructed prospective studies are needed.
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Affiliation(s)
- Antonio Moretti
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands; Unit of Respiratory Diseases, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bojan Kovacevic
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Peter Vilmann
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Jouke T Annema
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Daniël A Korevaar
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands.
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Jeffus S, Quiroga EF, Hasan Z, Fedda F, Meena N, Bartter T. The yield and impact of pulmonologist-performed EUS-B-FNA of subdiaphragmatic lesions-an institutional experience. J Am Soc Cytopathol 2023; 12:362-367. [PMID: 37336683 DOI: 10.1016/j.jasc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Pulmonologists can biopsy structures below the diaphragm using the convex curvilinear ultrasound bronchoscope via the esophagus (EUS-B). The literature with respect to the value of EUS-B, rapid on-site evaluation, and final diagnostic yield for structures below the diaphragm is limited. We review our institutional experience. MATERIALS AND METHODS Our database was queried retrospectively for EUS-B fine needle aspirations (FNAs) from 2013 to 2021. All procedures involving EUS-B-FNA of subdiaphragmatic structures were selected for analysis. The following data elements were collected for each patient: age, gender, clinical indication, sample site, on-site adequacy (OSA), preliminary and final diagnoses, and sufficiency of cell block for ancillary studies. RESULTS A total of 75 subdiaphragmatic sites were biopsied in 74 patients. Of which, 87% of samples subjected to rapid on-site evaluation were deemed to contain adequate material (OSA+). There were no false-positive OSAs. Six cases remained nondiagnostic at the final diagnosis. The final diagnostic yield (with cell block) was 92% (69/75 cases). Cell block was sufficient for immunohistochemistry or special stains in all applicable cases (n = 36). Molecular testing was requested for 11 cases and successful in 10 (91%). Sampling of subdiaphragmatic sites changed the stage in 67% (38/57) of lung cancer patients. CONCLUSIONS Pulmonologists can perform EUS-B-FNA of subdiaphragmatic sites with high OSA and final diagnostic yield when assisted by cytopathologists. Strong correlations exist between OSA, cell block adequacy, and subsequent capacity to perform ancillary testing. EUS-B below the diaphragm can make an important contribution to the diagnosis of lung cancer, nonpulmonary malignancies, and other diseases.
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Affiliation(s)
- Susanne Jeffus
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | | | - Zeinab Hasan
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Faysal Fedda
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nikhil Meena
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Koratala A, Chandra NC, Yu Lee‐Mateus A, Abia‐Trujillo D, Hazelett BN, Reisenauer J, Chadha R, Fernandez‐Bussy S. One-stop-shop: Lung cancer and pheochromocytoma diagnosed by robotic-assisted bronchoscopy and EBUS scope on a single endoscopic event. Respirol Case Rep 2023; 11:e01176. [PMID: 37303308 PMCID: PMC10252916 DOI: 10.1002/rcr2.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
Lung cancer is the deadliest cancer worldwide, therefore, early and prompt diagnosis is essential for better patient outcomes. It is known to have a high predilection for metastasis to the adrenal glands; however, two-thirds of adrenal masses in patients with lung cancer will turn out to be benign, so timely detection is crucial. We present a case of a lung squamous cell carcinoma diagnosed by shape-sensing robotic-assisted bronchoscopy (ssRAB), negative mediastinal and hilar staging with endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA), and a pheochromocytoma diagnosed through endoscopic ultrasound with bronchoscope (EUS-B) fine needle aspiration (FNA) all in the same endoscopic procedure.
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Affiliation(s)
- Anoop Koratala
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Nikitha C. Chandra
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | | | - David Abia‐Trujillo
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Britney N. Hazelett
- Division of Pulmonary, Allergy, and Sleep MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Janani Reisenauer
- Department of Pulmonary Medicine and Thoracic SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Ryan Chadha
- Department of AnesthesiologyMayo ClinicJacksonvilleFloridaUSA
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Issa MA, Sidhu JS, Tehrani SG, Clementsen PF, Bodtger U. Endoscopic ultrasound-guided pancreas biopsy in the hands of a chest physician. Respir Med Case Rep 2023; 43:101833. [PMID: 36942163 PMCID: PMC10024129 DOI: 10.1016/j.rmcr.2023.101833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
This is the first paper to report sampling of pancreatic lesions by EUS-B-FNA. A 76 year old patient suspected of primary lung cancer presented with a 36 × 24 mm lesion in the pancreas. Thoracentesis showed malignant cells suggestive of mucinous adenocarcinoma, but immunohistochemistry was inconclusive. Due to rapid deterioration of performance status of this frail patient, the program was shortened to EUS-B-FNA of the pancreatic lesion, which showed mucinous adenocarcinoma suggestive of primary pancreatic cancer. We conclude that EUS-B-FNA from a pancreatic lesion in the hands of a chest physician is feasible and diagnostic of a tumor in pancreas.
