1
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Yu S, Doyle LA, Hornick JL, Mito JK. The diagnostic utility of methylthioadenosine phosphorylase immunohistochemistry for pancreatic ductal adenocarcinoma in FNA and small biopsy specimens. Cancer Cytopathol 2024; 132:87-95. [PMID: 38054349 DOI: 10.1002/cncy.22777] [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: 08/07/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Accurate diagnosis of pancreatic lesions by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or fine-needle biopsy can be challenging. Although surrogate immunohistochemical markers for genetic alterations associated with pancreatic ductal adenocarcinoma (PDAC) have been identified, they have modest sensitivity. Biallelic loss of CDKN2A occurs in up to 46% of PDACs, and methylthioadenosine phosphorylase (MTAP) immunohistochemistry (IHC) has been identified as a reliable surrogate marker for this alteration. The current study evaluates the utility of MTAP IHC for the diagnosis of PDAC. METHODS In total, 136 cases of EUS-FNA cell block or core biopsy targeting solid pancreatic masses were identified. MTAP IHC was performed and evaluated for complete loss of expression in neoplastic cells. These results were correlated with available clinical next-generation sequencing that was performed on a subset of cases. RESULTS Complete loss of MTAP expression was identified in 23 of 80 (29%) PDACs. A subset of cases classified as suspicious (4 of 21) and atypical (4 of 22) showed MTAP loss. All morphologically indeterminate cases with MTAP loss were confirmed as PDAC on resection/additional sampling. No benign samples (n = 13) showed loss of MTAP. In samples that had available clinical next-generation sequencing data (n = 13), copy number loss of CDKN2A was detected in all cases that had loss of MTAP expression (n = 4). CONCLUSIONS Loss of MTAP was identified in approximately 30% of PDAC small biopsy specimens. As loss of MTAP expression is not expected in nonneoplastic cells, and these findings suggest that MTAP IHC can support a diagnosis of PDAC in small biopsy samples.
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Affiliation(s)
- Sanhong Yu
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Milluzzo SM, Olivari N, Rossi G, Bianchi D, Liserre B, Graffeo M, Lovera M, Correale L, Hassan C, Spada C. Rapid on-site evaluation improves the sensitivity of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for solid pancreatic lesions irrespective of technique: A single-centre experience. Cytopathology 2023; 34:318-324. [PMID: 37186418 DOI: 10.1111/cyt.13237] [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: 06/30/2022] [Revised: 02/20/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the first-line technique for the sampling of pancreatic lesions. Many factors can influence the diagnostic performance of this procedure, including the use of rapid on-site evaluation (ROSE). The primary aim of this study was to compare the adequacy, diagnostic yield, accuracy, sensitivity and specificity of EUS-FNA for solid pancreatic lesions before and after the introduction of ROSE. METHODS This retrospective single-centre study evaluated all consecutive patients who underwent EUS-FNA for suspicious, solid pancreatic masses from April 2012 to March 2015. We compared the findings of EUS-FNA procedures performed during the first and second years following the adoption of ROSE ("ROSE1" and "ROSE2", respectively) to those performed the year before ROSE introduction (the "pre-ROSE" group). RESULTS Ninety-one consecutive patients with a total of 93 pancreatic lesions were enrolled. For the pre-ROSE, ROSE1 and ROSE2 groups, the adequacy rates were 96.2%, 96.6% and 100%, the diagnostic yield values were 76.9%, 89.7% and 92.1% and accuracy values were 69.2%, 86.2% and 89.5% (p = NS). Sensitivity for malignancy improved from 63.7% in the pre-ROSE group to 91.7% and 91.2% in the post-ROSE groups (p < 0.05). Specificity for malignancy was 100% in all groups. CONCLUSIONS ROSE can improve the diagnostic performance of EUS-FNA for solid pancreatic lesions, although only sensitivity reached statistical significance.
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Affiliation(s)
| | - Nicola Olivari
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Giulio Rossi
- Pathology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Denise Bianchi
- Pathology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Massimo Graffeo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Mauro Lovera
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Loredana Correale
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Harindranath S, Sundaram S. Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis. Diagnostics (Basel) 2023; 13:diagnostics13101797. [PMID: 37238280 DOI: 10.3390/diagnostics13101797] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic pancreatitis (CP) is a known risk factor for pancreatic cancer. CP may present with an inflammatory mass, and differentiation from pancreatic cancer is often difficult. Clinical suspicion of malignancy dictates a need for further evaluation for underlying pancreatic cancer. Imaging modalities remain the mainstay of evaluation for a mass in background CP; however, they have their shortcomings. Endoscopic ultrasound (EUS) has become the go-to investigation. Adjunct modalities such as contrast-harmonic EUS and EUS elastography, as well as EUS-guided sampling using newer-generation needles are useful in differentiating inflammatory from malignant masses in the pancreas. Paraduodenal pancreatitis and autoimmune pancreatitis often masquerade as pancreatic cancer. In this narrative review, we discuss the various modalities used to differentiate inflammatory from malignant masses of the pancreas.
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Affiliation(s)
- Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai 400012, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
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4
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Pausawasdi N, Hongsrisuwan P, Chalermwai WV, Butt AS, Maipang K, Charatchareonwitthaya P. The diagnostic performance of combined conventional cytology with smears and cell block preparation obtained from endoscopic ultrasound-guided fine needle aspiration for intra-abdominal mass lesions. PLoS One 2022; 17:e0263982. [PMID: 35320282 PMCID: PMC8942242 DOI: 10.1371/journal.pone.0263982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIM Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the primary method for tissue acquisition of intra-abdominal masses. However, the main limitation of cytology alone is the lack of tissue architecture and inadequate samples. This study aimed to evaluate the diagnostic performance of combined conventional cytology and cell block preparation obtained from EUS-FNA of intra-abdominal masses without Rapid On-site Evaluation (ROSE). METHODS Cytologic smears and cell block slides of 166 patients undergoing EUS-FNA during 2010-2015 were reviewed by an experienced cytopathologist blinded to clinical data. RESULTS 125 patients had neoplastic lesions. Pancreatic adenocarcinoma was the most common etiology (35.5%), followed by lymph node metastasis (27.7%). The mean mass size was 2.5±1.3 cm. The mean number of passes was 1.9±1.28. Tissue adequacy for conventional cytology and cell block preparation was 78.9% and 78.1%, respectively. Factors associated with tissue adequacy were assessed. For cytology, lesions of > 2.1 cm, masses in the pancreatic body or tail, malignancy, and pancreatic cancer were positively associated with adequate cellularity. For cell block preparation, lesions of > 3 cm and malignancy were associated with increased tissue adequacy. The conventional cytology alone had a sensitivity of 68.5%, a specificity of 95.7%, and an area under the receiver operating characteristics (AUROC) of 0.821. The cell block preparation alone had a sensitivity of 65.4%, a specificity of 96%, and an AUROC of 0.807. The combined conventional cytology and cell block preparation performed significantly better than either method alone (p<0.05), as demonstrated by an increased AUROC of 0.853. Furthermore, cell block detected malignancy in 9.3% of cases where the cytologic smears failed to identify malignant cells. CONCLUSIONS The combined conventional cytology and cell block preparation increased the diagnostic accuracy of EUS-FNA compared to either method alone. This approach should be implemented in routine practice, especially where ROSE is unavailable.
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Affiliation(s)
- Nonthalee Pausawasdi
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Penprapai Hongsrisuwan
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wipapat Vicki Chalermwai
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amna Subhan Butt
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Kotchakon Maipang
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phunchai Charatchareonwitthaya
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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5
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Ge QC, Dietrich CF, Bhutani MS, Zhang BZ, Zhang Y, Wang YD, Zhang JJ, Wu YF, Sun SY, Guo JT. Comprehensive review of diagnostic modalities for early chronic pancreatitis. World J Gastroenterol 2021; 27:4342-4357. [PMID: 34366608 PMCID: PMC8316907 DOI: 10.3748/wjg.v27.i27.4342] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic pancreatitis (CP) is a progressive condition caused by several factors and characterised by pancreatic fibrosis and dysfunction. However, CP is difficult to diagnose at an early stage. Various advanced methods including endoscopic ultrasound based elastography and confocal laser endomicroscopy have been used to diagnose early CP, although no unified diagnostic standards have been established. In the past, the diagnosis was mainly based on imaging, and no comprehensive evaluations were performed. This review describes and compares the advantages and limitations of the traditional and latest diagnostic modalities and suggests guidelines for the standardisation of the methods used to diagnose early CP.
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Affiliation(s)
- Qi-Chao Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Salem und Permanence, Bern CH-3000, Switzerland
| | - Manoop S Bhutani
- Department of Gastrointestinal, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Bao-Zhen Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yue Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yi-Dan Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jing-Jing Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu-Fan Wu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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6
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Khoury T, Sbeit W. The level of agreement between rapid-on-site evaluation of endoscopic ultrasound fine needle aspirate and surgical histological diagnosis in gastrointestinal lesions. Cytopathology 2021; 32:436-440. [PMID: 33983646 DOI: 10.1111/cyt.12985] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/14/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endoscopic ultrasound (EUS) is the main tool for biopsy via fine needle aspiration (FNA) from gastrointestinal (GI) lesions including pancreatic, upper gastrointestinal, and adjacent lesions. The variable diagnostic yield and delay until the final pathological results can affect treatment planning and cause patient anxiety. We aimed to assess the agreement of rapid on-site evaluation (ROSE) of EUS-FNA with the surgical histological diagnosis of patients who underwent resection. METHOD A retrospective study was performed including all patients 18 years or older who underwent EUS-FNA with ROSE for GI lesions. For patients who underwent surgical resection, the correlation between ROSE and the surgical histological diagnosis was evaluated with the kappa coefficient. RESULTS Overall, 73 patients who underwent EUS-FNA with ROSE were included, of whom 22 (30.1%) had curative resection. The final pathological diagnosis from surgery showed 17 malignant and 5 benign lesions. Among the benign lesions, ROSE correctly identified 2 (diagnostic accuracy of 40%), while among the malignant lesions, ROSE correctly identified 14 (diagnostic accuracy of 82.4%), yielding a fair kappa coefficient of 0.366 (95% CI 0.035-0.697). When classifying the lesions as either malignant vs benign or suspicious of malignancy, the kappa coefficient increased to 0.58 (95% CI 0.180-0.975) for the subgroup of pancreatic lesions, with diagnostic accuracy of 81.2% for the malignant category. CONCLUSIONS A high level of agreement for malignancy was found between FNA-EUS with ROSE and the final surgical histological diagnosis. ROSE can be used as an adjuvant diagnostic tool to optimise patient management and decrease delay-related anxiety.
