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Yang Y, Aruna, Cheng B, Xiong D, Kuang D, Cui H, Xiong S, Mao X, Feng Y, Zhao Y. Comparison of Fine-Needle Biopsy (FNB) versus Fine-Needle Aspiration (FNA) Combined with Flow Cytometry in the Diagnosis of Deep-Seated Lymphoma. Diagnostics (Basel) 2023; 13:2777. [PMID: 37685315 PMCID: PMC10487053 DOI: 10.3390/diagnostics13172777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Evidence comparing ultrasound endoscopy-guided fine-needle biopsy (EUS-FNB) with EUS-guided fine-needle aspiration (EUS-FNA) in deep-seated lymphoma tissue sampling is insufficient. This study aims to evaluate the diagnostic efficacy of immunohistochemistry (IHC) or flow cytometry (FCM) on specimens obtained from EUS-FNB and EUS-FNA in the diagnosis and staging of deep-seated lymphomas. This real-world, dual-center study prospectively evaluated all eligible specimens from patients who underwent EUS-FNB/FNA over an 8-year period. 53 patients were enrolled, with 23 patients in the EUS-FNB group and 30 patients in the EUS-FNA group. FNB yielded specimens with longer core tissues (0.80 mm [0.55, 1.00] vs. 0.45 mm [0.30, 0.50], p = 0.009) and higher scores of specimen adequacy [4 (3.75, 4.00) vs. 3 (1.00, 4.00), p = 0.025]. Overall analysis revealed that the diagnostic accuracy of IHC based on specimens acquired from EUS-FNB was significantly higher than that of EUS-FNA (91.30% vs. 60.00%, p = 0.013). After controlling confounding factors including lesion size and endoscopists, EUS-FNB with IHC maintained a higher-level diagnostic accuracy compared to EUS-FNA (OR = 1.292 [1.037-1.609], p = 0.023). When FCM was additionally used to analyze the specimen acquired from EUS-FNA, the diagnostic yield was significantly improved (ROC AUC: 0.733 vs. 0.550, p = 0.015), and the AUC of FNB alone or combined with FCM was 0.739 and 0.761. Conclusions: FNB needles generate higher histopathological diagnostic accuracy and specimen quality than FNA for the deep-seated lymphoma. Though the application of FCM significantly improves the diagnostic efficacy of EUS-FNA, FNB was still the preferred diagnostic modality with a shorter procedure time, comparable diagnostic accuracy, and better cost-effectiveness.
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Affiliation(s)
- Yilei Yang
- The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430030, China; (Y.Y.); (A.); (H.C.); (S.X.)
| | - Aruna
- The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430030, China; (Y.Y.); (A.); (H.C.); (S.X.)
| | - Bin Cheng
- The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430030, China; (Y.Y.); (A.); (H.C.); (S.X.)
| | - Dingkun Xiong
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (D.X.); (Y.F.)
| | - Dong Kuang
- The Division of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Haochen Cui
- The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430030, China; (Y.Y.); (A.); (H.C.); (S.X.)
| | - Si Xiong
- The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430030, China; (Y.Y.); (A.); (H.C.); (S.X.)
| | - Xia Mao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Yunlu Feng
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (D.X.); (Y.F.)
| | - Yuchong Zhao
- The Division of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430030, China; (Y.Y.); (A.); (H.C.); (S.X.)
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Tejedor-Tejada J, Chavarría C, Burgueño-Gómez B, Fanjul I, García-Alonso FJ, Torres MÁ, Madrigal B, Pérez-Miranda M, De la Serna-Higuera C. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and classification of lymphomas. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:404-410. [PMID: 33222483 DOI: 10.17235/reed.2020.7191/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and effective technique in the diagnosis of mediastinal and abdominal masses. However, the usefulness of EUS-FNA in the diagnosis and classification of lymphomas is controversial. The aim of this study was to determine the yield of EUS-FNA in the diagnosis and classification of lymphomas. METHODS a retrospective case series was performed in a tertiary referral center. All consecutive patients referred for EUS-FNA with a suspected diagnosis of lymphoma from March 2013 to June 2019 were included. RESULTS thirty-five patients (54.3 % women, median age 72 years) were included. The most frequent location of the node was the abdomen (67.9 %). Nodes were punctured using a 22-gauge (85.7 %) and 19-gauge needle (14.3 %) with a slow-pull technique. The number of passes performed were three or more in 82.9 % of patients. The samples were processed by the cellblock method. Adequate samples for immunohistochemical and molecular biological study were obtained in 33 (94.3 %) patients. EUS-FNA correctly diagnosed lymphoma in 30 out of 35 patients (85.7 %), and subclassification was determined in 23 patients (65.7 %). The most frequent diagnosis was non-Hodgkin lymphoma (85.7 %). There was one moderate adverse event (bleeding), which was resolved during the procedure. CONCLUSIONS EUS-FNA may be a valuable technique in the evaluation of suspected lymphomas with an adequate diagnostic yield and a very low rate of adverse events.
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Affiliation(s)
- Javier Tejedor-Tejada
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Carlos Chavarría
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Beatriz Burgueño-Gómez
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Ignacio Fanjul
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | | | | | | | - Manuel Pérez-Miranda
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
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Chi PD, Liu YJ, Huang YH, Mao MJ, Wang Y, Li ZM, Li J. Rinsing sampling of core needle biopsy for flow cytometric analysis: A favorable method for lymphoma diagnosis. Cancer Med 2020; 9:9336-9345. [PMID: 33070470 PMCID: PMC7774716 DOI: 10.1002/cam4.3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/08/2020] [Accepted: 09/24/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Conventional protocols utilize core needle biopsy (CNB) or fine needle aspiration (FNA) to produce cell suspension for flow cytometry (FCM) is a diagnostic challenge for lymphoid malignancies. We aim to develop an alternative CNB rinsing technique (RT) to produce cell suspension for FCM during this mini-invasive procedure of CNB for lymphoma diagnosis. METHODS FNA and CNB specimens from the same lesion of 93 patients with suspected lymphoma were collected under the guidance of B-ultrasound simultaneously. The fresh CNB samples were prepared to cell suspension by RT for FCM immunophenotyping analysis (Group CNB-RT). Then, the CNB tissues after performing the RT process and the fresh FNA tissues were processed by conventional tissue cell suspension (TCS) technique to obtain the cell suspensions (Groups of CNB-TCS & FNA-TCS), respectively, as comparison. The diagnostic efficacies, as well as the concordances of the FCM results with reference to the morphologic diagnoses were compared in these three groups. RESULTS RT could yield sufficient cells for FCM immunophenotyping analysis, though a lower cell numbers compared to TCS technique. The diagnostic concordance was comparable in group CNB-RT (91.1%) to the group CNB-TCS (88.9%) and group FNA-TCS (88.4%) (p = 0.819). The diagnostic sensitivity and specificity of CNB-RT (91.1%; 100%) was not inferior to that of CNB-TCS (88.9%; 100%) and FNA-TCS (88.4%; 98.8%). CONCLUSIONS This study shows the CNB-RT presented non-inferior diagnostic concordance and efficacy as compared to the TCS technique. CNB-RT has the potential to produce cell suspension for FCM immunophenotyping while preserving tissue for lymphoma diagnosis and research.