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Affiliation(s)
- Mohammad Ahmad Issa
- Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital in Roskilde & Næstved, Denmark
- Corresponding author. Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital Næstved, 61 Ringstedgade, DK-4700, Næstved, Denmark.
| | - Jatinder Singh Sidhu
- Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital in Roskilde & Næstved, Denmark
| | | | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Uffe Bodtger
- Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital in Roskilde & Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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5
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Alıcı İO, Aydoğdu Z. EUS-B-FNA for Left Adrenal Lesions in Non-Small Cell Lung Cancer Patients: Report of Cases and Literature Review. Turk Thorac J 2019; 21:209-212. [PMID: 32584239 DOI: 10.5152/turkthoracj.2019.190109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
Abstract
The left adrenal gland (LAG) is a common metastatic site in patients with non-small-cell lung cancer. In practice, staging mainly relies on radiologic studies and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Recently, a new technique using convex probe-endobronchial ultrasound (CP-EBUS) scope through the esophagus (EUS-B) has been introduced. A complete mediastinal staging and a reach for upper-abdominal structures in a single session naturally attract attention. However, scientific data are not sufficient to clearly judge the role of this technique in the cytological diagnosis of left adrenal lesions. Therefore, we present cases in which our patients have undergone EUS-B for LAG lesions to increase the data in the literature with regard to accessibility, diagnostic performance, and rate of complications.
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Affiliation(s)
- İbrahim Onur Alıcı
- Department of Pulmonary Medicine, Dr. Suat Seren Training and Research Hospital for Pulmonary Diseases and Thoracic Surgery, İzmir, Turkey
| | - Zekiye Aydoğdu
- Department of Pathology, Dr. Suat Seren Training and Research Hospital for Pulmonary Diseases and Thoracic Surgery, İzmir, Turkey
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Martin-Cardona A, Fernandez-Esparrach G, Subtil JC, Iglesias-Garcia J, Garcia-Guix M, Barturen Barroso A, Gimeno-Garcia AZ, Esteban JM, Pardo Balteiro A, Velasco-Guardado A, Vazquez-Sequeiros E, Loras C, Martinez-Moreno B, Castellot A, Huertas C, Martinez-Lapiedra M, Sanchez-Yague A, Teran A, Morales-Alvarado VJ, Betes M, de la Iglesia D, Sánchez-Montes C, Lozano MD, Lariño-Noia J, Gines A, Tebe C, Gornals JB. EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study. PLoS One 2019; 14:e0216658. [PMID: 31170163 PMCID: PMC6553722 DOI: 10.1371/journal.pone.0216658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. Methods This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist’s suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. Results A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16–4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1–3.9), variegated AG shape (OR2.46; 95%CI, 1–6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2–58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. Conclusions EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.
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Affiliation(s)
- A Martin-Cardona
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain
| | - G Fernandez-Esparrach
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - J C Subtil
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - J Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - M Garcia-Guix
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - A Barturen Barroso
- Department of Digestive Diseases, Hospital Universitario Cruces, Bilbao, Spain
| | - A Z Gimeno-Garcia
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - J M Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - A Pardo Balteiro
- Department of Digestive Diseases, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - A Velasco-Guardado
- Department of Digestive Diseases, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - E Vazquez-Sequeiros
- Endoscopy unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain
| | - C Loras
- Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - B Martinez-Moreno
- Department of Digestive Diseases, Hospital General Universitario de Alicante, Alicante, Spain
| | - A Castellot
- Department of Digestive Diseases, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - C Huertas
- Department of Digestive Diseases, Hospital Dr. Josep Trueta Girona, Girona, Spain
| | | | | | - A Teran
- Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - V J Morales-Alvarado
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Betes
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - D de la Iglesia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - C Sánchez-Montes
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M D Lozano
- Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain
| | - J Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | - A Gines
- Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - C Tebe
- Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Patel S, Jinjuvadia R, Devara A, Naylor PH, Anees M, Jinjuvadia K, Al-Haddad M. Performance characteristics of EUS-FNA biopsy for adrenal lesions: A meta-analysis. Endosc Ultrasound 2019; 8:180-187. [PMID: 30880721 PMCID: PMC6589998 DOI: 10.4103/eus.eus_42_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Objective: The role of EUS-FNA biopsy (EUS-FNAB) for detection of metastatic lesions (mets) to adrenals has not been evaluated systematically. Our aim is to systematically evaluate the performance characteristics of EUS-FNAB in detecting metastasis to the adrenal glands. Materials and Methods: We performed a systematic search on PubMed and OvidSP from January 1990 to July 2016 using various search terms for EUS and adrenal lesion. Only articles published in English literature were included in the study. Studies with fewer than 10 patients were excluded from the study. Publication bias was assessed using Begg-Mazumdar test and visual inspection of funnel plots. Results: Eight studies including 360 adrenal lesions that underwent EUS-FNAB were identified. Of these, 137 FNABs were conclusive for malignancy. Sensitivity of EUS-FNAB in detecting metastasis to the adrenals was 95% (95% confidence interval [CI]: 90%–98%) and specificity was 99% (95% CI: 96%–100%). Pooled positivity of EUS-FNAB in detecting lung cancer metastasis to the adrenals was 44% (95% CI: 31.5%–57.3%). No evidence of publication bias was noted. Conclusion: Our study demonstrates that EUS-FNAB is highly sensitive and specific in detecting metastasis to adrenals. It also shows that up to about half of the patients with lung cancer and adrenal lesions on imaging have metastasis, a finding with profound implications on lung cancer staging and treatment.