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Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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7
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Delconte G, Cavalcoli F, Magarotto A, Centonze G, Bezzio C, Cattaneo L, Rausa E, Kelly ME, Bonitta G, Milione M, Enzo M. Does ProCore Fine-Needle Biopsy Really Improve the Clinical Outcome of Endoscopic Ultrasound-Guided Sampling of Pancreatic Masses? Dig Dis 2021; 40:78-84. [PMID: 33780932 DOI: 10.1159/000516177] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fine-needle biopsy (FNB) has been suggested to provide better histological samples as compared to endoscopic ultrasound fine-needle aspiration (EUS-FNA). However, studies comparing EUS-FNA and EUS-FNB for pancreatic lesions reported contrasting results. The aim of this study was to compare the clinical performance of EUS-FNA versus EUS-FNB with the ProCore needle for the investigation of pancreatic lesions. METHODS We reviewed all patients undergoing EUS for the investigation of pancreatic lesions from August 2012 to September 2018. From August 2012 to January 2015, all procedures were performed with standard needles, whereas from February 2015 to September 2018, the use of ProCore needles had been introduced. Data on diagnostic accuracy, number of needle passes, and/or adverse events were collected. RESULTS Three hundred twenty-four patients were retrospectively evaluated: 190 (58.6%) underwent EUS-FNA and 134 (41.4%) EUS-FNB. Both EUS-FNA and EUS-FNB showed high diagnostic accuracy for malignancy (94% [95% CI: 89-97%] vs. 94% [95% CI: 89-98%]). Notably, there were no differences between EUS-FNA and EUS-FNB in terms of sensitivity, specificity, positive and negative likelihood ratio, histological core tissue retrieval, adverse events, or number of needle passes. However, subgroup analysis noted a higher diagnostic accuracy for 25G EUS-FNB as compared to 25G EUS-FNA (85.7 vs. 55.5%; *p = 0.023). CONCLUSION EUS-FNB with the ProCore needle is safe and feasible in pancreatic lesions. The ProCore needle did not provide any advantage in terms of diagnostic accuracy, sensitivity, specificity, positive and/or negative likelihood ratio, or acquisition of the core specimen; therefore, its routine application is not supported.
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Affiliation(s)
- Gabriele Delconte
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Federica Cavalcoli
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Centonze
- First Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Laura Cattaneo
- First Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Rausa
- General, Emergency and Trauma Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Gianluca Bonitta
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Massimo Milione
- First Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Masci Enzo
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Chandan S, Mohan BP, Khan SR, Ofosu A, Dhaliwal AS, Shah AR, Bhogal N, Mashiana HS, Mashiana SS, Kassab LL, Ponnada S, Facciorusso A, Bhat I, Singh S, Witt BL, Adler DG. Comparison of EUS-guided conventional smear and liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis. Endosc Int Open 2020; 8:E1611-E1622. [PMID: 33140017 PMCID: PMC7581473 DOI: 10.1055/a-1240-0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) has limitations of inadequate sampling and false-negative results for malignancy. It has been performed using conventional smear (CS) cytology with rapid on-site evaluation (ROSE) with reasonable diagnostic accuracy. An alternative to ROSE is liquid-based cytology (LBC). Commonly used LBC techniques include precipitation-based (SurePath™) and filtration-based (ThinPrep ® , CellPrep ® ). Data regarding the diagnostic efficacy of LBC compared with CS are limited. Methods Multiple databases were searched through March 2020 to identify studies reporting diagnostic yield of EUS-guided CS and LBC in pancreatic lesions. Pooled diagnostic odds and rates of performance for the cytologic diagnoses of benign, suspicious, and malignant lesions were calculated. Diagnostic efficacy was evaluated by pooled rates of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Nine studies with a total of 1308 patients were included in our final analysis. Pooled diagnostic odds of CS cytology were 1.69 (CI 1.02-2.79) and 0.39 (CI 0.19-0.8) for malignant lesions when compared to filtration-based and precipitation-based LBC techniques, respectively. For CS, precipitation-based and filtration-based LBC, pooled diagnostic accuracy was 79.7 %, 85.2 %, 77.3 %, sensitivity was 79.2 %, 83.6 %, 68.3 %, and specificity was 99.4 %, 99.5 %, 99.5 %, respectively. Conclusions The precipitation-based LBC technique (SurePath™) had superior diagnostic odds for malignant pancreatic lesions compared with CS cytology in the absence of ROSE. It showed superior accuracy and sensitivity, but comparable specificity and PPV. Diagnostic odds of CS cytology in the absence of ROSE were superior to the filtration-based LBC technique (ThinPrep ® , Cellprep ® ) for diagnosing malignant pancreatic lesions.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew Ofosu
- Division of Gastroenterology & Hepatology, Stanford University, Stanford, California, United States
| | - Amaninder S. Dhaliwal
- Division of Digestive Diseases & Nutrition, University of South Florida, Tampa, Florida, USA
| | - Aun R. Shah
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Neil Bhogal
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Harmeet S. Mashiana
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Simran S. Mashiana
- Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Ishfaq Bhat
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailender Singh
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Benjamin L. Witt
- Cytopathology Section, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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9
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Yoshinaga S, Itoi T, Yamao K, Yasuda I, Irisawa A, Imaoka H, Tsuchiya T, Doi S, Yamabe A, Murakami Y, Ishikawa H, Saito Y. Safety and efficacy of endoscopic ultrasound-guided fine needle aspiration for pancreatic masses: A prospective multicenter study. Dig Endosc 2020; 32:114-126. [PMID: 31166046 DOI: 10.1111/den.13457] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 10/24/2018] [Accepted: 06/02/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for solid pancreatic lesions has high diagnostic yield. However, few prospective multicenter studies have been performed. We performed a prospective cohort study to evaluate the efficacy and safety of EUS-FNA for diagnosis of solid pancreatic lesions. METHODS This prospective cohort study involved five hospitals in Japan. The primary outcome was sensitivity of EUS-FNA for diagnosing malignant lesions. We also evaluated parameters of diagnostic sufficiency and the safety of EUS-FNA. RESULTS In total, 246 patients were enrolled. The absolute values of the parameters evaluated showed no significant differences; however, the percentage changes in the white blood cell counts and C-reactive protein levels after examination were significantly higher, and the percentage change in hemoglobin concentrations was significantly lower. The minor and major complication rates at the time of puncture, 24 h, 7 days and 28 days were 4.1%, 2.8%, 1.6%, and 0.0%, respectively. The true complication rate was 1.2%. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 97.2%, 88.0%, 96.2%, 100%, and 81.4%, respectively. CONCLUSIONS EUS-FNA for solid pancreatic lesions has high diagnostic yield and is safe, consistent with previously studies.
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Affiliation(s)
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Ichiro Yasuda
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.,Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan.,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Imaoka
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan.,Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Shinpei Doi
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.,Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan.,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | | | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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10
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Guarneri G, Gasparini G, Crippa S, Andreasi V, Falconi M. Diagnostic strategy with a solid pancreatic mass. Presse Med 2019; 48:e125-45. [DOI: 10.1016/j.lpm.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
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11
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Affiliation(s)
- Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
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12
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Bor R, Vasas B, Fábián A, Bálint A, Farkas K, Milassin Á, Czakó L, Rutka M, Molnár T, Szűcs M, Tiszlavicz L, Kaizer L, Hamar S, Szepes Z. Prospective comparison of slow-pull and standard suction techniques of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of solid pancreatic cancer. BMC Gastroenterol 2019; 19:6. [PMID: 30626331 PMCID: PMC6327397 DOI: 10.1186/s12876-018-0921-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 10/27/2017] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
Background The usage of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of solid pancreatic cancer is increasing, however mainly retrospective studies are available about the detailed methods of sampling. Methods To compare prospectively the diagnostic yield of EUS-FNA samples obtained with slow-pull (SP) and with standard suction technique (SS). Results EUS-FNA sampling was diagnostic in 72 of 92 cases (78.3%). Diagnostic yield was 67.4% in the SS and 65.2% in the SP group. The number of smear pairs (1.84 vs. 3.56; p < 0.001) and blood contamination (1.50 vs. 2.19; p < 0.001) were significantly higher in the SS group, which resulted in lower rate of diagnostic samples (41.8% vs. 30.0%; p = 0.003). There was no difference in the cellularity (1.58 vs. 1.37; p = 0.2554), or in the sensitivity and specificity in the identification of malignancy between SP and SS subgroups (69.9, 100% vs. 73.5, 100%). Histological samples were obtained in 60 cases (with SP: 49 cases; with SS: 46 cases). There was no difference in the diagnostic yield of histological samples between the groups (63 and 58.7%). Conclusion The diagnostic yield, the cellularity of smears and the rate of acquiring sufficient histological material are similar in the SP and SS group, but due to lower bloodiness and decreased number of slides, the pathological diagnosis is faster and more cost-effective.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - László Kaizer
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Sándor Hamar
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary.
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Senoo J, Mikata R, Kishimoto T, Hayashi M, Kusakabe Y, Yasui S, Yamato M, Ohyama H, Sugiyama H, Tsuyuguchi T, Yoshitomi H, Ohtsuka M, Maeda J, Ota S, Nakatani Y, Kato N. Immunohistochemical analysis of IMP3 and p53 expression in endoscopic ultrasound-guided fine needle aspiration and resected specimens of pancreatic diseases. Pancreatology 2018; 18:176-183. [PMID: 29305088 DOI: 10.1016/j.pan.2017.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 07/02/2017] [Revised: 11/21/2017] [Accepted: 12/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insulin-like growth factor II messenger ribonucleic acid-binding protein 3 (IMP3) is a valuable marker that distinguishes malignant from benign lesions and predicts prognosis. METHODS First, we evaluated IMP3 expression in 77 resected specimens of pancreatic ductal adenocarcinoma (PDAC), intraductal papillary mucinous neoplasm (IPMN), and chronic pancreatitis (CP). Eleven PDAC patients preoperatively underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Survival analysis of IMP3 and clinicopathological factors was performed. IMP3 and p53 expression was evaluated in another 127 EUS-FNA samples of solid pancreatic masses to compare the diagnostic value of routine and immunohistochemical staining. RESULTS IMP3 expression was detected in 72.3%, 50%, 20%, and 0% of PDAC, malignant IPMN, benign IPMN, and CP, respectively. Evaluation of IMP3 expression in EUS-FNA specimens coincided with that in resected specimens in 10 of 11. IMP3 expression correlated with tumor differentiation in PDAC samples (p = .006) and with poor prognosis through univariate analysis (p = .045). Tumor differentiation and lymph node metastasis were significantly associated with poor prognosis through multivariate analysis. In EUS-FNA specimens, the sensitivity, specificity, and accuracy of cytohistological analysis were 80.8%, 100%, and 85.0%, respectively. IMP3 and p53 expression were detected in 80.8% and 44.9% of malignant and 0% and 5% of benign lesions. Combined with IMP3 immunostaining, the sensitivity, specificity and accuracy of cytohistological analysis significantly increased to 87.9%, 100%, and 90.8% (p = .016), respectively. Meanwhile, p53 staining had no impact on the results. CONCLUSIONS IMP3 immunohistochemical staining can improve the diagnostic accuracy of EUS-FNA for malignant pancreatic tumors.