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Affiliation(s)
- Pei-Dong Chi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yi-Jun Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yu-Hua Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Ming-Jie Mao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yu Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Internal Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Zhi-Ming Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Internal Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Jian Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
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Diagnosis of Hodgkin Lymphoma from Cell Block: A Reliable and Helpful Tool in "Selected" Diagnostic Practice. Diagnostics (Basel) 2020; 10:diagnostics10100748. [PMID: 32992679 PMCID: PMC7601842 DOI: 10.3390/diagnostics10100748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The diagnosis of lymphoma requires surgical specimens to perform morphological evaluation, immunohistochemical and molecular analyses. Ultrasound-guided fine needle aspiration may represent an appropriate first approach to obtain cytological samples in impalpable lesions and/or in patients unsuitable for surgical procedures. Although cytology has intrinsic limitations, the cell block method may increase the possibility of achieving an accurate diagnosis. Methods: We retrospectively selected a total of 47 ultrasound-guided fine needle aspiration and drainage samples taken from patients with effusion and deep-seated lesions which are clinically suspicious in terms of malignancy. Results: In 27 cases, both cell block and conventional cytology were performed: 21/27 cell blocks were adequate for the diagnosis of lymphoma and suitable for immunocytochemistry and molecular analyses vs. 12/20 samples to which only conventional cytology was applied. Moreover, in five patients we were able to make a diagnosis of Hodgkin lymphoma with the cell block (CB) technique. Conclusions: Contrary to conventional cytology, the cell block method may allow immunocytochemistry and molecular studies providing useful information for the diagnosis and subtypization of lymphoma in patients unsuitable for surgical procedure or with deep-seated lesions or extra-nodal diseases; additionally, it is a daily, simple and helpful approach. Moreover, we describe the usefulness of cell blocks in the diagnosis of Hodgkin lymphoma.
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Mehershahi S, Ghazanfar H, Shaikh DH, Baiomi A, Ihimoyan A. Recent Anti-platelet Therapy Revealing Underlying Undiagnosed Gastrointestinal Stromal Tumor in Otherwise Healthy Patient. Cureus 2020; 12:e7450. [PMID: 32351829 PMCID: PMC7186083 DOI: 10.7759/cureus.7450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) are uncommon tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. Usually, GIST presents as chronic gastrointestinal symptoms or obscure gastrointestinal bleed. Not many cases have been reported in the literature with acute symptoms in the setting of recent aspirin use. We report a case of 70-year-old male otherwise healthy who presented to the hospital with the complaint of black tarry stool for the past two days after taking one tablet of aspirin once a day for two days. The patient underwent upper endoscopy which showed a moderate size polypoid mass in the gastric fundus. Initially, standard endoscopic biopsy was negative for malignancy, due to high suspicion for GIST, later the patient underwent upper endoscopic ultrasound with fine-needle aspiration which confirmed low-grade GIST.
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Affiliation(s)
| | | | | | - Ahmed Baiomi
- Internal Medicine, BronxCare Health System, Bronx, USA
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Ding S, Lu A, Chen X, Xu B, Wu N, Edoo MIA, Zheng S, Li Q. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration: A single-center analysis. Int J Med Sci 2020; 17:2861-2868. [PMID: 33162814 PMCID: PMC7645325 DOI: 10.7150/ijms.48882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) has become an important modality for identification of intra-abdominal masses. This study analyzed the accuracy of EUS-FNAB in a single medical center and explored factors related to positive diagnosis. Materials and methods: In total, 77 patients with EUS-FNAB were retrospectively reviewed from July 2016 to February 2020. "Atypical (tends to be neoplasm/malignancy)," "suspicious (first consider neoplasm/malignancy)," and "malignant" were defined as positive cytology. The final diagnoses were based on histopathologic examination. The positive rate of EUS-FNAB for the diagnosis of neoplasm and its associations with age, sex, target puncture mass size, liver function, tumor markers, albumin, hypertension, and diabetes were examined. Results: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNAB cytologic diagnoses in all patients were 77.9% (60/77), 76.1% (54/71), 100%, 100%, and 26.1% (6/23), respectively. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNAB cytologic diagnoses in the pancreas were 80.0% (48/60), 79.3% (46/58), 100%, 100%, and 14.3% (2/14), respectively. The results of EUS-FNAB in pancreatic masses showed that the level of CA19-9 was higher in the true positive group than in the false-negative group (p<0.05). There were no factors associated with the true positive cytologic diagnoses (p>0.05). Conclusions: Our single-medical center study showed that EUS-FNAB is an accurate diagnostic procedure for the evaluation of intra-abdominal masses. Further follow-up is required to explore factors associated with the true positive cytology.
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Affiliation(s)
- Songming Ding
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, #848 Dongxin Road, Hangzhou, Zhejiang, P.R. China
| | - Aili Lu
- Division of oncology department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Xinhua Chen
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, ZhejiangUniversity School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Bingqian Xu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, #848 Dongxin Road, Hangzhou, Zhejiang, P.R. China
| | - Ning Wu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, #848 Dongxin Road, Hangzhou, Zhejiang, P.R. China
| | - Muhammad Ibrahim Alhadi Edoo
- Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, ZhejiangUniversity School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Shusen Zheng
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, #848 Dongxin Road, Hangzhou, Zhejiang, P.R. China.,Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, ZhejiangUniversity School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Qiyong Li
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, #848 Dongxin Road, Hangzhou, Zhejiang, P.R. China
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Candoli P, Ceron L, Trisolini R, Romagnoli M, Michieletto L, Scarlata S, Galasso T, Leoncini F, Pasini V, Dennetta D, Marchesani F, Zotti M, Corbetta L. Competence in endosonographic techniques. Panminerva Med 2019; 61:249-279. [DOI: 10.23736/s0031-0808.18.03570-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
EUS-guided tissue acquisition technique plays an essential role for evaluation of gastrointestinal tumors. Several components affect the yield of EUS-guided tissue acquisition outcomes such as sampling techniques, use of ROSE (rapid onsite evaluation), training and experience, and needle designs. In this review we discuss advancement in EUS-guided fine needle sampling.