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Affiliation(s)
- Suhag Patel
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Anupama Devara
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Paul H Naylor
- Division of Gastroenterology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Mohammad Anees
- Division of Gastroenterology, Mayo Clinic, Rochester MN, USA
| | - Kartikkumar Jinjuvadia
- Division of Gastroenterology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Liu M, Zhang Q, Long H, Xu M, Shou Y, Guo Z. Diagnosis of lung adenocarcinoma with left adrenal metastasis via transesophageal endoscopic ultrasound-guided fine-needle aspiration biopsy: A case report. Mol Clin Oncol 2018; 9:145-148. [PMID: 30101011 PMCID: PMC6083413 DOI: 10.3892/mco.2018.1648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022] Open
Abstract
Lung cancer is generally diagnosed through traditional bronchoscopy by pulmonologists, whereas data on the application of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for lung cancer diagnosis in China are very rarely reported. We herein describe a case of a 62-year-old woman who presented with non-productive cough and was found to have a pulmonary mass in the upper lobe of the right lung. The results of positron emission tomography revealed an elevated level of 18F-fluorodeoxyglucose accumulation (maximum standardized uptake value of 13.6) in the left adrenal gland. Thus, EUS-FNA was performed to identify the suspected metastasis to the left adrenal gland, and the histopathological examination of the bioptic specimen demonstrated an adenocarcinoma, confirming the value of EUS-FNA as a first-line minimally invasive approach for diagnosis and staging in patients with lung cancer.
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Affiliation(s)
- Meixuan Liu
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, P.R. China
| | - Qian Zhang
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, P.R. China
| | - Haihu Long
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, P.R. China
| | - Ming Xu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, P.R. China
| | - Yi Shou
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, P.R. China
| | - Zhongliang Guo
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, P.R. China
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Pais FM, Shah RA, Vempilly JJ, Gullapalli S, Upadhyay D, Peterson M, Liberman M, Hegde P. Transesophageal approach to lung, adrenal biopsy and fiducial placement using endoscopic ultrasonography (EUS): An interventional pulmonology experience. Initial experience of the UCSF-FRETOC (fresno tracheobronchial & oesophageal center) study group. Respir Med 2018; 141:52-55. [PMID: 30053972 DOI: 10.1016/j.rmed.2018.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Routine lung cancer surveillance has resulted in early detection of pulmonary nodules and masses. Combined endobronchial ultrasound (EBUS) and trans-esophageal endoscopic ultrasound (EUS) are approved methods for sampling lymph nodes or masses. Furthermore, EUS allows for adrenal sampling as part of staging, and can assist with fiducial placement for stereotactic body radiation therapy (SBRT). OBJECTIVES Promote use of EUS by interventional pulmonologists in the United States when diagnosing and staging lung cancer or when placing fiducials. METHODS All patients undergoing EUS and/or EBUS were serially entered into a prospectively maintained database. Only patients undergoing EUS guided lung and/or adrenal biopsy and/or fiducial placement were selected for analysis. All patients underwent a post-procedure chest radiograph and were followed outpatient. RESULTS 20 of 39 patients underwent sampling of a suspicious lung mass. An adequate sample was obtained in 19 of 20 patients. In all 19 patients a definitive diagnosis was achieved (95%). In all 13 patients who underwent adrenal sampling, presence or absence of metastasis was conclusively established. 6 patients successfully underwent fiducial placement. In all 39 patients, no major procedure related complications were noted for a period of 30 days. One patient had a small pneumothorax that resolved spontaneously. CONCLUSIONS EUS can be safely performed by a trained interventional pulmonologist for the diagnosis of lung, adrenal masses and placement of fiducials. We think that interventional pulmonologists in the United States involved in lung cancer staging should receive training in EUS techniques.
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Affiliation(s)
- Faye M Pais
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Raj A Shah
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Jose J Vempilly
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Sneha Gullapalli
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Daya Upadhyay
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Michael Peterson
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Moishe Liberman
- Division of Thoracic Surgery, University of Montreal, Canada
| | - Pravachan Hegde
- Division of Pulmonary Critical Care Medicine, University of California, San Francisco, Fresno, CA, USA.
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Chassagnon G, Bennani S, Freche G, Magdeleinat P, Mansuet-Lupo A, Revel MP. CT-guided percutaneous core biopsy for assessment of morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer. Br J Radiol 2018; 91:20180090. [PMID: 29906237 DOI: 10.1259/bjr.20180090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Increased fludeoxyglucose (FDG) uptake in morphologically normal adrenal glands on positron emission tomography-CT (PET-CT) is a diagnostic challenge with major implications on treatment. The purpose of this retrospective study was to report our experience of CT-guided percutaneous core biopsy of morphologically normal adrenal glands showing increased FDG uptake in a context of lung cancer. METHODS: Biopsies for non-enlarged adrenal glands showing increased FDG uptake in lung cancer patients performed at our institution from December 2014 to December 2016 were retrospectively analyzed. Six biopsies were performed in five patients during the study period. All procedures were performed with the patients in the prone position, using a posterior approach and coaxial 17-gauge needles with 18-gauge automated cutting needles. Patient characteristics, procedural details and final pathological diagnosis were analyzed, as well as the duration of hospitalization. RESULTS: Five of the six biopsies (83.3%) confirmed adrenal metastasis from the primary lung cancer. No complications were reported and the patients were discharged the day after the procedure. CONCLUSION: The high confirmation rate of metastasis and lack of complications support performing CT-guided percutaneous biopsy of non-enlarged adrenal glands showing increased FDG uptake, for optimal management in lung cancer patients. ADVANCES IN KNOWLEDGE: Morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer are metastasis. This manuscript shows that CT-guided percutaneous biopsy should be proposed. Increased FDG uptake in morphologically normal adrenal glands may indicate metastasis.