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Affiliation(s)
- Junichi Senoo
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Rintaro Mikata
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan.
| | - Takashi Kishimoto
- Department of Molecular Pathology, Chiba University Graduate School of Medicine, Japan
| | - Masahiro Hayashi
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Yuko Kusakabe
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Shin Yasui
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Mutsumi Yamato
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
| | - Hideyuki Yoshitomi
- Department of General Surgery, Chiba University Graduate School of Medicine, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University Graduate School of Medicine, Japan
| | - Juri Maeda
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Japan
| | - Satoshi Ota
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Japan
| | - Naoya Kato
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Japan
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Klaassen R, Gurney-Champion OJ, Wilmink JW, Besselink MG, Engelbrecht MRW, Stoker J, Nederveen AJ, van Laarhoven HWM. Repeatability and correlations of dynamic contrast enhanced and T2* MRI in patients with advanced pancreatic ductal adenocarcinoma. Magn Reson Imaging 2018; 50:1-9. [PMID: 29476781 DOI: 10.1016/j.mri.2018.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/13/2017] [Revised: 02/15/2018] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND In current oncological practice of pancreatic ductal adenocarcinoma (PDAC), there is a great demand for response predictors and markers for early treatment evaluation. In this study, we investigated the repeatability and the interaction of dynamic contrast enhanced (DCE) and T2* MRI in patients with advanced PDAC to enable for such evaluation using these techniques. MATERIALS & METHODS 15 PDAC patients underwent two DCE, T2* and anatomical 3 T MRI sessions before start of treatment. Parametric maps were calculated for the transfer constant (Ktrans), rate constant (kep), extracellular extravascular space (ve) and perfusion fraction (vp). Quantitative R2* (1/T2*) maps were obtained from the multi-echo T2* images. Differences between normal and cancerous pancreas were determined using a Wilcoxon matched pairs test. Repeatability was obtained using Bland-Altman analysis and relations between DCE and T2*/R2* were observed by Spearman correlation and voxel-wise binned plots of tumor voxels. RESULTS PDAC Ktrans (p = 0.007), kep (p < 0.001), vp (p = 0.035) were lower and ve (p < 0.001) was higher compared to normal pancreas. The coefficient of variation between sessions was 21.8% for Ktrans, 9.9% for kep, 19.3% for ve, 18.2% for vp and 18.7% for R2*. Variation between patients ranged from 20.2% for kep to 43.6% for Ktrans. In the tumor both Ktrans (r = 0.56, p = 0.030) and ve (r = 0.54, p = 0.037) showed a positive correlation with T2*. Voxel wise analysis showed a steep increase in R2* for tumor voxels with lower Ktrans and ve. CONCLUSION We showed good repeatability of DCE and T2* related MRI parameters in advanced PDAC patients. Furthermore, we have illustrated the relation of DCE Ktrans and ve with tissue T2* and R2* indicating substantial value of these parameters for detecting tumor hypoxia in future studies. The results from our study pave the way for further response evaluation studies and patient selection based on DCE and T2* parameters.
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Affiliation(s)
- Remy Klaassen
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Cancer Center Amsterdam, LEXOR (Laboratory for Experimental Oncology and Radiobiology), Academic Medical Center, Amsterdam, The Netherlands.
| | - Oliver J Gurney-Champion
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
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Liu C, Wang L, He X, Xu Y, Lu D, Li P, Lv R, Feng Y, Liu M, Li C. 1.0T MR-guided percutaneous coaxial cutting needle biopsy in pancreatic lesion diagnosis. J Magn Reson Imaging 2018; 48:382-388. [PMID: 29319916 DOI: 10.1002/jmri.25952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/26/2017] [Accepted: 12/21/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic carcinoma is a common cause of cancer deaths worldwide. Biopsy is often required for the initial diagnosis of pancreatic masses. Biopsy can be performed endoscopically or percutaneously with computed tomography (CT) and ultrasound (US) guidance. MRI offers many inherent advantages over CT and US. PURPOSE/HYPOTHESIS To prospectively evaluate the feasibility, accuracy, and safety of MRI-guided percutaneous coaxial cutting needle biopsy of pancreatic lesions using an open 1.0T high-field MR scanner. STUDY TYPE Prospective. POPULATION Thirty-one patients with 31 pancreatic lesions underwent MR-guided percutaneous coaxial cutting needle biopsy. FIELD STRENGTH/SEQUENCE 1.0T T2 WI-TSE PDW-aTSE T1 WI-TFE. ASSESSMENT Final diagnosis was confirmed by surgery and clinical follow-up for at least 12 months. The accuracy, sensitivity, and specificity were calculated. Complications were recorded. STATISTICAL TESTS There was no statistical analysis in this study. RESULTS The procedure was technically successful and final biopsy samples were adequate for histopathological examination in all patients. Biopsy pathology revealed malignant pancreatic tumor in 25 patients (25/31, 80.6%), and benign pancreatic lesions were present in six patients (6/31, 19.4%). The final diagnosis was pancreatic malignancy in 27 patients and benign disease in four patients, which was confirmed by surgery and clinical follow-up. Two biopsy results were false-negative. The diagnostic accuracy in biopsies was 93.5% (29 of 31). The sensitivity to detect a malignant disease was 92.6% (25 of 27), and the specificity was 100%. All patients tolerated the procedure well; minor peripancreatic hemorrhage was found in two patients after the procedure, and none had major complications either during or after the procedure. DATA CONCLUSION MRI-guided percutaneous biopsy of pancreatic lesions using an open 1.0T high-field scanner has high diagnostic accuracy, which is feasible and safe for use in clinical practice. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2018;48:382-388.
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Affiliation(s)
- Chao Liu
- Department of Minimally Invasive Tumor, Tai'an Central Hospital, Tai'an, Shandong, P.R. China
| | - Ligang Wang
- Department of Interventional Therapy, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, P.R. China
| | - Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Dong Lu
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
| | - Peipei Li
- Department of Oncology, Liaocheng Tumor Hospital, Liaocheng, Shandong, P.R. China
| | - Rongbin Lv
- Department of Nuclear Medicine, Tai'an Central Hospital, Tai'an, Shandong, P.R. China
| | - Yong Feng
- Department of Minimally Invasive Tumor, Tai'an Central Hospital, Tai'an, Shandong, P.R. China
| | - Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, Shandong, P.R. China
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16
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He XK, Ding Y, Sun LM. Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: an updated meta-analysis. Oncotarget 2017; 8:66392-66401. [PMID: 29029521 PMCID: PMC5630421 DOI: 10.18632/oncotarget.18915] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 06/18/2017] [Indexed: 11/25/2022] Open
Abstract
Aim We aim to assess the diagnostic value of contrast-enhanced endoscopic ultrasound (CE-EUS) for pancreatic cancer and inflammatory lesions by pooling current evidence. Materials and Methods A systematical search of PubMed, Web of Science and the Cochrane Library was performed from inception to January 2016. Two authors independently screened and extracted detailed data from included studies. A random effect model was adopted to estimate the pooled sensitivity, specificity in order to determine the diagnostic ablitity of CE-EUS. Furthermore, we conducted the meta-regression and subgroup analyses to explore possible heterogeneity. Results Eighteen eligible studies enrolling 1668 patients were finally included in the study. The pooled sensitivity of CE-EUS for distinguishing pancreatic cancers from solid inflammatory masses was 0.93 (95% CI, 0.91–0.94), and the specificity was 0.88 (95% CI, 0.84–0.90). The area under summary receiver operating characteristic curve yielded 0.97. No publication bias was observed by Deeks’ funnel plot in current meta-analysis. Conclusions We provided evidence that CE-EUS is a promising modality for differential diagnosis of pancreatic adenocarcinomas. Further multicenter prospective studies should be carried out to certify its utility.
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Affiliation(s)
- Xing-Kang He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou 310016, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, China
| | - Yue Ding
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou 310016, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, China
| | - Lei-Min Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou 310016, China.,Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, China
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Cooray M, Nistor I, Pham J, Bair D, Arya N. Accuracy of endoscopic ultrasound-fine needle aspiration of solid lesions over time: Experience from a new endoscopic ultrasound program at a Canadian community hospital. Endosc Ultrasound 2017; 6:187-194. [PMID: 28621296 PMCID: PMC5488522 DOI: 10.4103/2303-9027.208177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/19/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A Canadian Community Hospital launched a new Endoscopic Ultrasound (EUS) Program in 2011. The aim of this study was to report the accuracy of EUS-fine needle aspiration (EUS-FNA) of solid lesions over time as it pertains to cytotechnologists' involvement and learning curves. METHODS The electronic medical records of patients that had a EUS from July 2011 to January 2014 were retrospectively reviewed. Only solid lesions with FNA sampling were included in the study. The primary outcome assessed was the accuracy of specimen acquisition for pathological review. The secondary outcome was diagnostic accuracy. Cases were separated by chronological order into thirds for the assessment of learning curves. Cytotechnologists' involvement was correlated to determine its impact on accuracy. RESULTS Two hundred and seventy-one EUS-FNA procedures were completed for solid lesions. Cytotechnologists' involvement resulted in a specimen acquisition accuracy of 82.6%, compared with 68.8% without a cytotechnologist (P = 0.009; 95% confidence interval [CI] 3.2%-25.0%). Diagnostic accuracy was 74.2% with a cytotechnologist while 62.4% without a cytotechnologist (P = 0.038; 95% CI 0.3%-23.7%). The specimen acquisition accuracy increased from 73.2% from the first third of cases to 92.3% for the last third with a cytotechnologist (P = 0.004; 95% CI 6%-33.0%). Without a cytotechnologist, the specimen accuracy was 67.6% for the first third while 57.7% for the last third of cases (P = 0.434; 95% CI - 33.9-14.4%). In the multivariable regression analysis, after adjusting for other predictors, a present cytotechnologist (P = 0.022) and lesion size 21 mm-30 mm (P = 0.039) and >30 mm (P = 0.001) were significantly associated with increased specimen acquisition accuracy. Only a present cytotechnologist (P = 0.046) was significantly associated with increased diagnostic accuracy. INTERPRETATION Cytotechnologists' involvement significantly improved the accuracy of specimen acquisition. Although accuracy was impacted by a cytotechnologist learning curve, our results highlight the importance of a cytotechnologist being present for EUS-FNA sampling of solid lesions.