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Abdelfatah MM, Hamed A, Koutlas NJ, Aly FZ. The diagnostic and cellularity yield of reverse bevel versus fork-tip fine needle biopsy. Diagn Cytopathol 2018; 46:649-655. [PMID: 29737018 DOI: 10.1002/dc.23966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/06/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Two new systems with a novel tip (Procore™ and SharkCore™) have been introduced for ultrasound-guided fine needle biopsy (US-FNB). Direct comparison of the diagnostic yield of these needles in the evaluation of pancreatic lesions is currently under investigation. This study aims to compare the diagnostic and cellular yields of the two needle systems. METHODS Consecutive patients with upper gastrointestinal lesions undergoing EUS-FNB using 22 gauge Procore™ (reverse bevel) or SharkCore™ (fork-tip) needles were included in the study. Cytological rapid on-site evaluation (ROSE) slides were scored on a numerical scale of diagnostic yield relative to the number of passes. Similarly, histology of biopsy material was assessed on diagnostic quality using a numeric score. The final diagnosis was based on resection specimens and/or follow-up of clinical and imaging data of the subject. RESULTS The diagnostic yield was similar between the fork-tip and reverse bevel needles (125/163; 77% vs 103/139;74% with P = .60). Sub-analysis for solid pancreatic masses demonstrated similar results (69/88; 78% vs. 83/107; 78% with P = .88). The fork-tip needle had a lower mean number of passes (2.5 vs 3.1; P = .04) and ROSE was utilized in significantly less cases than in the reverse bevel needle group (77% versus 98.3%). CONCLUSIONS Although we observed no difference in the diagnostic yield using either the fork-tip or the reverse bevel needle, the fork-tip needle had significantly better performance with regards to achieving more adequate cytologic specimen in fewer number of passes while at the same time requiring fewer episodes of ROSE.
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Affiliation(s)
- Mohamed M Abdelfatah
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, North Carolina
| | - Ahmed Hamed
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, North Carolina
| | - Nicholas J Koutlas
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, North Carolina
| | - F Zahra Aly
- Department of Pathology and Laboratory Medicine, East Carolina University, Greenville, North Carolina
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Liu YM, Yang XJ. Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop. World J Gastroenterol 2017; 23:2795-2801. [PMID: 28487617 PMCID: PMC5403759 DOI: 10.3748/wjg.v23.i15.2795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/20/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy (EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors.
METHODS Ten consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up.
RESULTS EUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors (GISTs), and only one case of chronic non-atrophic gastritis. That is, nine (90%) of the cases treated by EUS-CHDB showed positive findings.
CONCLUSION EUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.
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FNA diagnosis of deep-seated lymphoma: an institutional experience. J Am Soc Cytopathol 2017; 6:114-119. [PMID: 31043261 DOI: 10.1016/j.jasc.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Controversy remains as to whether image-guided fine-needle aspiration (FNA) biopsy coupled with appropriate ancillary techniques has clinical utility in the diagnosis of deep-seated lymphomas. MATERIALS AND METHODS A retrospective search (20 years) was performed to identify FNA cases with a definitive or indeterminate lymphoma diagnosis for deep-seated locations. The FNA diagnosis was compared with corresponding surgical pathology (SP) and clinical follow-up. The application of ancillary tests was also evaluated. RESULTS A total of 121 cases from 118 patients were recovered. Among 95 of 121 (79%) aspirates that had a definitive lymphoma diagnosis, 50 lacked SP follow-up. Most (82%) represented possible recurrent lymphoma, and thus therapy proceeded based on the FNA results alone. Additionally, 44 of 95 (46%) had an FNA diagnosis concordant with corresponding SP and 1 case was discordant. Of 44 with concordant SP diagnosis, 25 had further lymphoma subtyping that was concordant with SP. There were 26 of 121 (21%) with indeterminate diagnosis on FNAs. Of these, SP confirmed a diagnosis of lymphoma in 81%. Indeterminate cytologic diagnoses were due either to absent/inconclusive flow cytometry (FC) (11 of 21) or Hodgkin lymphoma (10 of 21). Of 121 cases, 93 utilized FC, 53 utilized cell-block immunohistochemical stains, and 29 utilized molecular testing as part of FNA work-up. CONCLUSIONS FNA plays an important role in the diagnosis/clinical management of deep-seated non-Hodgkin B cell lymphoma (NHL), particularly for recurrence. The addition of ancillary techniques, particularly FC, markedly increases NHL diagnostic accuracy and subclassification. Our study is one of the few large series examining the clinical utility of FNA in the setting of deep-seated lymphomas.
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Othman MO, Abdelfatah MM, Padilla O, Hussinat M, Elhanafi S, Eloliby M, Torabi A, Hakim N, Boman DA. The cellularity yield of three different 22-gauge endoscopic ultrasound fine needle aspiration needles. Diagn Cytopathol 2017; 45:426-432. [PMID: 28261978 DOI: 10.1002/dc.23689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) fine needle aspiration (FNA) is an integral part in the diagnosis of pancreatic, intestinal and extra-intestinal masses or lesions. There is no clear data on the superiority of the core biopsy needle over standard 22-gauge needles. The aim of this study is to prospectively compare the cellularity yield of three commonly used 22-gauge FNA needles available in the US market. METHODS This is a prospective, randomized study comparing the cellularity yield of three commercially available EUS needles (two standard FNA needles and core biopsy needle). Two blinded pathologists evaluated the cytology specimens based on an already agreed upon cytology score. We included adult patients (18-80 years old) who presented to our endoscopy unit for FNA of pancreatic or extrapancreatic masses. RESULTS 109 patients (57 F, 52 M) were recruited to the study, 88 lesions were pancreatic lesions. 39 patients were recruited in the EZ Shot 2™ group, 36 in the Procore® group and 34 in the Expect™ group. The average cellularity score and the mean number of passes (SD) were not different between the three needles; P = 0.91 and P = 0.16, respectively. There was no difference between the three needles in obtaining an onsite diagnosis (P = 0.627) and no difference in reported adverse events between the three groups. CONCLUSION The cellularity yields, the mean number of passes and reported adverse events were similar in the three compared 22-gauge needles. Diagn. Cytopathol. 2017;45:426-432. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Mohamed M Abdelfatah
- Division of Gastroenterology, Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Osvaldo Padilla
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Maha Hussinat
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Sherif Elhanafi
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Mohamed Eloliby
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Alireza Torabi
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Nawar Hakim
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Darius A Boman
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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Abstract
Pancreatic cytopathology, particularly through the use of endoscopic ultrasound-guided fine-needle aspiration (FNA), has excellent specificity and sensitivity for the diagnosis of pancreatic lesions. Such diagnoses can help guide preoperative management of patients, provide prognostic information, and confirm diagnoses in patients who are not surgical candidates. Furthermore, FNA can be used to obtain cyst fluid for ancillary tests that can improve the diagnosis of cystic lesions. In this article, we describe the cytomorphological features and differential diagnoses of the most commonly encountered pancreatic lesions on FNA.