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Affiliation(s)
- Guillaume Chassagnon
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Souhail Bennani
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Gaël Freche
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Pierre Magdeleinat
- 2 Department of Thoracic Surgery, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Audrey Mansuet-Lupo
- 3 Department of Pathology, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
| | - Marie-Pierre Revel
- 1 Radiology Department, Groupe Hospitalier Cochin Broca Hôtel-Dieu - Université Paris Descartes , Paris , France
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Bansal RK, Choudhary NS, Patle SK, Agarwal A, Kaur G, Sarin H, Puri R. Endoscopic ultrasound-guided fine-needle aspiration of enlarged adrenals in patients with pyrexia of unknown origin: A single-center experience of 52 cases. Indian J Gastroenterol 2018; 37:108-112. [PMID: 29594708 DOI: 10.1007/s12664-018-0825-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of adrenals is needed in patients with pyrexia of unknown origin (PUO) and adrenal enlargement in absence of other diagnostic clues. Adrenals are easily accessible by endoscopic ultrasound (EUS) due to proximity; however, there is no systemic study available on FNA of adrenals in patients with PUO. The aim of this study was to evaluate the diagnostic yield and safety of EUS-FNA of enlarged adrenal in patients with PUO. METHODS Data was analyzed from October 2010 to September 2016 at a single tertiary care center in northern India. EUS-FNA of enlarged adrenals was done in 52 patients for the etiological diagnosis of PUO in whom a definitive diagnosis could not be made with other means. RESULTS The mean age was 48±14 years; 36 were males and 16 were females. EUS-FNA was done from the left adrenal in 50 patients and from the right sample in 2 patients. A technical success was achieved in 100% cases. The 19-G needle was used in the majority (75%) to the presence of necrotic areas in adrenals; median numbers of passes were 2. The cytopathological diagnoses were tuberculosis (n = 36), histoplasmosis (n = 13), lymphoma (n = 2), and metastasis from undiagnosed neuroendocrine tumor of lung (n = 1). Thus, a diagnosis could be made in 52/52 (100%) patients. None of the patients had any procedure-related complications. CONCLUSIONS EUS-FNA is a safe and effective method for evaluating etiology of PUO in patients with adrenal enlargement.
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Affiliation(s)
- Rinkesh K Bansal
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Narendra S Choudhary
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Saurabh K Patle
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Amit Agarwal
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Gagandeep Kaur
- Department of Cytopathology, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Haimanti Sarin
- Department of Cytopathology, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India.
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Gupta RK, Majumdar K, Saran RK, Srivastava S, Sakhuja P, Batra VV. Role of Endoscopic Ultrasound-guided Fine-needle Aspiration in Adrenal Lesions: Analysis of 32 Patients. J Cytol 2018; 35:83-89. [PMID: 29643654 PMCID: PMC5885609 DOI: 10.4103/joc.joc_241_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is a precise and safe technique that provides both radiological and pathological diagnosis with a better diagnostic yield and minimal adverse events. EUS-FNAC led to the remarkable increase in the detection rate of incidentaloma found during radiologic staging or follow-up in various malignancy or unrelated conditions. Aims: We did this preliminary study with an aim to evaluate the role of EUS-FNA in diagnosing and classifying adrenal lesions, clinical impact, and compare the outcome with the previously published literature. Materials and Methods: We included 32 consecutive cases (both retrospective and prospective) of EUS-guided adrenal aspirate performed over a period of 3.3 years. The indications for the aspirate in decreasing order were metastasis (most common carcinoma gall bladder) > primary adrenal mass > disseminated tuberculosis > pyrexia of unknown origin. On EUS, 28 cases revealed space occupying lesion or mass (two cases bilateral) and four cases revealed diffuse enlargement (two cases bilateral) with a mean size of 21 mm. Results: The cytology reports were benign adrenal aspirate (43.8%), metastatic adenocarcinoma (15.6%), histoplasmosis (9.4%), tuberculosis (9.4%), round cell tumor (6.2%), adrenocortical carcinoma (3.1%), and descriptive (3.1%). Three cases (9.4%) yielded inadequate sample. The TNM staging was altered in 22.23% of the cases by result of adrenal aspirate. Conclusions: EUS-FNA of the adrenal gland is a safe, quick, and sensitive and real-time diagnostic technique, which requires an integrated approach of clinician, endoscopist, and cytopathologist for high precision in diagnosis. Although the role of EUS-FNA for right adrenal is not much described, we found adequate sample yield in all the four patients that underwent the procedure.