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Affiliation(s)
- Mohan Cooray
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - Irina Nistor
- Department of Medicine, Division of Gastroenterology, Oakville-Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Joe Pham
- Department of Medicine, Division of Gastroenterology, Oakville-Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Douglas Bair
- Department of Medicine, Division of Gastroenterology, Oakville-Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Naveen Arya
- Department of Medicine, Division of Gastroenterology, Oakville-Trafalgar Memorial Hospital, Oakville, Ontario, Canada
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18
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Abstract
BACKGROUND Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of focal pancreatic lesions. OBJECTIVES To determine and compare the diagnostic accuracy of various imaging modalities in detecting cancerous and precancerous lesions in people with focal pancreatic lesions. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, and Science Citation Index until 19 July 2016. We searched the references of included studies to identify further studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We planned to include studies reporting cross-sectional information on the index test (CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), EUS (endoscopic ultrasound), EUS elastography, and EUS-guided biopsy or FNA (fine-needle aspiration)) and reference standard (confirmation of the nature of the lesion was obtained by histopathological examination of the entire lesion by surgical excision, or histopathological examination for confirmation of precancer or cancer by biopsy and clinical follow-up of at least six months in people with negative index tests) in people with pancreatic lesions irrespective of language or publication status or whether the data were collected prospectively or retrospectively. DATA COLLECTION AND ANALYSIS Two review authors independently searched the references to identify relevant studies and extracted the data. We planned to use the bivariate analysis to calculate the summary sensitivity and specificity with their 95% confidence intervals and the hierarchical summary receiver operating characteristic (HSROC) to compare the tests and assess heterogeneity, but used simpler models (such as univariate random-effects model and univariate fixed-effect model) for combining studies when appropriate because of the sparse data. We were unable to compare the diagnostic performance of the tests using formal statistical methods because of sparse data. MAIN RESULTS We included 54 studies involving a total of 3,196 participants evaluating the diagnostic accuracy of various index tests. In these 54 studies, eight different target conditions were identified with different final diagnoses constituting benign, precancerous, and cancerous lesions. None of the studies was of high methodological quality. None of the comparisons in which single studies were included was of sufficiently high methodological quality to warrant highlighting of the results. For differentiation of cancerous lesions from benign or precancerous lesions, we identified only one study per index test. The second analysis, of studies differentiating cancerous versus benign lesions, provided three tests in which meta-analysis could be performed. The sensitivities and specificities for diagnosing cancer were: EUS-FNA: sensitivity 0.79 (95% confidence interval (CI) 0.07 to 1.00), specificity 1.00 (95% CI 0.91 to 1.00); EUS: sensitivity 0.95 (95% CI 0.84 to 0.99), specificity 0.53 (95% CI 0.31 to 0.74); PET: sensitivity 0.92 (95% CI 0.80 to 0.97), specificity 0.65 (95% CI 0.39 to 0.84). The third analysis, of studies differentiating precancerous or cancerous lesions from benign lesions, only provided one test (EUS-FNA) in which meta-analysis was performed. EUS-FNA had moderate sensitivity for diagnosing precancerous or cancerous lesions (sensitivity 0.73 (95% CI 0.01 to 1.00) and high specificity 0.94 (95% CI 0.15 to 1.00), the extremely wide confidence intervals reflecting the heterogeneity between the studies). The fourth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (dysplasia) provided three tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing invasive carcinoma were: CT: sensitivity 0.72 (95% CI 0.50 to 0.87), specificity 0.92 (95% CI 0.81 to 0.97); EUS: sensitivity 0.78 (95% CI 0.44 to 0.94), specificity 0.91 (95% CI 0.61 to 0.98); EUS-FNA: sensitivity 0.66 (95% CI 0.03 to 0.99), specificity 0.92 (95% CI 0.73 to 0.98). The fifth analysis, of studies differentiating cancerous (high-grade dysplasia or invasive carcinoma) versus precancerous (low- or intermediate-grade dysplasia) provided six tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing cancer (high-grade dysplasia or invasive carcinoma) were: CT: sensitivity 0.87 (95% CI 0.00 to 1.00), specificity 0.96 (95% CI 0.00 to 1.00); EUS: sensitivity 0.86 (95% CI 0.74 to 0.92), specificity 0.91 (95% CI 0.83 to 0.96); EUS-FNA: sensitivity 0.47 (95% CI 0.24 to 0.70), specificity 0.91 (95% CI 0.32 to 1.00); EUS-FNA carcinoembryonic antigen 200 ng/mL: sensitivity 0.58 (95% CI 0.28 to 0.83), specificity 0.51 (95% CI 0.19 to 0.81); MRI: sensitivity 0.69 (95% CI 0.44 to 0.86), specificity 0.93 (95% CI 0.43 to 1.00); PET: sensitivity 0.90 (95% CI 0.79 to 0.96), specificity 0.94 (95% CI 0.81 to 0.99). The sixth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (low-grade dysplasia) provided no tests in which meta-analysis was performed. The seventh analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) provided two tests in which meta-analysis was performed. The sensitivity and specificity for diagnosing cancer were: CT: sensitivity 0.83 (95% CI 0.68 to 0.92), specificity 0.83 (95% CI 0.64 to 0.93) and MRI: sensitivity 0.80 (95% CI 0.58 to 0.92), specificity 0.81 (95% CI 0.53 to 0.95), respectively. The eighth analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) or benign lesions provided no test in which meta-analysis was performed.There were no major alterations in the subgroup analysis of cystic pancreatic focal lesions (42 studies; 2086 participants). None of the included studies evaluated EUS elastography or sequential testing. AUTHORS' CONCLUSIONS We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons.
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Affiliation(s)
- Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
| | - Vishal Rawji
- University College London Medical SchoolLondonUK
| | - Stephen P Pereira
- Royal Free Hospital CampusUCL Institute for Liver and Digestive HealthUpper 3rd FloorLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
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19
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Ge N, Zhang S, Jin Z, Sun S, Yang A, Wang B, Wang G, Xu G, Hao J, Zhong L, Zhong N, Li P, Zhu Q, Nian W, Li W, Zhang X, Zhou X, Yang X, Cui Y, Ding Z. Clinical use of endoscopic ultrasound-guided fine-needle aspiration: Guidelines and recommendations from Chinese Society of Digestive Endoscopy. Endosc Ultrasound 2017; 6:75-82. [PMID: 28440232 PMCID: PMC5418971 DOI: 10.4103/eus.eus_20_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nan Ge
- Department of Endoscopy, Shengjing Hospital, Medical University, Shenyang, Liaoning Province, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Siyu Sun
- Department of Endoscopy, Shengjing Hospital, Medical University, Shenyang, Liaoning Province, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guiqi Wang
- Department of Endoscopy, Chinese Academy of Medical Sciences, Beijing, China
| | - Guoqiang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jianyu Hao
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liang Zhong
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ning Zhong
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qi Zhu
- Department of Endoscopy, Shanghai Jiao Tong University, Shanghai, China
| | - Weidong Nian
- Department of General Surgery, Peking University Hospital, Beijing, China
| | - Wen Li
- Department of Gastroenterology, Tianjin Nankai Hospital, Tianjin, China
| | - Xiaofeng Zhang
- Department of Gastroenterology, The First People's Hospital of Hangzhou, Nanjing Medical University, Hangzhou, Zhejiang Province, China
| | - Xiaoping Zhou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xiujiang Yang
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Yi Cui
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zhen Ding
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Sterlacci W, Sioulas AD, Veits L, Gönüllü P, Schachschal G, Groth S, Anders M, Kontos CK, Topalidis T, Hinsch A, Vieth M, Rösch T, Denzer UW. 22-gauge core vs 22-gauge aspiration needle for endoscopic ultrasound-guided sampling of abdominal masses. World J Gastroenterol 2016; 22:8820-8830. [PMID: 27818598 PMCID: PMC5075557 DOI: 10.3748/wjg.v22.i39.8820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/21/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the aspiration needle (AN) and core biopsy needle (PC) in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of abdominal masses.
METHODS Consecutive patients referred for EUS-FNA were included in this prospective single-center trial. Each patient underwent a puncture of the lesion with both standard 22-gauge (G) AN (Echo Tip Ultra; Cook Medical, Bloomington, Indiana, United States) and the novel 22G PC (EchoTip ProCore; Cook Medical, Bloomington, Indiana, United States) in a randomized fashion; histology was attempted in the PC group only. The main study endpoint was the overall diagnostic accuracy, including the contribution of histology to the final diagnosis. Secondary outcome measures included material adequacy, number of needle passes, and complications.
RESULTS Fifty six consecutive patients (29 men; mean age 68 years) with pancreatic lesions (n = 38), lymphadenopathy (n = 13), submucosal tumors (n = 4), or others lesions (n = 1) underwent EUS-FNA using both of the needles in a randomized order. AN and PC reached similar overall results for diagnostic accuracy (AN: 88.9 vs PC: 96.1, P = 0.25), specimen adequacy (AN: 96.4% vs PC: 91.1%, P = 0.38), mean number of passes (AN: 1.5 vs PC: 1.7, P = 0.14), mean cellularity score (AN: 1.7 vs PC: 1.1, P = 0.058), and complications (none). A diagnosis on the basis of histology was achieved in the PC group in 36 (64.3%) patients, and in 2 of those as the sole modality. In patients with available histology the mean cellularity score was higher for AN (AN: 1.7 vs PC: 1.0, P = 0.034); no other differences were of statistical significance.
CONCLUSION Both needles achieved high overall diagnostic yields and similar performance characteristics for cytological diagnosis; histological analysis was only possible in 2/3 of cases with the new needle.