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Affiliation(s)
- Jennifer A Collins
- Department of Pathology, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Jin M, Wakely PE. Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas. Acta Cytol 2016; 60:326-335. [PMID: 27414717 DOI: 10.1159/000447253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/24/2016] [Indexed: 12/14/2022]
Abstract
Evaluation of deep-seated lymphomas by fine-needle aspiration (FNA) can be challenging due to their reduced accessibility. Controversy remains as to whether FNA and ancillary techniques can be used to diagnose deep-seated lymphomas reliably and sufficiently for clinical management. Most published studies are favorable that endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS)-FNA plays an important role in the diagnosis of deep-seated lymphomas. The addition of ancillary techniques, particularly flow cytometry, increases diagnostic yield. While subclassification is possible in a reasonable proportion of cases, the reported rates of successful subclassification are lower than those for lymphoma detection/diagnosis. The diagnostic limitation exists for Hodgkin's lymphoma, grading of follicular lymphoma, and some T-cell lymphomas. The role of FNA in deep-seated lymphomas is much better established for recurrent than primary disease. It remains unclear whether the use of large-sized-needle FNA or a combination of core needle biopsy and FNA improves subclassification. It is important for cytopathologists to have considerable understanding of the WHO lymphoma classification and develop a collaborative working relationship with hematopathologists and oncologists. As EUS/EBUS-FNA techniques advance and sophisticated molecular techniques such as next- generation sequencing become possible, the role of FNA in the diagnosis of deep-seated lymphomas will possibly increase.
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Affiliation(s)
- Ming Jin
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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16
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Poincloux L, André M, Darcha C, Goutte M, Dapoigny M, Bommelaer G, Abergel A, Tournilhac O. Usefulness of EUS-guided fine needle aspiration biopsy in the diagnosis of suspected or recurring lymphoproliferative disorders. Surg Oncol 2015; 25:459-465. [PMID: 26362342 DOI: 10.1016/j.suronc.2015.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND EUS-guided fine needle aspiration biopsy (EUS-FNAB) of deep-seated lymphadenopathy is proposed to identify lymphoproliferative disorders when no superficial lesion is accessible. METHODS We analyzed prospectively collected data of 115 EUS-FNABs from 73 thoracic or abdomino-pelvic targets in 52 patients with suspected lymphoproliferative disorders (LPDs) between January 2005 and May 2011 from a single institution. Conventional histology and immunohistochemistry procedures were performed on samples. RESULTS No complications were recorded. An LPD was identified in 29 cases and ruled out in 21 cases. In 2 cases the analysis was negative, but an LPD was identified using a secondary procedure. For the identification of LPDs irrespective of subtype, this procedure has positive and negative predictive values of 100% and 91.3% respectively, with 93.6% sensitivity and 100% specificity. In 31 patients finally diagnosed with LPDs, an accurate diagnosis meeting the 2008 World Health Organization classification criteria was established in 21 (68%) cases, success being significantly associated with target size above 30 mm in multivariate analysis (odds ratio 7.47; p = 0.05). CONCLUSION EUS-FNAB of deep-seated lymphadenopathy with conventional morphological assessment appears to have a high diagnostic value for LPD identification and can obviate invasive surgery. A sub-classification was possible in two thirds of the cases.
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Affiliation(s)
- Laurent Poincloux
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France; UMR Université d'Auvergne/CNRS 6284 ISIT, Clermont-Ferrand, France.
| | - Morgane André
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Claude Darcha
- Department of Pathology, CHU Gabriel Montpied Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Marion Goutte
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France; Clinical Research Unit, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Michel Dapoigny
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Gilles Bommelaer
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing de Clermont-Ferrand, F-63003 Clermont-Ferrand, France; UMR Université d'Auvergne/CNRS 6284 ISIT, Clermont-Ferrand, France
| | - Olivier Tournilhac
- Department of Haematology and Cell Therapy, CHU Estaing de Clermont-Ferrand, Inserm CIC-501, Université d'Auvergne, CREaT - EA3846, Clermont-Ferrand, France
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17
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Murad FM, Komanduri S, Abu Dayyeh BK, Chauhan SS, Enestvedt BK, Fujii-Lau LL, Konda V, Maple JT, Pannala R, Thosani NC, Banerjee S. Echoendoscopes. Gastrointest Endosc 2015; 82:189-202. [PMID: 26077457 DOI: 10.1016/j.gie.2015.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023]
Abstract
Advances in echoendoscopes and their processors have significantly expanded the role of EUS and its clinical applications.The diagnostic and therapeutic capabilities of EUS continue to evolve and improve. EUS has made a large impact on patient care but comes with significant startup and maintenance costs. As improved technology continues to enhance image resolution while decreasing the size of EUS processors, use of endosonography will become more widespread. EUS will continue to be a vital part of patient care and complement currently available cross-sectional imaging.
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18
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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] [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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Endosonography for the Diagnosis of Malignant Lymphoma Presenting With Mediastinal Lymphadenopathy. J Bronchology Interv Pulmonol 2014; 21:298-305. [DOI: 10.1097/lbr.0000000000000093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Nieuwoudt M, Lameris R, Corcoran C, Rossouw TM, Slavik T, Du Plessis J, Omoshoro-Jones JAO, Stivaktas P, Potgieter F, Van der Merwe SW. Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2031-2038. [PMID: 25023118 DOI: 10.1016/j.ultrasmedbio.2014.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 06/03/2023]
Abstract
Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7%, and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity, whereas PCR identified 90% of mycobacterial infections. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.
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Affiliation(s)
- Martin Nieuwoudt
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa; DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Roeland Lameris
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Craig Corcoran
- Department of Molecular Pathology, Ampath Laboratories, Pretoria, South Africa
| | - Theresa M Rossouw
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Tomas Slavik
- Department of Pathology, Ampath laboratories, Pretoria, South Africa; Department of Anatomical Pathology, University of Pretoria, Pretoria, South Africa
| | - Johannie Du Plessis
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Jones A O Omoshoro-Jones
- Department of Surgery, Chris Hani-Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Paraskevi Stivaktas
- MRC Unit of Inflammation and Immunity, Department of Immunology, University of Pretoria, Pretoria, South Africa; Tshwane Academic Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Fritz Potgieter
- Interventional GI Unit, Pretoria East Hospital, Pretoria, South Africa
| | - Schalk W Van der Merwe
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa.