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Affiliation(s)
- Rakesh K Gupta
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Kaushik Majumdar
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ravindra K Saran
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Puja Sakhuja
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Vineeta V Batra
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Marchand C, Medford AR. Relationship between endobronchial ultrasound-guided (EBUS)-transbronchial needle aspiration utility and computed tomography staging, node size at EBUS, and positron emission tomography scan node standard uptake values: A retrospective analysis. Thorac Cancer 2017; 8:285-290. [PMID: 28436173 PMCID: PMC5494455 DOI: 10.1111/1759-7714.12438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) diagnoses and stages mediastinal lymph node pathology. This retrospective study determined the relationship between EBUS-TBNA utility and non-small cell lung cancer (NSCLC) stage, lymph node size, and positron emission tomography (PET) standard uptake values (SUV), and the utility of neck ultrasound in bulky mediastinal disease. METHODS Data of 284 consecutive patients who had undergone EBUS-TBNA was collected. Two hundred patients had suspected NSCLC, with 148 confirmed NSCLC cases. The diagnostic utility of EBUS-TBNA was determined according to NSCLC stage, EBUS lymph node size, PET SUV, use in distal metastases, and mutation testing. The utility of neck ultrasound for N3 disease was calculated in patients with bulky mediastinal disease. RESULTS EBUS-TBNA was well tolerated with 97% sensitivity in distant metastatic disease, avoiding the need for distal metastases biopsy in 81% of cases. It had equivalent diagnostic accuracy in all NSCLC stages and in lymph nodes <10 mm, <20 mm or >20 mm (sensitivity >92% in all cases), with no mutation testing failures. EBUS-TBNA had 33% sensitivity in PET indolent (SUV < 4) nodes and 79% sensitivity in PET active nodes (SUV > 4). EBUS-TBNA diagnosed 12 cases of lymphoma without flow cytometry. CONCLUSIONS The use of EBUS-TBNA meant that distant metastatic biopsy was avoided in 81% of cases, performing well irrespective of cancer stage, node size, and facilitating mutation testing. Neck ultrasound failed to detect N3 disease in patients with bulky mediastinal disease. EBUS-TBNA had a sensitivity of 33% for metastases in PET negative nodes, highlighting PET limitations.
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Affiliation(s)
- Clare Marchand
- North Bristol Lung CentreNorth Bristol NHS Trust, Southmead HospitalBristolUK
| | - Andrew R.L. Medford
- North Bristol Lung CentreNorth Bristol NHS Trust, Southmead HospitalBristolUK
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Crombag LMMJ, Szlubowski A, Stigt JA, Schuurbiers O, Korevaar DA, Bonta PI, Annema JT. EUS-B-FNA vs conventional EUS-FNA for left adrenal gland analysis in lung cancer patients. Lung Cancer 2017; 108:38-44. [PMID: 28625645 DOI: 10.1016/j.lungcan.2017.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In patients with lung cancer, left adrenal glands (LAG) suspected for distant metastases (M1b) based on imaging require further evaluation for a definitive diagnosis. Tissue acquisition is regularly performed using conventional EUS-FNA. The aim of this study was to investigate the success rate of endoscopic ultrasound guided fine-needle aspiration using the EBUS scope (EUS-B-FNA) for LAG analysis. METHODS This is a prospective multicenter study in consecutive patients with (suspected) lung cancer and suspected mediastinal and LAG metastases. Following complete mediastinal staging using the EBUS scope (EBUS+EUS-B), the LAG was evaluated and sampled by both EUS-B (experimental procedure) and conventional EUS (current standard of care). RESULTS The success rate for LAG analysis (visualized, sampled and adequate tissue obtained) was 89% (39/44; 95% CI 76-95%) for EUS-B-FNA, and 93% (41/44; 95%CI 82-98%) for EUS-FNA. In the absence of metastases at EUS-B and/or EUS, surgical verification of the LAG or 6 months clinical and radiological follow-up was obtained, but missing for 5 patients. The prevalence of LAG metastases was 54% (21/39). In patients in whom LAG was seen and sampled, sensitivity for LAG metastases was at least 87% (95%CI 65-97%) for EUS-B, and at least 83% (95%CI 62-95%) for conventional EUS. CONCLUSION LAG analysis by EUS-B shows a similar high success rate in comparison to conventional EUS. IMPLICATION Both a mediastinal nodal and LAG evaluation can be adequately performed with just an EBUS scope and single endoscopist. This staging strategy is likely to reduce patient-burden and costs.
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Abstract
PURPOSE OF REVIEW Linear endosonography, including intrathoracic lymph nodal sampling by endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and endoesophageal ultrasound fine-needle aspiration (EUS-FNA), has an important role in the diagnosing and staging of lung cancer. Furthermore, endosonography is applied in the mediastinal evaluation of sarcoidosis, lymphoma, cysts, and nodal metastases of extrathoracic malignancies. Endosonography-related complications as well as sedation and training strategies are discussed. The purpose of this review is to summarize current practice, recent advances, and future directions. RECENT FINDINGS Lung cancer guidelines recommend endosonography - above mediastinoscopy - as the initial test for mediastinal nodal tissue staging. By introducing the EBUS-scope into the esophagus (EUS-B) - following an EBUS procedure - the complete mediastinum and the left adrenal gland can be investigated in a single scope procedure by one operator. In patients with suspected stage I/II sarcoidosis, EBUS-TBNA/EUS-FNA is the test with the highest granuloma detection rate. Diagnosing (recurrent) lymphoma is an increasingly accepted indication for endosonography. Systematic surveys showed that endosonography has a low complication rate. Simulator-based training and assessment tools measuring competency are important instruments to provide standardized and optimal implementation. SUMMARY Endosonography is generally accepted as a powerful and safe diagnostic test for various diseases affecting the mediastinum. Large-scale implementation is needed.