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21
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DiMaio CJ, Kolb JM, Benias PC, Shah H, Shah S, Haluszka O, Maranki J, Sharzehi K, Lam E, Gordon SR, Hyder SM, Kaimakliotis PZ, Allaparthi SB, Gress FG, Sethi A, Shah AR, Nieto J, Kaul V, Kothari S, Kothari TH, Ho S, Izzy MJ, Sharma NR, Watson RR, Muthusamy VR, Pleskow DK, Berzin TM, Sawhney M, Aljahdi E, Ryou M, Wong CK, Gupta P, Yang D, Gonzalez S, Adler DG. Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study. Endosc Int Open 2016; 4:E974-9. [PMID: 27652304 PMCID: PMC5025313 DOI: 10.1055/s-0042-112581] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/05/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS The ability to safely and effectively obtain sufficient tissue for pathologic evaluation by using endoscopic ultrasound (EUS) guidance remains a challenge. Novel designs in EUS needles may provide for improved ability to obtain such core biopsies. The aim of this study was to evaluate the diagnostic yield of core biopsy specimens obtained using a novel EUS needle specifically designed to obtain core biopsies. PATIENTS AND METHODS Multicenter retrospective review of all EUS-guided fine-needle biopsies obtained using a novel biopsy needle (SharkCore FNB needle, Medtronic, Dublin, Ireland). Data regarding patient demographics, lesion type/location, technical parameters, and diagnostic yield was obtained. RESULTS A total of 250 lesions were biopsied in 226 patients (Median age 66 years; 113 (50 %) male). Median size of all lesions (mm): 26 (2 - 150). Overall, a cytologic diagnosis was rendered in 81 % specimens with a median number of 3 passes. When rapid onsite cytologic evaluation (ROSE) was used, cytologic diagnostic yield was 126/149 (85 %) with a median number of 3 passes; without ROSE, cytologic diagnostic yield was 31/45 (69 %, P = 0.03) with a median number of 3 passes. Overall, a pathologic diagnosis was rendered in 130/147 (88 %) specimens with a median number of 2 passes. Pathologic diagnostic yield for specific lesion types: pancreas 70/81 (86 %), subepithelial lesion 13/15 (87 %), lymph node 26/28 (93 %). Ten patients (10/226, 4 %) experienced adverse events: 4 acute pancreatitis, 5 pain, 1 fever/cholangitis. CONCLUSIONS Initial experience with a novel EUS core biopsy needle demonstrates excellent pathologic diagnostic yield with a minimum number of passes.
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Affiliation(s)
- Christopher J. DiMaio
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, United States
| | - Jennifer M. Kolb
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, United States
| | - Petros C. Benias
- Mount Sinai Beth Israel Medical Center, New York, New York, United States
| | - Hiral Shah
- Lehigh Valley Hospital, Allentown, Pennsylvania, United States
| | - Shashin Shah
- Lehigh Valley Hospital, Allentown, Pennsylvania, United States
| | - Oleh Haluszka
- Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Jennifer Maranki
- Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Kaveh Sharzehi
- Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Eric Lam
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart R. Gordon
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Sarah M. Hyder
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | | | | | - Frank G. Gress
- NewYork-Presbyterian Hospital/Columbia University, New York, New York, United States
| | - Amrita Sethi
- NewYork-Presbyterian Hospital/Columbia University, New York, New York, United States
| | - Ashish R. Shah
- NewYork-Presbyterian Hospital/Columbia University, New York, New York, United States
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, Florida, United States
| | - Vivek Kaul
- University of Rochester Medical Center, Rochester, New York, United States
| | - Shivangi Kothari
- University of Rochester Medical Center, Rochester, New York, United States
| | | | - Sammy Ho
- Montefiore Medical Center, Bronx, New York, United States
| | - Manhal J. Izzy
- Montefiore Medical Center, Bronx, New York, United States
| | | | - Rabindra R. Watson
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - V. Raman Muthusamy
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Douglas K. Pleskow
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Tyler M. Berzin
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Mandeep Sawhney
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Emad Aljahdi
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Marvin Ryou
- Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | | | - Parantap Gupta
- Crystal Run Healthcare, Middletown, New York, United States
| | - Dennis Yang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, United States
| | - Susana Gonzalez
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York, United States
| | - Douglas G. Adler
- University of Utah School of Medicine, Salt Lake City, Utah, United States
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Jafri M, Sachdev AH, Khanna L, Gress FG. The Role of Real Time Endoscopic Ultrasound Guided Elastography for Targeting EUS-FNA of Suspicious Pancreatic Masses: A Review of the Literature and A Single Center Experience. JOP 2016; 17:516-524. [PMID: 28912670 PMCID: PMC5595420] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Endoscopic ultrasound guided elastography is an imaging modality that can be used to evaluate tissue stiffness and to assess solid pancreatic lesions. It can also assist in optimizing the diagnostic yield of endoscopic ultrasound guided fine needle aspiration biopsies. AIMS To review the literature on solid pancreatic lesions, the use of EUS guided fine needle aspiration and endoscopic ultrasound guided elastography and to present a single center experience using elastography to direct fine needle aspiration biopsies of solid pancreatic lesions. METHODS We present a review of the literature and a single center experience describing the use of EUS guided elastography in directing fine needle aspiration biopsies of solid pancreatic lesions. RESULTS Thirteen male veterans with an average age of 62.3 (SD±11.8) years were enrolled in the study. The mean pancreatic mass size on EUS was 5.1×5.2 (SD±4.4×4.5) cm. A total of 13 lesions were identified during elastography. The lesions were most commonly found in the body (n=5), followed by multifocal lesions (n=4), pancreatic head (n=3) and tail (n=1). The seven concerning pancreatic lesions were stratified based on color pattern identified on EUS and EUS-elastography. Three lesions were homogenously blue, and four lesions were heterogeneously blue. The remaining six lesions which were less concerning were predominantly green. Of the three lesions, that were homogenously blue, two were diagnosed as adenocarcinoma (n=2) and chronic pancreatitis (n=1) respectively. Of the four heterogeneously blue lesions two were adenocarcinomas, while the other two represented a large B-cell lymphoma and chronic pancreatitis. Patients whose lesions were characterized as homogenous or heterogeneous green were benign and remained disease free after a median of two years of regular follow up. LIMITATIONS Relatively small number of patients studied. CONCLUSIONS In our single center experience we found that the use of real time endoscopic ultrasound guided elastography for targeting fine needle aspiration of suspicious pancreatic lesions may be beneficial as an adjunct modality to complement conventional EUS. Larger prospective studies need to be conducted to evaluate the utility of this modality in targeting pancreatic lesions.
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Affiliation(s)
- Mikram Jafri
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Amit H Sachdev
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Lauren Khanna
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Frank G Gress
- Columbia University College of Physicians and Surgeons, New York, USA
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23
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Park JK, Kang KJ, Oh CR, Lee JK, Lee KT, Jang KT, Park SM, Lee KH. Evaluating the Minimal Specimens From Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Pancreatic Masses. Medicine (Baltimore) 2016; 95:e3740. [PMID: 27227937 PMCID: PMC4902361 DOI: 10.1097/md.0000000000003740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become one of the most useful diagnostic modalities for the diagnosis of pancreatic mass. The aim of this study was to investigate the role of analyzing the minimal specimens obtained by EUS-FNA for the diagnosis of solid masses of pancreas.This study consisted of retrospective and prospective analyses. The retrospective study was performed on 116 patients who underwent EUS-FNA of solid masses for cytological smear, histological analysis, and combined analysis including immunohistochemical (IHC) staining. In the prospective study, 79 patients were enrolled to evaluate the quality and accuracy of EUS-FNA histological analysis and feasibility of IHC staining.The final diagnoses of all patients included pancreatic cancer (n = 126), nonpancreatic cancer (n = 21), other neoplasm (n = 27), and benign lesions (n = 21). In our retrospective study, the combined analysis was more sensitive than cytological analysis alone (P < 0.01). The overall sensitivity of cytology, histology, and combined analysis was 69.8%, 67.2%, and 81.8%, respectively. In the prospective analysis, 64.2% of all punctures were helpful for determining the diagnosis and 40.7% provided sufficient tissue for IHC staining. Histological analysis was helpful for diagnosis in 74.7% of patients. IHC staining was necessary for a definite diagnosis in 11.4% of patients, especially in the cases of nonmalignant pancreatic mass.Histological analysis and IHC study of EUS-FNA specimens was useful for the accurate diagnosis of pancreatic and peripancreatic lesions. Combined analysis showed significantly higher sensitivity than cytology alone because IHC staining was helpful for a diagnosis in some patients.
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Affiliation(s)
- Joo Kyung Park
- From the Department of Medicine (JKP, JKL, KTL, KHL), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Medicine (KJK, CRO), Hallym University College of Medical School, Hallym University Sacred Heart Hospital, Anyang; Department of Pathology (KTJ), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and Department of pathology (SMP), Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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24
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Jani BS, Rzouq F, Saligram S, Lim D, Rastogi A, Bonino J, Olyaee M. Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions: A Systematic Review of Technical and Procedural Variables. N Am J Med Sci 2016; 8:1-11. [PMID: 27011940 PMCID: PMC4784176 DOI: 10.4103/1947-2714.175185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint.
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Affiliation(s)
- Bhairvi S Jani
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Fadi Rzouq
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shreyas Saligram
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Diego Lim
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amit Rastogi
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Bonino
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mojtaba Olyaee
- Department of Internal Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
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25
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Nemakayala D, Patel P, Rahimi E, Fallon MB, Thosani N. Use of quantitative endoscopic ultrasound elastography for diagnosis of pancreatic neuroendocrine tumors. Endosc Ultrasound 2016; 5:342-345. [PMID: 27803909 PMCID: PMC5070294 DOI: 10.4103/2303-9027.191680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Divyesh Nemakayala
- Department of Internal Medicine, Windsor University School of Medicine, Houston, Texas, USA
| | - Pragnesh Patel
- Department of Gastroenterology, Hepatology and Nutrition, Ertan Digestive Disease Center, Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Erik Rahimi
- Department of Gastroenterology, Hepatology and Nutrition, Ertan Digestive Disease Center, Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael B Fallon
- Department of Gastroenterology, Hepatology and Nutrition, Ertan Digestive Disease Center, Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nirav Thosani
- Department of Gastroenterology, Hepatology and Nutrition, Ertan Digestive Disease Center, Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Yin Q, Zou X, Zai X, Wu Z, Wu Q, Jiang X, Chen H, Miao F. Pancreatic ductal adenocarcinoma and chronic mass-forming pancreatitis: Differentiation with dual-energy MDCT in spectral imaging mode. Eur J Radiol 2015; 84:2470-6. [PMID: 26481480 DOI: 10.1016/j.ejrad.2015.09.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/01/2015] [Accepted: 09/27/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the value of dual-energy MDCT in spectral imaging in the differential diagnosis of chronic mass-forming chronic pancreatitis (CMFP) and pancreatic ductal adenocarcinoma (PDAC) during the arterial phase (AP) and the pancreatic parenchymal phase (PP). MATERIALS AND METHODS Thirty five consecutive patients with CMFP (n=15) or PDAC (n=20) underwent dual-energy MDCT in spectral imaging during AP and PP. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in iodine concentration between the AP and PP, contrast-to-noise ratio (CNR) and the slope K of the spectrum curve were calculated. RESULTS Normalized iodine concentrations (NICs) in patients with CMFP differed significantly from those in patients with PDAC during two double phases (mean NIC, 0.26±0.04 mg/mL vs. 0.53±0.02 mg/mL, p=0.0001; 0.07±0.02 mg/mL vs. 0.28±0.04 mg/mL, p=0.0002, respectively). There were significant differences in the value of the slope K of the spectrum curve in two groups during AP and PP (K(CMFP)=3.27±0.70 vs. K(PDAC)=1.35±0.41, P=0.001, and K(CMFP)=3.70±0.17 vs. K(PDAC)=2.16±0.70, p=0.003, respectively). CNRs at low energy levels (40-70 keV) were higher than those at high energy levels (80-40 keV). CONCLUSION Individual patient CNR-optimized energy level images and the NIC can be used to improve the sensitivity and the specificity for differentiating CMFP from PDAC by use of dual-energy MDCT in spectral imaging with fast tube voltage switching.