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21
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Gimeno-García AZ, Elwassief A, Paquin SC, Sahai AV. Endoscopic ultrasound-guided fine needle aspiration cytology and biopsy in the evaluation of lymphoma. Endosc Ultrasound 2014; 1:17-22. [PMID: 24949331 PMCID: PMC4062204 DOI: 10.7178/eus.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/17/2012] [Accepted: 03/18/2012] [Indexed: 12/19/2022] Open
Abstract
Accurate diagnosis and subtyping of lymphoma have important prognostic implications and are generally required for treatment planning. Histological assessment, immunophenotyping, and genetic studies are usually necessary. Endoscopic ultrasound guided-fine needle aspiration cytology (EUS-FNAC) is a minimally invasive technique widely used for the evaluation of deep-seated benign and malignant lesions. However, the value of cytological samples in lymphoma diagnosis is still a matter of debate. Endoscopic ultrasound guided-fine needle biopsy (EUS-FNAB) can provide tissue core samples that may help overcome the limitations of cytology. The aim of this review is to summarize the available literature regarding EUS-FNAC and EUS-FNAB for the diagnosis and subtyping of lymphoma. In addition, we discuss its usefulness in the management of primary extra-nodal lymphomas, as well as technical issues that may influence sample quality.
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Affiliation(s)
- Antonio Z Gimeno-García
- Gastroenterology Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Ahmed Elwassief
- Internal Medicine Department, Gastroenterology Unit, Alhossien Hospital, Alazhar University, Cairo, Egypt
| | - Sarto C Paquin
- Gastroenterology Department, Saint Luc Hospital, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Anand V Sahai
- Gastroenterology Department, Saint Luc Hospital, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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22
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Ramesh J, Hebert-Magee S, Kim H, Trevino J, Varadarajulu S. Frequency of occurrence and characteristics of primary pancreatic lymphoma during endoscopic ultrasound guided fine needle aspiration: a retrospective study. Dig Liver Dis 2014; 46:470-3. [PMID: 24560534 PMCID: PMC4158694 DOI: 10.1016/j.dld.2013.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/15/2013] [Accepted: 12/20/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary pancreatic lymphoma is a rare tumour of the pancreas. Data on the role of endoscopic ultrasound guided fine needle aspiration for its diagnosis are scant. AIM To identify the frequency of occurrence, sonographic characteristics and cytological findings that are predictive of primary pancreatic lymphoma. METHODS Pancreatic lymphoma cases were identified by retrospective review of solid pancreatic masses over 10-year period. RESULTS 12/2397 (0.5%) lesions were identified. Patients were predominantly white (92%) and male (58%). Mean largest dimension was 47.5mm and 83.3% were located in the head. The mass appeared heterogeneous in 75% and peripancreatic lymphadenopathy was noted in 58%. None of the patients showed features of chronic pancreatitis or pancreatic ductal dilation. Rapid onsite analysis revealed atypical lymphocytes in 92%. Flow cytometry confirmed diagnosis in 75% of cases. CONCLUSIONS Primary pancreatic lymphoma is encountered in 0.5% of patients undergoing endoscopic ultrasound guided fine needle aspiration. A large heterogeneous mass, in the absence of chronic pancreatitis or pancreatic duct dilation that reveals atypical lymphocytes on fine needle aspiration is suggestive.
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Affiliation(s)
- Jayapal Ramesh
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA,Corresponding author at: Director of Endoscopic Ultrasound Program, Basil Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, BDB 389, 1808 7th Avenue South, Birmingham, AL 35294, USA. Tel.: + 1 205 996 4059; fax: + 1 205 975 6381. (J. Ramesh)
| | - Shantel Hebert-Magee
- Center for Interventional Endoscopy, Florida Hospital, Orlando, FL, USA,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hwasoon Kim
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica Trevino
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
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How can an endosonographer assess for diagnostic sufficiency and options for handling the endoscopic ultrasound-guided fine-needle aspiration specimen and ancillary studies. Gastrointest Endosc Clin N Am 2014; 24:29-56. [PMID: 24215759 DOI: 10.1016/j.giec.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become well established as a minimally invasive technique in diagnosing and staging various gastrointestinal, pancreaticobiliary, and retroperitoneal malignancies. The diagnostic accuracy of this procedure is significantly enhanced by the presence of on-site cytopathology. However, in many EUS centers, cytopathology is not readily available for on-site evaluation. This article is intended to assist the independent endosonographer in the assessment of diagnostic sufficiency and in specimen handling.
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24
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Abstract
FNA is a simple, safe, and an inexpensive sampling technique that plays an important role in the evaluation of lymphadenopathy. The key to enhancing the accuracy of FNA diagnosis of lymphoma is the multi parameter approach in which the cytomorphologic features are evaluated in correlation with the results of ancillary studies and clinical context. A full understanding of the current lymphoma classification, clinical features associated with each lymphoma subtype and the impact of the diagnosis on patient management is essential in FNA diagnosis of lymphoma. It is also important to recognize the limitations of FNA in the primary diagnosis of some subtypes of lymphoma, and tissue biopsy should be recommended for a definitive diagnosis and subclassification in such cases.
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Affiliation(s)
- Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
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25
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Zhang S, Gong Y. From cytomorphology to molecular pathology: maximizing the value of cytology of lymphoproliferative disorders and soft tissue tumors. Am J Clin Pathol 2013; 140:454-67. [PMID: 24045541 DOI: 10.1309/ajcphdovgw64fipb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The field of cytopathology has been rapidly advancing in the era of molecular pathology and personalized medicine. On-site cytologic evaluation for adequacy and triaging specimens for small core biopsy or fine-needle aspiration (FNA) are often required. Cytopathologists face the challenge of how to best triage small specimens for diagnosis, molecular testing, and personalized treatment. Owing to its minimally invasive nature, FNA alone or combined with core biopsy for lymphoproliferative disorders and soft tissue tumors has gained popularity. METHODS Literature review and author's institutional experience are used for this review article. This article will focus mainly on lymphoproliferative disorders and soft tissue tumors. RESULTS Evaluation combining cytomorphology, immunohistochemistry, and/or molecular pathology is often needed to accurately diagnose and classify lymphomas and soft tissue tumors. Many molecular tests have been performed on cytologic specimens, such as tests for BRAF and RET in thyroid FNA. CONCLUSIONS Molecular pathology has been widely integrated into conventional cytopathology for diagnosing lymphoproliferative disorders and soft tissue tumors, and the diagnostic value of FNA on those tumors has increased significantly. Cytology will play a more important role in the era of personalized medicine.