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Abstract
Background: Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes. Methods: After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis. Results: Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications. Conclusions: Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure.
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Affiliation(s)
- Nikhil Meena
- Department of Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, AR, USA
| | - Cidney Hulett
- Department of Internal Medicine, CHI St. Vincent Infirmary, Little Rock, AR, USA
| | - Setu Patolia
- Department of Internal Medicine, St. Louis University, St. Louis, MO, USA
| | - Thaddeus Bartter
- Department of Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, AR, USA
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Bancos I, Tamhane S, Shah M, Delivanis DA, Alahdab F, Arlt W, Fassnacht M, Murad MH. DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis. Eur J Endocrinol 2016; 175:R65-80. [PMID: 27257146 DOI: 10.1530/eje-16-0297] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/02/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy. METHODS Medline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate. RESULTS We included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6-11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5-3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively. CONCLUSIONS Evidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.
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Affiliation(s)
- Irina Bancos
- Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shrikant Tamhane
- Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Muhammad Shah
- Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Danae A Delivanis
- Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fares Alahdab
- Evidence-Based Practice CenterCenter for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK and Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Martin Fassnacht
- Department of Internal MedicineDivision of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - M Hassan Murad
- Evidence-Based Practice CenterCenter for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
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Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2016; 175:G1-G34. [PMID: 27390021 DOI: 10.1530/eje-16-0467] [Citation(s) in RCA: 896] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/02/2016] [Indexed: 12/13/2022]
Abstract
: By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? SELECTED RECOMMENDATIONS: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50nmol/L (1.8µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1mg dexamethasone >138nmol/L (>5µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients with an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal incidentalomas.
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Affiliation(s)
- Martin Fassnacht
- Department of Internal Medicine IDivision of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany Comprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
| | - Wiebke Arlt
- Institute of Metabolism & Systems ResearchUniversity of Birmingham, Birmingham, UK Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Irina Bancos
- Institute of Metabolism & Systems ResearchUniversity of Birmingham, Birmingham, UK Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK Division of EndocrinologyMetabolism, Nutrition and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
| | - Henning Dralle
- Department of GeneralVisceral, and Vascular Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - John Newell-Price
- Department of Oncology and MetabolismMedical School, University of Sheffield, Sheffield, UK Endocrine UnitRoyal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anju Sahdev
- Department of ImagingSt Bartholomew's Hospital, Barts Health, London, UK
| | - Antoine Tabarin
- Department of Endocrinology and INSERM U862University and CHU of Bordeaux, Pessac, France
| | - Massimo Terzolo
- Internal Medicine 1Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Stylianos Tsagarakis
- Department of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Olaf M Dekkers
- Departments of Clinical Epidemiology and Internal MedicineLeiden University Medical Centre, Leiden, The Netherlands Department of Clinical EpidemiologyAarhus University, Aarhus, Denmark
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Fally M, Nessar R, Behrendt N, Clementsen PF. Endoscopic Ultrasound-Guided Liver Biopsy in the Hands of a Chest Physician. Respiration 2016; 92:53-5. [PMID: 27287428 DOI: 10.1159/000446924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
Liver biopsy using transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) has never been described before and biopsies of infradiaphragmatic lesions using this technique are not considered to be standard. A patient suspected for primary lung cancer with multiple lesions in the liver was referred to our department. We conducted bronchoscopy and endobronchial ultrasound-guided (EBUS) biopsy from several enlarged mediastinal lymph nodes. Thereafter, we conducted EUS-B-FNA from a lesion in the left liver lobe. Pathology showed that the liver lesion represented a metastasis from a pulmonary adenocarcinoma. Bronchoscopy and EBUS samples were not able to establish diagnosis. We hereby demonstrated that a diagnostic EUS-B-FNA from a liver metastasis in a patient with lung cancer is possible. This underlines that chest physicians should not forget the esophagus when staging lung cancer.
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Affiliation(s)
- Markus Fally
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
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Patil R, Ona MA, Papafragkakis C, Duddempudi S, Anand S, Jamil LH. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions. Ann Gastroenterol 2016; 29:307-11. [PMID: 27366030 PMCID: PMC4923815 DOI: 10.20524/aog.2016.0047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/26/2016] [Indexed: 12/13/2022] Open
Abstract
The use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) appears to be a safe and feasible means of confirming or excluding malignancy in the adrenal glands. EUS-FNA with biopsy of suspicious masses in either adrenal gland allows for assessment of these lesions while keeping complications relatively rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity, and a short hospital stay. Nevertheless, EUS-FNA of adrenal masses should be indicated only in selected cases, in which there is potential to either decrease unnecessary treatment or guide therapy in cancer patients by aiding in either staging of malignancy or treatment of recurrence.v.