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27
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Dietrich CF, Jenssen C, Arcidiacono PG, Cui XW, Giovannini M, Hocke M, Iglesias-Garcia J, Saftoiu A, Sun S, Chiorean L. Endoscopic ultrasound: Elastographic lymph node evaluation. Endosc Ultrasound 2015; 4:176-90. [PMID: 26374575 PMCID: PMC4568629 DOI: 10.4103/2303-9027.162995] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives.
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Affiliation(s)
- Christoph F Dietrich
- Department of Medicine, Caritas-Krankenhaus, Uhlandstr, Bad Mergentheim, Germany
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28
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Soares JB, Iglesias-Garcia J, Goncalves B, Lindkvist B, Lariño-Noia J, Bastos P, Caetano ACL, Ferreira A, Pimentel-Nunes P, Lopes L, Moutinho-Ribeiro P, Dominguez-Muñoz JE. Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions. Endosc Ultrasound 2015; 4:244-9. [PMID: 26374584 PMCID: PMC4568638 DOI: 10.4103/2303-9027.163016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Previous reports assessing the reproducibility of endoscopic ultrasound elastography (EUS-E) in evaluation of solid pancreatic lesions (SPL) involved only experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of EUS-E in the evaluation of SPL by endoscopists with different levels of experience in EUS and EUS-E. Materials and Methods: A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups: Group A (long experience in EUS and EUS-E); Group B (short experience in EUS and EUS-E); Group C (long experience in EUS and no experience in EUS-E); and Group D (no experience in EUS or EUS-E). The observers independently classified the patterns of 60 video sequences of EUS-E, after a 20-min training session. For each group, we calculated IOA (kappa statistic, κ) of EUS-E and the diagnostic accuracy of EUS-E for pancreatic malignancy, by comparing the pattern of EUS-E indicative of malignancy (heterogeneous or homogenous blue) with the final diagnosis. Results: The overall IOA was moderate (κ = 0.42; 95% confidence interval (CI) 0.33-0.52). The IOA of Group A (κ = 0.80; 95% CI 0.65-1.00) was significantly higher than that of Groups B (κ = 0.54; 95%CI 0.40-0.71), C (κ = 0.54; 95%CI 0.39-0.68), and D (κ = 0.28; 95%CI 0.14-0.40). IOA of Groups B and C was not significantly different, but it was significantly higher than that of Group D. The diagnostic accuracy of Group A (area under the curve under summary receiver operating characteristic (AUROC) = 0.83; 95%CI 0.75-0.90) was not significantly different from that of Group B (AUROC = 0.77; 95%CI 0.71-0.83), but it was significantly higher than that of Groups C (AUROC = 0.74; 95%CI 0.67-0.81) and D (AUROC = 0.74; 95%CI 0.67-0.81). No significant difference was seen between Groups B, C, and D for diagnostic accuracy. Conclusion: EUS-E is reproducible in the evaluation of SPL, even between endoscopists with no or limited experience in EUS and/or EUS-E. Reproducibility and diagnostic accuracy increase with experience in EUS and EUS-E.
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29
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Soares JB, Iglesias-Garcia J, Gonçalves B, Lindkvist B, Lariño-Noia J, Bastos P, Caetano AC, Ferreira A, Pimentel-Nunes P, Lopes L, Moutinho P, Dominguez-Muñoz JE. Interobserver agreement of contrast-enhanced harmonic endoscopic ultrasonography in the evaluation of solid pancreatic lesions. Endosc Int Open 2015; 3:E205-9. [PMID: 26171432 PMCID: PMC4486026 DOI: 10.1055/s-0034-1391415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 01/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Previous reports assessing the reproducibility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in the evaluation of solid pancreatic lesions (SPLs) involved mainly experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of CH-EUS in the evaluation of SPLs by endoscopists with different levels of experience in EUS and CH-EUS. PARTICIPANTS AND METHODS A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups according to their experience in EUS and CH-EUS: group A (long experience in EUS and CH-EUS); group B (short experience in EUS and CH-EUS); group C (long experience in EUS and no experience in CH-EUS); and group D (no experience in EUS or CH-EUS). The observers independently classified the patterns of 60 CH-EUS video sequences of 60 SPLs after a 20-minute training session. For each group, we calculated the IOA (kappa statistic, κ) of CH-EUS and the accuracy of CH-EUS for the diagnosis of pancreatic adenocarcinoma by comparing the pattern of CH-EUS indicative of pancreatic adenocarcinoma (hypo-enhanced contrast pattern) with the final diagnosis. RESULTS The overall IOA for CH-EUS was fair (κ = 0.32; 95 %CI 0.22 - 0.41). Group A (κ = 0.63; 95 %CI 0.45 - 0.85) had the highest IOA, followed by group C (κ = 0.54; 95 %CI 0.39 - 0.71), group B (κ = 0.38; 95 %CI 0.22 - 0.55), and group D (κ = 0.21; 95 %CI 0.07 - 0.36). The IOA of groups A and C was significantly higher than that of group D. No significant difference was seen between groups A, B, and C or between groups B and D in terms of IOA. Group A (area under the curve under summary receiver operating characteristic [AUROC] = 0.67; 95 %CI 0.58 - 0.75) had the highest accuracy for the diagnosis of pancreatic adenocarcinoma, followed by group C (AUROC = 0.58; 95 %CI 0.50 - 0.65), group B (AUROC = 0.55; 95 %CI 0.48 - 0.63), and group D (AUROC = 0.51; 95 %CI 0.43 - 0.58). The diagnostic accuracy of group A was not significantly different from that of group C, but it was significantly higher than that of groups B and D. No significant difference was seen between groups B, C, and D in terms of diagnostic accuracy. CONCLUSIONS CH-EUS is reproducible in the evaluation of SPLs, even between endoscopists with no or limited experience in EUS and/or CH-EUS. Long experience in EUS is a major contributor to the IOA and diagnostic accuracy of CH-EUS.
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Affiliation(s)
- João-Bruno Soares
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal ,Corresponding author João-Bruno Soares, MD Department of Gastroenterology, Hospital of BragaSete Fontes – S. Victor Apartado 2056 4701-901 Braga Portugal+351-253-027999
| | - Julio Iglesias-Garcia
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain,Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Bruno Gonçalves
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - Björn Lindkvist
- Department of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden,Sahlgrenska Academy, University of Gothenburg Institute of Medicine, Gothenburg, Sweden
| | - Jose Lariño-Noia
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain,Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pedro Bastos
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal
| | - Ana Célia Caetano
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal ,Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Aníbal Ferreira
- Department of Gastroenterology, Hospital of Braga, Braga, Portugal ,Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Portuguese Institute of Oncology – Oporto, Porto, Portugal,Department of Physiology, Cardiovascular Research and Development Unit, University of Porto Faculty of Medicine, Porto, Portugal
| | - Luís Lopes
- Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal,Department of Gastroenterology, Hospital Center of Alto Minho, Viana do Castelo, Portugal
| | - Pedro Moutinho
- Department of Gastroenterology, Hospital Center of Alto Ave, Guimarães, Portugal
| | - J. Enrique Dominguez-Muñoz
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain,Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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Opačić D, Rustemović N, Kalauz M, Markoš P, Ostojić Z, Majerović M, Ledinsky I, Višnjić A, Krznarić J, Opačić M. Endoscopic ultrasound elastography strain histograms in the evaluation of patients with pancreatic masses. World J Gastroenterol 2015; 21:4014-4019. [PMID: 25852289 PMCID: PMC4385551 DOI: 10.3748/wjg.v21.i13.4014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the accuracy of the strain histogram endoscopic ultrasound (EUS)-based method for the diagnostic differentiation of patients with pancreatic masses.
METHODS: In a prospective single center study, 149 patients were analyzed, 105 with pancreatic masses and 44 controls. Elastography images were recorded using commercially available ultrasound equipment in combination with EUS linear probes. Strain histograms (SHs) were calculated by machine integrated software in regions of interest and mean values of the strain histograms were expressed as Mode 1 (over the mass) and Mode 2 (over an adjacent part of pancreatic tissue, representing the reference area). The ratio between Mode 2 and Mode 1 was calculated later, representing a new variable, the strain histogram ratio. After the final diagnosis was established, two groups of patients were formed: a pancreatic cancer group with positive cytology achieved by fine needle aspiration puncture or histology after surgery (58 patients), and a mass-forming pancreatitis group with negative cytology and follow-up after 3 and 6 mo (47 patients). All statistical analyses were conducted in SPSS 14.0 (SPSS Inc., Chicago, IL, United States).
RESULTS: Results were obtained with software for strain histograms with reversed hue scale (0 represents the hardest tissue structure and 255 the softest). Based on the receiver operating characteristics (ROC) curve coordinates, the cut-off point for Mode 1 was set at the value of 86. Values under the cut-off point indicated the presence of pancreatic malignancy. Mode 1 reached 100% sensitivity and 45% specificity with overall accuracy of 66% (95%CI: 61%-66%) in detection of pancreatic malignant tumors among the patients with pancreatic masses. The positive and negative predictive values were 54% and 100%, respectively. The cut-off for the new calculated variable, the SH ratio, was set at the value 1.153 based on the ROC curve coordinates. Values equal or above the cut-off value were indicative of pancreatic malignancy. The SH ratio reached 98% sensitivity, 50% specificity and an overall accuracy of 69% (95%CI: 63%-70%). The positive and negative predictive values were 92% and 100%, respectively.
CONCLUSION: SH showed high sensitivity in pancreatic malignant tumor detection but disappointingly low specificity. Slight improvements in specificity and accuracy were achieved using the SH ratio.