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Affiliation(s)
- Songlin Zhang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, TX, and the Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yun Gong
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, TX, and the Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Oka S, Muroi K, Sato K, Fujiwara SI, Oh I, Matsuyama T, Ohmine K, Suzuki T, Ozaki K, Mori M, Nagai T, Fukushima N, Fukushima N, Tanaka A, Ozawa K. Flow cytometric analysis of kappa and lambda light chain expression in endoscopic biopsy specimens before the diagnosis of B-cell lymphoma. J Clin Exp Hematop 2013; 52:127-31. [PMID: 23037629 DOI: 10.3960/jslrt.52.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Forty-eight patients with gastrointestinal (GI) tract B-cell lymphoma (BCL) were analyzed retrospectively. The diagnosis was based on the histological examination of specimens obtained by endoscopic biopsy. Before the diagnosis was made, single-color flow cytometry was performed to analyze the expression of light chains and B-cell antigens including CD10 in the specimens. Restricted light chain (RLC) expression, a marker of B-cell clonality, was defined as κ and λ ratios of either more than 3.0 or less than 0.5. The specimens from 30 patients (62.5%) showed RLC expression. No RLC expression or RLC expression not examined was divided into two groups : those showing CD10 positivity in more than 20% of cells (4 patients, 8.3%) and those showing no positivity (14 patients, 29.2%). The cell number analyzed in the latter group was significantly smaller than that in the other two groups. Abnormal karyotypes were found in the specimens from 8 patients (16.7%). These results indicate that the flow cytometric analysis of endoscopic biopsy specimens is useful when BCL is suspected if an adequate number of cells are obtained.
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Affiliation(s)
- Satoko Oka
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Osaka, Japan
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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] [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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28
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Korenblit J, Anantharaman A, Loren DE, Kowalski TE, Siddiqui AA. The role of endoscopic ultrasound-guided fine needle aspiration (eus-fna) for the diagnosis of intra-abdominal lymphadenopathy of unknown origin. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:172-176. [PMID: 23687604 DOI: 10.4161/jig.23742] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/16/2012] [Accepted: 08/28/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The diagnosis of intra-abdominal lymphadenopathy of is difficult, especially when no primary lesion has been identified. We aimed to evaluate the diagnostic yield of EUS-FNA cytology in patients with enlarged intra-abdominal lymph nodes of unknown etiology. PATIENT AND METHODS 147 patients with abdominal lymphadenopathy on imaging in whom EUS-FNA was performed with a 22-gauge needle. Performance characteristics of EUS-FNA including the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were compared between the 2 groups. RESULTS AThe location of the enlarged lymph nodes was the celiac axis (8.2%), peri-gastric (34%), peri-pancreatic (25.2%), peri-portal (27.9%), and other intra-abdominal locations (4.8%). The median number of EUS-FNA passes was 5. The final diagnosis were lymphoma in (n=27), metastatic adenocarcinoma (n=44) patients, other miscellaneous malignancies (n=22) and benign disease (n=54). The sensitivity, specificity, and accuracy of EUS-FNA were 89.7, 98.3, and 93.5% respectively. A false positive FNA result was present in only 1 case (0.7%); false negative FNA results were present in eight cases (5.8%). Lymph node morphologic features of roundness, echogenicity, and homogeneity on EUS were not a predictor of lymph node malignancy. CONCLUSION In a retrospective cohort trial, EUS-FNA was found to be highly accurate and safe in diagnosing patients with intra-abdominal lymphadenopathy of unknown etiology.
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Affiliation(s)
- Jason Korenblit
- Division of Gastroenterology and Hepatology, Department of Internal Medicine1, Thomas Jefferson University Hospital, Philadelphia, PA
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29
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Sodikoff JB, Johnson HL, Lewis MM, Garud SS, Bharmal SJ, Keilin SA, Siddiqui MT, Cai Q, Willingham FF. Increased diagnostic yield of endoscopic ultrasound-guided fine needle aspirates with flow cytometry and immunohistochemistry. Diagn Cytopathol 2012; 41:1043-51. [PMID: 22833389 DOI: 10.1002/dc.22903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/24/2012] [Indexed: 12/22/2022]
Abstract
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the most sensitive and specific test for establishing a tissue diagnosis for many gastrointestinal malignancies; however, cytologic morphology alone may not be definitive for subsets of tumors. Our aim was to quantify the impact of the broad application of flow cytometry (FC) and immunohistochemistry (IHC) on EUS-FNA diagnostic yield. A retrospective chart review was performed on EUS procedures at a tertiary referral, academic medical center. All EUS-FNA cases performed over a 21-month period were examined. Of 606 EUS procedures reviewed during the period of study, 264 utilized FNA. After pancreatic cyst cases were excluded, 235 EUS-FNA cases for 221 patients were selected for analysis. For cases with subsequent histological evaluation, including the subset utilizing FC/IHC, the sensitivity of EUS-FNA was 89%, specificity was 100%, and accuracy was 91%. One quarter (58/235, 25%) of the tissue specimens underwent further testing by FC/IHC. There were 48 definitive diagnoses made in the subset utilizing FC/IHC. In 20 of the 48 diagnoses (42%), FC/IHC was deemed critical to the diagnosis, and without FC/IHC testing in those cases, the overall sensitivity and accuracy of EUS-FNA would be reduced to 74 and 77%, respectively. FC/IHC allowed for six diagnoses rarely or not previously described by EUS-FNA. Application of FC/IHC improves characterization predominantly for nonadenocarcinoma tumor subtypes and may lead to a diagnostic result for tumors not previously characterized by EUS-FNA. With an adequate tissue sample, broad application of FC/IHC increases the diagnostic yield of EUS-FNA.
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Affiliation(s)
- Jamie B Sodikoff
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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da Cunha Santos G, Ko HM, Saieg MA, Geddie WR. “The petals and thorns” of ROSE (rapid on-site evaluation). Cancer Cytopathol 2012; 121:4-8. [DOI: 10.1002/cncy.21215] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/23/2012] [Indexed: 11/09/2022]
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[Role of endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS) for the evaluation of mediastinal adenopathy]. Bull Cancer 2012; 99:761-70. [PMID: 22713588 DOI: 10.1684/bdc.2012.1606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mediastinal lymphadenopathy may be detected by CT-scan or positron emission tomography. Malignant (e.g, lung cancer, metastatic cancer, lymphoma), infectious (e.g, tuberculosis, histoplasmosis), and systemic processes (e.g, sarcoidosis) can cause mediastinal adenopathy. In the posterior and inferior mediastinum, endoscopic ultrasound visualizes and directs transesophageal fine needle aspiration of adenopathy. In the anterior mediastinum, endobronchial ultrasound visualizes and directs transbronchial fine needle aspiration of adenopathy. We discuss the role of EUS and EBUS in the evaluation of mediastinal adenopathy according to their anatomical localization.