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Affiliation(s)
- Rashmee Patil
- Department of Internal Medicine, Mount Sinai Health Systems, New York (Rashmee Patil)
| | - Mel A Ona
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York (Mel A. Ona, Sushil Duddempudi, Sury Anand)
| | - Charilaos Papafragkakis
- Department of Advanced Therapeutic Endoscopy, MD Anderson Cancer Center, Academic and Clinical Affiliate of the University of Texas, Houston, Texas (Charilaos Papafragkakis)
| | - Sushil Duddempudi
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York (Mel A. Ona, Sushil Duddempudi, Sury Anand)
| | - Sury Anand
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York (Mel A. Ona, Sushil Duddempudi, Sury Anand)
| | - Laith H Jamil
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA (Laith H. Jamil), USA
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Crombag LMMJ, Annema JT. Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial. Respiration 2016; 91:235-40. [PMID: 26930053 DOI: 10.1159/000443991] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In lung cancer patients, the adrenal glands are predilection sites for distant metastases. Esophageal endoscopic ultrasound - fine-needle aspiration (EUS-FNA) is a minimally invasive and accurate method for left adrenal gland (LAG) analysis but requires a conventional gastrointestinal echoendoscope. Complete endobronchial and esophageal mediastinal nodal staging can be achieved by just a single endobronchial ultrasound (EBUS) scope, introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. OBJECTIVES The aim of the study was to investigate the feasibility of identifying the LAG with the EBUS scope. METHODS We conducted a retrospective analysis of lung cancer patients who underwent EBUS and EUS-B for mediastinal staging and LAG assessment between January 2013 and May 2015. RESULTS A total of 143 patients with (suspected) lung cancer were investigated by the combination of EBUS and EUS-B. In 68 of the 80 patients (85%) in whom an attempt was made to identify the LAG, it was feasible to transgastrically detect the LAG with the EBUS scope. In 9 patients with endosonographic signs of malignant involvement, diagnostic transgastric FNAs were obtained in all. In the 12 patients (15%) in whom the LAG was not detected, the contact between the ultrasound transducer and the gastric wall was suboptimal - the length of the scope was not a limiting factor. CONCLUSIONS The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. IMPLICATION In patients with (suspected) lung cancer, in addition to complete hilar and mediastinal staging, LAG assessment using just a single EBUS scope also seems feasible. Prospective studies are indicated.
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Affiliation(s)
- Laurence M M J Crombag
- Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Usmanij EA, de Geus-Oei LF, Bussink J, Oyen WJ. Update on F-18-fluoro-deoxy-glucose-PET/computed tomography in nonsmall cell lung cancer. Curr Opin Pulm Med 2015; 21:314-21. [PMID: 25978629 DOI: 10.1097/MCP.0000000000000182] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an outline of current evidence for the use of F-18-fluoro-deoxy-glucose PET computed tomography (FDG-PET/CT) in nonsmall cell lung cancer (NSCLC) for diagnosis, staging, radiotherapy planning, response assessment and response monitoring. RECENT FINDINGS Management of patients with NSCLC requires a multimodality approach to accurately diagnose and stage patients. In this approach, FDG-PET/CT has become a standard staging instrument in lung cancer. FDG-PET/CT is, in addition to staging, also valuable for the characterization of the solitary pulmonary nodule. An increased uptake in the nodule as compared with mediastinal blood pool is suspected for malignancy. In radiotherapy planning, FDG-PET/CT can assist the radiation oncologist for optimal dose delivery to the tumour, while sparing healthy tissues. Evidence of the prognostic and predictive implications of FDG-PET/CT is accumulating. Volumetric parameters of PET, such as metabolic active tumour volume and total lesion glycolysis, are promising predictive and prognostic biomarkers. However, for implementation of metabolic response parameters in clinical practice, more randomized, PET-based, multicentre trials are necessary. The introduction of integrated PET and MRI scanners did not change the pivotal role of standard FDG-PET/CT yet, as with current technology, PET/MRI did not show superior performance in thoracic staging. SUMMARY The role of PET is described for diagnosis, staging and response assessment.
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015; 48:1-15. [DOI: 10.1093/ejcts/ezv194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. Eur Respir J 2015; 46:40-60. [DOI: 10.1183/09031936.00064515] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
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Puri R, Thandassery RB, Choudhary NS, Kotecha H, Misra SR, Bhagat S, Paliwal M, Madan K, Saraf N, Sarin H, Guleria M, Sud R. Endoscopic ultrasound-guided fine-needle aspiration of the adrenal glands: analysis of 21 patients. Clin Endosc 2015; 48:165-70. [PMID: 25844346 PMCID: PMC4381145 DOI: 10.5946/ce.2015.48.2.165] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/22/2014] [Accepted: 10/17/2014] [Indexed: 01/23/2023] Open
Abstract
Background/Aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible. Methods Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years. Results Of the 21 patients (mean age, 56±12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4×1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred. Conclusions EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities.
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Affiliation(s)
- Rajesh Puri
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Ragesh Babu Thandassery
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Narendra S Choudhary
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Hardik Kotecha
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Smruti Ranjan Misra
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Suraj Bhagat
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Manish Paliwal
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Kaushal Madan
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Neeraj Saraf
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Haimanti Sarin
- Department of Cytopathology, Medanta The Medicity, Gurgaon, India
| | - Mridula Guleria
- Department of Cytopathology, Medanta The Medicity, Gurgaon, India
| | - Randhir Sud
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
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Gasparini S, Bonifazi M. Bronchoscope: beyond the thorax! ACTA ACUST UNITED AC 2015; 89:17-8. [PMID: 25592827 DOI: 10.1159/000370127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
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Meena N, Hulett C, Jeffus S, Bartter T. Left adrenal biopsy using the convex curvilinear ultrasound scope. ACTA ACUST UNITED AC 2014; 89:57-61. [PMID: 25502409 DOI: 10.1159/000368370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/02/2014] [Indexed: 11/19/2022]
Abstract
Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) is well described. EUS-B has not been described for diagnostic sampling of the left adrenal gland. We describe 6 cases of diagnostic fine-needle aspiration of the left adrenal gland using EUS-B. This capacity increases the diagnostic capabilities of the pulmonologist experienced in EUS-B.