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Schneider AR, Nerlich A, Topalidis T, Schepp W. Specialized clinical cytology may improve the results of EUS (endoscopic ultrasound)-guided fine-needle aspiration (FNA) from pancreatic tumors. Endosc Int Open 2015; 3:E134-7. [PMID: 26135655 PMCID: PMC4477028 DOI: 10.1055/s-0034-1390886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/22/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND STUDY AIMS A variety of factors (needle type, needle passes, tumor location, cytological assessment, etc.) may influence the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) from pancreatic tumors. Whereas most published studies report a diagnostic accuracy of > 80 % for EUS-FNAC, the results in routine settings are often considerably lower. This retrospective study aimed to define the effect of switching microscopic assessment from a standard pathology department to a highly specialized institute of cytology. PATIENTS AND METHODS A total of 63 patients underwent EUS-FNAC of solid or semisolid pancreatic masses. Specimens of the first consecutive 20 cases (Phase 1) were assessed by the local department of pathology. Then in Phase 2, involving another 43 subsequent cases, a specialized cytology laboratory examined all aspirates. All EUS-FNACs were performed in the same manner, using a 22-gauge needle. After cytological evaluation, all patients either underwent surgery or were followed up for at least 6 months. RESULTS Of the tumors, 56 were solid and 7 semisolid; the mean size was 30 mm. Sensitivity (sens.), specificity (spec.), positive predictive value (PPV), and negative predictive value (NPV) of EUS-FNAC were 38.5 % (95 %CI [confidence interval] 13.9 - 68.4 %), 100 % (59.0 - 100 %), 100 % (47.8 - 100 %), and 46.7 % (21.3 - 73.4 %) during Phase 1 versus 91.4 % (95 %CI 76.9 - 98.2 %), 100 % (63.1 - 100 %), 100 % (89.1 - 100 %), and 72.7 % (39.0 - 94.0 %) during Phase 2. CONCLUSION These results emphasize the considerable impact of a dedicated cytological evaluation on the results of EUS-FNAC.
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Affiliation(s)
- Arne R. Schneider
- Department of Gastroenterology, Hepatology, and Gastroenterological Oncology, Bogenhausen Academic Teaching Hospital, Munich Municipal Hospital Holding, Munich, Germany,Corresponding author Arne Schneider, MD Department of Gastroenterology, Hepatology, and Gastroenterological OncologyBogenhausen Academic Teaching HospitalEnglschalkinger Str. 77D-81925 MunichGermany+4989/9270-2486
| | - Andreas Nerlich
- Department of Pathology, Bogenhausen Academic Teaching Hospital, Munich Municipal Hospital Holding, Munich, Germany
| | | | - Wolfgang Schepp
- Department of Gastroenterology, Hepatology, and Gastroenterological Oncology, Bogenhausen Academic Teaching Hospital, Munich Municipal Hospital Holding, Munich, Germany
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Hou X, Jin Z, Xu C, Zhang M, Zhu J, Jiang F, Li Z. Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study. PLoS One 2015; 10:e0121236. [PMID: 25793739 PMCID: PMC4368099 DOI: 10.1371/journal.pone.0121236] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/28/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The negative predictive value of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of solid pancreatic lesions remains low, and the biopsy specimens are sometimes inadequate for appropriate pathological diagnosis. AIMS To evaluate the usefulness of a novel method of contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for the differential diagnosis and adequate sampling of solid pancreatic lesions. METHODS Patients with a diagnosis of solid pancreatic lesions who underwent fine-needle aspiration guided by contrast-enhanced harmonic endoscopic ultrasonography or by endoscopic ultrasonography from October 2010 to July 2013 were retrospectively identified and classified into the CH-EUS or EUS group, respectively. Surgical pathology and/or follow-up results were defined as the final diagnosis. Operating characteristics and adequacy of biopsy specimens by fine-needle aspiration were compared between the two groups. RESULTS Operating characteristics for contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration in solid pancreatic lesions were as follows: area under the curve = 0.908, sensitivity = 81.6%, specificity = 100%, positive predictive value = 100%, negative predictive value = 74.1%, and accuracy = 87.9%. The percentage of adequate biopsy specimens in the CH-EUS group (96.6%) was greater than that in the EUS group (86.7%). CONCLUSION Simultaneous contrast-enhanced harmonic endoscopic ultrasonography during fine-needle aspiration is useful for improving the diagnostic yield and adequate sampling of solid pancreatic lesions.
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Affiliation(s)
- Xiaojia Hou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Can Xu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Minmin Zhang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Jianwei Zhu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Fei Jiang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
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Grieve K, Palazzo L, Dalimier E, Vielh P, Fabre M. A feasibility study of full-field optical coherence tomography for rapid evaluation of EUS-guided microbiopsy specimens. Gastrointest Endosc 2015; 81:342-50. [PMID: 25262102 DOI: 10.1016/j.gie.2014.06.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/18/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Rapid on-site evaluation of cytologic specimens is a way of determining the adequacy of fine-needle aspiration (FNA). However, alternatives may be useful when the presence of a cytotechnologist and/or pathologist is not possible. OBJECTIVE To evaluate the feasibility of using full-field optical coherence tomography (FFOCT) for FNA specimen quality assessment. DESIGN FFOCT images were acquired on gastric, pancreatic, pelvic, and lymph-node formalin-fixed FNA specimens and were compared with histology of the same samples. SETTING Pathology suite in a hospital. PATIENTS Fourteen patients undergoing gastric, pancreatic, pelvic, or lymph-node EUS-guided FNA biopsy. INTERVENTIONS FFOCT imaging on formalin-fixed samples before histologic procedures. MAIN OUTCOME MEASUREMENTS FFOCT imaging feasibility and visibility of normal and abnormal features on images. RESULTS FFOCT imaging was possible. Blood, mucus, muscle, collagen, and digestive mucosa could be identified as well as abnormal architectural features including infiltrative pancreatic ductal carcinoma and a neuroendocrine neoplasm. Lesions at the individual cell level could not be detected. LIMITATIONS The study was performed on a limited number of cases. CONCLUSION FFOCT offers rapid, noninvasive, nondestructive imaging of FNA biopsy specimens. In the future, it could be performed in the endoscopy suite to improve detection of satisfactory specimens and obviate the need for rapid on-site evaluation.
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Affiliation(s)
- Kate Grieve
- Institut de la Vision, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | | | | | - Philippe Vielh
- Department of Biology and Pathology, Translational Research Laboratory, Gustave Roussy, Villejuif, France
| | - Monique Fabre
- Department of Biology and Pathology, Translational Research Laboratory, Gustave Roussy, Villejuif, France
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Ward A, Piccardi S, Milenkovic S, Cole V, Dill T, Lochhead A. The accuracy of endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-GUIDED FNAB) cytology for the diagnosis of pancreatic malignancy at the wollongong hospital (TWH). Pathology 2015; 47:S62. [DOI: 10.1097/01.pat.0000461479.97300.82] [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: 11/25/2022]
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Kudo T, Kawakami H, Hayashi T, Yasuda I, Mukai T, Inoue H, Katanuma A, Kawakubo K, Ishiwatari H, Doi S, Yamada R, Maguchi H, Isayama H, Mitsuhashi T, Sakamoto N. High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2014; 80:1030-7.e1. [PMID: 24890422 DOI: 10.1016/j.gie.2014.04.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/03/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) has a high diagnostic accuracy for pancreatic diseases. However, although most reports have typically focused on cytology, histological tissue quality has rarely been investigated. The effectiveness of EUS-FNA combined with high negative pressure (HNP) suction was recently indicated for tissue acquisition, but has not thus far been tested in a prospective, randomized clinical trial. OBJECTIVE To evaluate the adequacy of EUS-FNA with HNP for the histological diagnosis of pancreatic lesions by using 25-gauge needles. DESIGN Prospective, single-blind, randomized, controlled crossover trial. SETTING Seven tertiary referral centers. PATIENTS Patients referred for EUS-FNA of pancreatic solid lesions. From July 2011 to April 2012, 90 patients underwent EUS-FNA of pancreatic solid masses by using normal negative pressure (NNP) and HNP with 2 respective passes. The order of the passes was randomized, and the sample adequacy, quality, and histology were evaluated by a single expert pathologist. INTERVENTION EUS-FNA by using NNP and HNP. MAIN OUTCOME MEASUREMENTS The adequacy of tissue acquisition and the accuracy of histological diagnoses made by using the EUS-FNA technique with HNP. RESULTS We found that 72.2% (65/90) and 90% (81/90) of the specimens obtained using NNP and HNP, respectively, were adequate for histological diagnosis (P = .0003, McNemar test). For 73.3% (66/90) and 82.2% (74/90) of the specimens obtained by using NNP and HNP, respectively, an accurate diagnosis was achieved (P = .06, McNemar test). Pancreatitis developed in 1 patient after this procedure, which subsided with conservative therapy. LIMITATIONS This was a single-blinded, crossover study. CONCLUSION Biopsy procedures that combine the EUS-FNA with HNP techniques are superior to EUS-FNA with NNP procedures for tissue acquisition. ( CLINICAL TRIAL REGISTRATION NUMBER UMIN000005939.).
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Affiliation(s)
- Taiki Kudo
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Ichiro Yasuda
- The First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Hiroyuki Inoue
- Department of Gastroenterology and Hepatology, Mie University, Mie, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Ishiwatari
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Shinpei Doi
- The First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University, Mie, Japan
| | - Hiroyuki Maguchi
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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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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Abstract
Endoscopic ultrasound (EUS)-guided fine needle aspiration has emerged as the procedure of choice to obtain samples to reach a definitive diagnosis of lesions of the gastrointestinal tract and of adjacent organs. The obtainment of a tissue core biopsy presents several advantages that can substantially contribute to the widespread diffusion of EUS utilization in the community and in countries where cytology expertise may be difficult to be achieved. This article will review the EUS-guided fine needle biopsy techniques developed so far, the clinical results, their limitations as well as their future perspective.
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Affiliation(s)
- Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
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Abstract
Endoscopic ultrasound (EUS) has evolved to become a crucial tool for the evaluation of pancreatic diseases, among them solid pancreatic lesions. However, its ability to determine whether a lesion is malignant or not is difficult to establish based only in the endosonographic image. EUS-guided fine needle aspiration (EUS-FNA) allows obtaining a cytological and/or histological sample from pancreatic lesions, with a high overall accuracy and low complication rates. Although the clinical usefulness of EUS-FNA for pancreatic diseases is widely accepted, the indications for tissue diagnosis of pancreatic lesions suspected to be malignant is still controversial. This review highlights the diagnostic accuracy and complications of EUS-FNA, focusing on its current indications.