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Nunez AL, Jhala NC, Carroll AJ, Mikhail FM, Reddy VVB, Xian RR, Jhala DN. Endoscopic ultrasound and endobronchial ultrasound-guided fine-needle aspiration of deep-seated lymphadenopathy: Analysis of 1338 cases. Cytojournal 2012; 9:14. [PMID: 22615712 PMCID: PMC3352588 DOI: 10.4103/1742-6413.95845] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/12/2012] [Indexed: 02/07/2023] Open
Abstract
Background: We retrospectively studied 1338 samples of lymph nodes obtained by endoscopic and endobronchial ultrasound-guided fine needle aspiration biopsy (EUS and EBUS-FNAB) with an objective of characterizing the utility of this diagnostic modality in the assessment of deep-seated lymphadenopathy. The secondary aims were to establish the utility in the diagnosis of lymphoma and to determine the number of passes required to obtain adequate cellularity for flow cytometric analysis. Materials and Methods: On-site assessment was performed by a cytopathologist using Diff-Quik (American Scientific Products, McGraw Park, IL) stain. In addition, Papanicolaou and immunohistochemical stains were performed and additional samples were sent for flow cytometric analyses (n = 145). The final cytologic diagnosis was correlated with surgical pathology diagnosis and/or clinical follow-up. In select cases, fluorescence in situ hybridization analysis with specific probes was performed on Diff-Quik smears. Results: Both morphology as well as ancillary studies (flow cytometry or immunohistochemical stain and/or fluorescence in situ hybridization) show that EUS and EBUS-FNA are effective techniques to detect and stage intrathoracic and intra-abdominal tumors. Operating characteristics show that these are highly sensitive (89%) and specific (100%) techniques for the diagnosis of lymphoma. At least two passes provided an average of 5.66 million cells (range, 0.12-62.32 million) for lymphoma cases. Conclusions: EUS and EBUS-FNA are powerful modalities to stage malignancies and at least two passes can provide adequate cells for flow cytometric analysis. We also demonstrate that fluorescence in situ hybridization analysis can be performed on Diff-Quik-stained and mounted smears.
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Affiliation(s)
- Amberly L Nunez
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Endoscopic ultrasound-guided fine needle aspiration biopsy for diagnosis of lymphoproliferative disorders: feasibility of immunohistological, flow cytometric, and cytogenetic assessments. Am J Gastroenterol 2012; 107:397-404. [PMID: 21989147 DOI: 10.1038/ajg.2011.350] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In addition to morphology, immunophenotype and genetic abnormalities should be assessed during diagnosis and subclassification of lymphoproliferative disorders. The objective of this study was to evaluate the yield of endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) using a standard 19-gauge needle for diagnosis and subclassification of lymphoma, assessing the feasibility of immunohistological, flow cytometric, and cytogenetic assessments. METHODS Two hundred forty patients with suspected lymphoma were referred for EUS-FNAB to our quaternary EUS center between June 2005 and December 2010. EUS-FNAB using a conventional 19-gauge needle was attempted for all patients, followed by histological assessments including immunohistological staining, flow cytometry, and cytogenetic analysis (G-band karyotyping). Among the patients, 152 were ultimately diagnosed with lymphoma. The primary outcome measure of this study was the sensitivity of histological assessment, including immunohistological staining, flow cytometry, and G-band karyotyping, for diagnosis and subclassification of lymphoma. RESULTS Among the 152 patients ultimately diagnosed with lymphoma, 147 patients (96.7%) were diagnosed by EUS-FNAB, and classification in accordance with the WHO (World Health Organization) system was also possible for 135 patients (88.8%) on the basis of histological findings, including immunohistological staining. Flow cytometry showed abnormal or unusual cell populations in 121 (79.6%) of the 152 patients diagnosed with lymphoma, and in 114 (90.5%) of the 126 patients diagnosed with B-cell lymphoma. Specific cytogenetic abnormalities were detected in 21 (13.8%) of the lymphoma patients. CONCLUSIONS EUS-FNAB using a standard 19-gauge needle has high diagnostic value for lymphoma. Immunophenotyping is usually possible, while cytogenetic abnormalities can be identified in a relatively limited number of patients.
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Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc 2011; 74:239-45. [PMID: 21802583 DOI: 10.1016/j.gie.2011.03.1255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/11/2022]
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van Krieken JH. New developments in the pathology of malignant lymphoma: a review of the literature published from October 2009 to January 2010. J Hematop 2011; 3:47-58. [PMID: 21633487 DOI: 10.1007/s12308-010-0060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- J Han van Krieken
- Department of Pathology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Ko HM, da Cunha Santos G, Darling G, Pierre A, Yasufuku K, Boerner SL, Geddie WR. Diagnosis and subclassification of lymphomas and non-neoplastic lesions involving mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration. Diagn Cytopathol 2011; 41:1023-30. [PMID: 21630485 DOI: 10.1002/dc.21741] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/16/2011] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been established for staging mediastinal lymph nodes in lung carcinoma patients with radiologically enlarged lymph nodes, but its utility for evaluation of primary lymph node disorders is not well defined. The objective of this study was to evaluate the usefulness of EBUS-TBNA with on-site assessment and triage of sample for multiple ancillary techniques, for the diagnosis and subclassification of lymphomas and non-neoplastic lesions involving mediastinal lymph nodes. METHODS One hundred and twenty consecutive patients who underwent EBUS-TBNA between January 2008 and August 2009 were reviewed. The final cytological diagnosis was based on air-dried Romanowsky and alcohol-fixed Papanicolaou stained direct smears, immunohistochemistry, immunophenotyping, and fluorescence in situ hybridization (FISH). RESULTS A total of 38 cases were included in this study consisting of eight reactive lymphoid hyperplasia, 20 granulomatous lymphadenitis (17 non-necrotizing and 3 necrotizing granulomatous inflammations), 3 Hodgkin lymphomas and 7 non-Hodgkin lymphomas (1 small lymphocytic lymphoma (SLL), 1 SLL with scattered Reed-Sternberg cells, 1 marginal zone lymphoma, and 4 large B cell lymphomas). Cultures performed in 13 cases were negative for AFB and fungi. Immunophenotyping and immunohistochemistry for MIB1 in six cases, and FISH in five cases provided necessary information for subclassification. CONCLUSIONS EBUS-TBNA is a minimally invasive procedure which provides sufficient sample for definitive primary diagnosis and classification of malignant lymphoma and granulomatous inflammation in patients with mediastinal lymphadenopathy. Rapid on-site specimen assessment is invaluable for appropriate assignment of sample to ancillary studies.