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Affiliation(s)
- Nikhil Meena
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark., USA
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Wani S, Muthusamy VR, Komanduri S. EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014; 80:939-59.e7. [PMID: 25434654 DOI: 10.1016/j.gie.2014.07.066] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/17/2014] [Indexed: 02/08/2023]
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Martinez M, LeBlanc J, Al-Haddad M, Sherman S, DeWitt J. Role of endoscopic ultrasound fine-needle aspiration evaluating adrenal gland enlargement or mass. World J Nephrol 2014; 3:92-100. [PMID: 25332900 PMCID: PMC4202496 DOI: 10.5527/wjn.v3.i3.92] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To report the clinical impact of adrenal endoscopic ultrasound fine-needle aspiration (EUS-FNA) in the evaluation of patients with adrenal gland enlargement or mass.
METHODS: In a retrospective single-center case-series, patients undergoing EUS-FNA of either adrenal gland from 1997-2011 in our tertiary care center were included. Medical records were reviewed and results of EUS, cytology, adrenal size change on follow-up imaging ≥ 6 mo after EUS and any repeat EUS or surgery were abstracted. A lesion was considered benign if: (1) EUS-FNA cytology was benign and the lesion remained < 1 cm from its original size on follow-up computed tomography (CT), magnetic resonance imaging or repeat EUS ≥ 6 mo after EUS-FNA; or (2) subsequent adrenalectomy and surgical pathology was benign.
RESULTS: Ninety-four patients had left (n = 90) and/or right (n = 5) adrenal EUS-FNA without adverse events. EUS indications included: cancer staging or suspected recurrence (n = 31), pancreatic (n = 20), mediastinal (n = 10), adrenal (n = 7), lung (n = 7) mass or other indication (n = 19). Diagnoses after adrenal EUS-FNA included metastatic lung (n = 10), esophageal (n= 5), colon (n = 2), or other cancer (n = 8); benign primary adrenal mass or benign tissue (n = 60); or was non-diagnostic (n = 9). Available follow-up confirmed a benign lesion in 5/9 non-diagnostic aspirates and 32/60 benign aspirates. Four of the 60 benign aspirates were later confirmed as malignant by repeat biopsy, follow-up CT, or adrenalectomy. Adrenal EUS-FNA diagnosed metastatic cancer in 24, and ruled out metastasis in 10 patients. For the diagnosis of malignancy, EUS-FNA of either adrenal had sensitivity, specificity, positive predictive value and negative predictive value of 86%, 97%, 96% and 89%, respectively.
CONCLUSION: Adrenal gland EUS-FNA is safe, minimally invasive and a sensitive technique with significant impact in the management of adrenal gland mass or enlargement.
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Abstract
Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.
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Affiliation(s)
- Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B 1070 Brussels, Belgium
| | - Mostafa Ibrahim
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B 1070 Brussels, Belgium
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Kang HJ, Hwangbo B, Lee GK, Nam BH, Lee HS, Kim MS, Lee JM, Zo JI, Lee HS, Han JY. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax 2013; 69:261-8. [DOI: 10.1136/thoraxjnl-2013-203881] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Stigt JA, ´t Hart NA, Knol AJ, Uil SM, Groen HJ. Pyrosequencing Analysis of EGFR and KRAS Mutations in EUS and EBUS-Derived Cytologic Samples of Adenocarcinomas of the Lung. J Thorac Oncol 2013; 8:1012-8. [DOI: 10.1097/jto.0b013e31829ce93e] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Tharian B, Tsiopoulos F, George N, Pietro SD, Attili F, Larghi A. Endoscopic ultrasound fine needle aspiration: Technique and applications in clinical practice. World J Gastrointest Endosc 2012; 4:532-44. [PMID: 23293723 PMCID: PMC3536850 DOI: 10.4253/wjge.v4.i12.532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 11/09/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
Since its initial report in 1992, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of adjacent organs. Its introduction constitutes a major breakthrough in the endoscopic field and has gradually transformed EUS from a pure imaging modality into a more interventional. In addition, the possibility of collecting samples, providing a definitive cytological and/or histological evidence of the presence of malignancy, has strongly contributed to changing EUS from a subjective, highly operator dependant procedure into a more objective one. This article will review the instrumentation, technique and the most important clinical applications of EUS-FNA.
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Affiliation(s)
- Benjamin Tharian
- Benjamin Tharian, Fotios Tsiopoulos, Nayana George, Salvatore Di Pietro, Fabia Attili, Alberto Larghi, Digestive Endoscopy Unit, Catholic University, 00168 Rome, Italy
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van der Heijden HF, Looijen-Salamon MG, Schuurbiers OC, Bussink J, Ligtenberg MJ. EBUS and EUS guided fine needle aspirations for molecular diagnostic analysis in lung cancer. Thorac Cancer 2012; 3:201-206. [DOI: 10.1111/j.1759-7714.2012.00116.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-125. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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