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Affiliation(s)
- Hyang Mi Ko
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
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Endoscopic ultrasound fine needle aspiration in the diagnosis of lymphoma. JOURNAL OF ONCOLOGY 2011; 2011:785425. [PMID: 21559244 PMCID: PMC3087462 DOI: 10.1155/2011/785425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 01/09/2011] [Accepted: 02/19/2011] [Indexed: 12/20/2022]
Abstract
In recent years, endoscopic ultrasound techniques with Fine Needle Aspiration (FNA) have become an increasingly used diagnostic aid in the differentiation of mediastinal lymphadenopathy. Endobronchial ultrasound (EBUS) and endoesophageal ultrasound (EUS) are now available for clinicians to reach mediastinal and paramediastinal masses using a minimally invasive approach. These techniques are an established component for diagnosing and staging lung cancer and their benefit in the diagnosis of lymphoma's has been highlighted in a number of case studies. However, the lack of tissue architecture obtained by cytological FNA specimens decreases the diagnostic accuracy for benign causes of thoracic lymphadenopathies, lymphomas, and histopathological subtyping of lung cancer. Accordingly, our study group have adapted the FNA sampling technique, resulting in tissue fragments that can be used for histopathological examinations. As an illustration, we report a case of follicular non-Hodgkin lymphoma, diagnosed on tissue fragments obtained by adjusted EUS FNA. We believe that this relatively simple adjustment to routine FNA sampling can help to overcome the diagnostic limitations inherent in cytology obtained by routine FNA.
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Stacchini A, Carucci P, Pacchioni D, Accinelli G, Demurtas A, Aliberti S, Bosco M, Bruno M, Balbo Mussetto A, Rizzetto M, Bussolati G, De Angelis C. Diagnosis of deep-seated lymphomas by endoscopic ultrasound-guided fine needle aspiration combined with flow cytometry. Cytopathology 2011; 23:50-6. [PMID: 21219488 DOI: 10.1111/j.1365-2303.2010.00842.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although endoscopic ultrasound combined with fine needle aspiration (EUS-FNA) is rapidly becoming the preferred diagnostic approach for the sampling and diagnosis of gastrointestinal and mediastinal malignancies, there are limited data as to its use in the diagnosis of lymphoproliferative disorders. Therefore, we carried out a retrospective evaluation of the performance of EUS-guided FNA combined with flow cytometry (FC) as a tool to improve overall sensitivity and specificity in the diagnosis of lymphoma. METHODS Of 1560 patients having EUS-guided FNA during the period of the study, a total of 56 patients were evaluated by cytology with FC after EUS-FNA. There was adequate material to perform FC analysis for all but one case. RESULTS EUS-FNA-FC gave a diagnosis of lymphoma in 11 cases and of reactive lymphadenopathy in 20. A specific histological type was defined by FC alone in eight cases. The remaining cases were diagnosed later by cytology and cell block sections: 13 carcinomas, nine granulomatous lymphadenopathies and one mediastinal extramedullary haematopoiesis. One case was considered only suspicious for lymphoma on cytology and FC but was not confirmed on molecular analysis and one had insufficient material for FC. CONCLUSIONS Our results show that a combination of EUS-FNA-FC is a feasible and highly accurate method, which may be used for the diagnosis and subtyping of deep-seated lymphoma, providing a significant improvement to cytomorphology alone both for diagnosis and treatment planning, as long as immunocytochemistry is available for non-lymphoma cases.
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Affiliation(s)
- A Stacchini
- Flow Cytometry Unit, Department of Pathology, Molinette Hospital, Turin, Italy.
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Zeppa P, Barra E, Napolitano V, Cozzolino I, Troncone G, Picardi M, De Renzo A, Mainenti PP, Vetrani A, Palombini L. Impact of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lymph nodal and mediastinal lesions: a multicenter experience. Diagn Cytopathol 2010; 39:723-9. [PMID: 20960473 DOI: 10.1002/dc.21450] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/25/2010] [Indexed: 11/06/2022]
Abstract
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established procedure in lung cancer (LC) staging and in the diagnosis of mediastinal masses. Most of the experiences reported refer to single specialized centers where dedicated teams of endoscopists and pathologists perform the procedure. We report the EUS-FNA experience of a cooperation group involving clinicians and cytopathologists from three hospitals. Fifty-seven consecutive EUS-FNA of mediastinal nodes in LC patients, eight mediastinal and two subdiaphragmatic masses were collected in 3 years. EUS-FNA was performed by two endoscopists and three experienced pathologists. On-site evaluation was performed in all cases by the three cytopathologists. Lymph node negative cases underwent surgery, which confirmed the cytological diagnoses but also detected two false negatives. Four of the 10 EUS cytological diagnoses of mediastinal and subdiaphragmatic masses were histologically confirmed. All EUS diagnoses were blindly reviewed by three pathologists to assess intra and interpersonal reproducibility. FNA-EUS diagnoses were: 10 inadequate (17%), 10 negative (17%), 4 suspicious (7%) and 33 positive (59%). Diagnoses of mediastinal and subdiaphragmatic masses were: relapse of lung carcinoma (3), mesenchimal tumor not otherwise specifiable (3), gastrointestinal stromal tumor (GIST) (1), esophageal carcinoma (2) and paraganglioma (1). The sensitivity attained was 85% and the specificity 100%; revision of the slides demonstrated a significant diagnostic reproducibility of the three cytopathologists (P < 0.5). The sensitivity and specificity attained were similar to those reported in the literature suggesting that experienced cytopathologists and endoscopists from different institutions can employ the same procedure reaching comparable results.
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Affiliation(s)
- Pio Zeppa
- Dipartimento di Scienze Biomorfologiche e Funzionali, Università di Napoli Federico II, Napoli, Italia.
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Wakely PE. The diagnosis of non-Hodgkin lymphoma using fine-needle aspiration cytopathology. Cancer Cytopathol 2010; 118:238-43. [DOI: 10.1002/cncy.20106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kwan V, Gottlieb D. Endoscopic ultrasound-fine needle aspiration for the diagnosis of lymphoma: are we there yet? J Gastroenterol Hepatol 2009; 24:1808-9. [PMID: 20002939 DOI: 10.1111/j.1440-1746.2009.06137.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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