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Affiliation(s)
- Julio Iglesias-Garcia
- Gastroenterology Department, Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Spain
| | - Jose Lariño-Noia
- Gastroenterology Department, Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Spain
| | - J Enrique Domínguez-Muñoz
- Gastroenterology Department, Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Spain
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Abstract
Endoscopic ultrasound (EUS) is one of the best diagnostic methods for diseases of the digestive tract and surrounding organs. Whereas EUS-guided fine needle aspiration (FNA) has been very useful for providing histological confirmation for previously hard to reach lesions, elastography is aiming to obtain a “virtual biopsy” by assessing differences in elasticity between the normal and pathological – usually malignant – tissue. A question that arises is whether EUS-elastography has reached a stage where it might successfully supplant the use of EUS-FNA in some of its clinical indications. The main indications of EUS-guided FNA are listed in this article and published data on the usage of elastography in these settings is reviewed for each one. In some of the indications, a plethora of studies have been published, notably for the evaluation of solid pancreatic masses and lymph nodes, while in others there is little relevant data (submucosal masses, left liver lesions, left adrenal masses), or elastography simply is not suitable as a diagnostic means (cystic lesions). Our conclusion is that elastography is not yet ready to replace EUS-FNA in its indications, but should complement it in various settings, especially for the assessment of lymph nodes. It can only be considered an alternative on a case-by-case basis, in situations where FNA is regarded as a contraindication. Furthermore, it could be used in conjunction with other imaging techniques, such as contrast-enhanced EUS, in order to further improve the accuracy of non-invasive EUS assessment, possibly making the case for a more limited or targeted use of EUS-FNA in selected cases.
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Affiliation(s)
- Alexandru Popescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Matynia AP, Schmidt RL, Barraza G, Layfield LJ, Siddiqui AA, Adler DG. Impact of rapid on-site evaluation on the adequacy of endoscopic-ultrasound guided fine-needle aspiration of solid pancreatic lesions: a systematic review and meta-analysis. J Gastroenterol Hepatol 2014; 29:697-705. [PMID: 24783248 DOI: 10.1111/jgh.12431] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) has the potential to improve adequacy rates for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic lesions, but its impact is context-dependent. No studies exist that summarize the relationship between ROSE, number of needle passes, and resulting adequacy rates. AIMS To analyze data from previous studies to establish if ROSE is associated with improved adequacy rates; to evaluate the relationship between ROSE, number of needle passes, and the resulting adequacy rates of EUS-FNA for solid pancreatic lesions. METHODS Systematic review and meta-analysis of studies reporting the adequacy rates for EUS-FNA of solid pancreatic lesions. RESULTS The search produced 3822 original studies, of which 70 studies met our inclusion criteria. The overall average adequacy rate was 96.2% (95% confidence interval: 95.5, 96.9). ROSE was associated with a statistically significant improvement of up to 3.5% in adequacy rates. There was heterogeneity in adequacy rates across all subgroups. No association between the assessor type and adequacy rates was found. Studies with ROSE have high per-case adequacy and a relatively high number of needle passes in contrast to non-ROSE studies. ROSE is an effect modifier of the relationship between number of needle passes and adequacy. CONCLUSIONS ROSE is associated with up to 3.5% improvement in adequacy rates for EUS-FNA of solid pancreatic lesions. ROSE assessor type has no impact on adequacy rates. ROSE is an effect modifier on the relationship between needle passes and per-case adequacy for EUS-FNA of solid pancreatic lesions.
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Layfield LJ, Schmidt RL, Hirschowitz SL, Olson MT, Ali SZ, Dodd LL. Significance of the diagnostic categories "atypical" and "suspicious for malignancy" in the cytologic diagnosis of solid pancreatic masses. Diagn Cytopathol 2014; 42:292-6. [PMID: 24578254 DOI: 10.1002/dc.23078] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 04/23/2013] [Accepted: 12/03/2013] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasound guided (EUS) fine-needle aspiration (FNA) investigation of solid pancreatic lesions has been shown to have good sensitivity and specificity. Many lesions can be definitely classified as benign or malignant but some can only be cytologically classified as "atypical" or "suspicious for malignancy". Risk for malignancy in these indeterminate categories has not been well categorized. The cytology records of four University Medical centers were searched for all EUS guided FNAs of solid pancreatic lesions. All cases with a diagnosis of "atypical", or "suspicious for malignancy" were selected for analysis when histologic biopsy or over 18 months clinical follow-up was available. Two hundred and ninety-two cases with a diagnosis of "atypical" or "suspicious for malignancy" and adequate follow-up were obtained from the combined data of the four institutions. The percentage malignant for the categories "atypical" and "suspicious for malignancy" were 79.2 and 96.3%, respectively. If the category "atypical" was classified as benign and "suspicious for malignancy" was classified as malignant, the resulting positive predictive value was 96.3 (95% CI: 92.6-98.5) and the negative predictive value 20.8 (95% CI: 13.4-30.0). The categories of "atypical" and "suspicious for malignancy" stratify risk for malignancy in a fashion, which may aid in patient counseling and selection of follow-up protocols. Classification of "suspicious for malignancy" as malignant optimizes diagnostic sensitivity and specificity.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
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Abstract
Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the method of choice to obtain samples to reach definitive diagnosis of lesions of the gastrointestinal tract and of adjacent organs, it cannot fully characterize certain neoplasms. The lack of cytology expertise has hindered the dissemination of EUS, limiting its widespread use. The obtainment of a tissue specimen through EUS fine-needle biopsy (EUS-FNB) may overcome the limitations of EUS-FNA. EUS-FNB is expected to move the practice of EUS from cytology to histology, expanding the use of EUS and facilitating targeted therapies and monitoring of treatment response in a more biologically driven manner.
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Affiliation(s)
- Nikola Panic
- Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, Rome 00168, Italy; Department of Medicine, University of Belgrade, Dr Subotica 8, Belgrade 11000, Serbia
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Abstract
The diagnostic yield of EUS-FNA depends on several factors, such as the experience of the endosonographer, the characteristics of the lesion, the clinical status of the patient, the size and type of needles, the methods of specimen preparation, as well as cytopathologist expertise. The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of FNA are known. Technical challenges of FNA are related to the characteristics of the lesion and its surroundings, sonographic imaging, and limitations related to the needle. Several tips and tricks necessary to overcome them are presented in this review.
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Affiliation(s)
- Peter Vilmann
- Department of Endoscopy, Gastrointestinal Unit, Copenhagen University Hospital, Herlev Ringvej 75, Herlev 2730, Denmark
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Layfield LJ, Dodd L, Factor R, Schmidt RL. Malignancy risk associated with diagnostic categories defined by the Papanicolaou Society of Cytopathology pancreaticobiliary guidelines. Cancer Cytopathol 2013; 122:420-7. [PMID: 24339321 DOI: 10.1002/cncy.21386] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the predominant method for obtaining a preoperative tissue diagnosis for pancreatic lesions suspicious for malignancy. The diagnostic sensitivity and specificity of EUS-FNA are well documented, but malignancy risk associated with the diagnostic categories proposed by the Papanicolaou Society of Cytopathology is poorly defined. METHODS The records of the Departments of Pathology at Duke University and the University of Utah were searched for all cases of EUS-FNA performed for the investigation of pancreatic lesions. All cases with follow-up surgical diagnosis or greater than 3 years of clinical follow-up were selected. Cytologic diagnostic categories were "nondiagnostic," "benign," "atypical (not otherwise specified)," "suspicious for malignancy," "neoplasm," and "malignant." Correlation of cytologic diagnosis with surgical and/or clinical follow-up was made and risk of malignancy calculated for each category. RESULTS Three hundred seventeen EUS-FNAs with adequate surgical or clinical follow-up were obtained. Risk of malignancy for nondiagnostic specimens was 21%;, benign specimens, 13%; atypical cases, 74%; suspicious for malignancy, 82%; the neoplasm category, 14%; and the malignant category, 97% CONCLUSIONS The cytologic categories proposed by the Papanicolaou Society of Cytopathology demonstrate an increasing risk for malignancy extending from benign to malignant. Aspirates designated benign have the lowest risk of malignancy (13%) and aspirates designated malignant the highest (97%). The proposed categorization scheme stratifies risk for malignancy giving useful information to clinicians treating patients with pancreatic lesions.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
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Abstract
This review addresses the role of endoscopy in the diagnosis and treatment of autoimmune pancreatitis (AIP) and provides a diagnostic process for patients with suspected AIP. When should AIP be suspected? When can it be diagnosed without endoscopic examination? Which endoscopic approaches are appropriate in suspected AIP, and when? What are the roles of diagnostic endoscopic retrograde pancreatography, endoscopic biopsies, and IgG4 immunostaining? What is the proper use of the steroid trial in the diagnosis of AIP in patients with indeterminate computed tomography imaging? Should biliary stenting be performed in patients with AIP with obstructive jaundice?
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Affiliation(s)
- Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea
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Haba S, Yamao K, Bhatia V, Mizuno N, Hara K, Hijioka S, Imaoka H, Niwa Y, Tajika M, Kondo S, Tanaka T, Shimizu Y, Yatabe Y, Hosoda W, Kawakami H, Sakamoto N. Diagnostic ability and factors affecting accuracy of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions: Japanese large single center experience. J Gastroenterol 2013; 48:973-81. [PMID: 23090002 DOI: 10.1007/s00535-012-0695-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 09/25/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies have investigated the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic lesions, but they have included only limited patient populations. This study aimed to clarify the diagnostic accuracy of EUS-FNA in a large number of pancreatic lesions, and to describe the factors that influence it. METHODS From March 1997 to May 2010, 944 consecutive patients who had undergone EUS-FNA for pancreatic solid lesions were evaluated retrospectively. Factors affecting EUS-FNA accuracy were then analyzed. RESULTS A total of 996 solid pancreatic lesions were sampled by EUS-FNA. The overall sampling adequacy and diagnostic accuracy of these lesions were 99.3 % (989/996) and 91.8 % (918/996), respectively. The sensitivity and specificity for differentiating malignant from benign lesions were 91.5 % (793/867) and 97.7 % (126/129), respectively. The diagnostic performance was significantly higher when both cytological and cell-block examinations were carried out than with only cytological examination. In multivariate analysis, final diagnosis, location of lesion, lesion size, availability of on-site cytopathological evaluation, and experience of EUS-FNA procedure were independent factors affecting the accuracy of EUS-FNA. On-site cytopathological evaluation and lesion size were found to be the most weighted factors affecting diagnostic accuracy. CONCLUSIONS EUS-FNA for pancreatic solid lesions yielded a high accuracy and low complication rate. Both cytological and cell-block preparations and on-site cytopathological evaluation contributed to improve the accuracy. The diagnostic ability of EUS-FNA was less for smaller lesions, and repeated procedures may be needed if malignancy is suspected.
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Mikata R, Ishihara T, Tada M, Tawada K, Saito M, Kurosawa J, Sugiyama H, Sakai Y, Tsuyuguchi T, Miyazaki M, Yokosuka O. Clinical usefulness of repeated pancreatic juice cytology via endoscopic naso-pancreatic drainage tube in patients with pancreatic cancer. J Gastroenterol 2013; 48:866-73. [PMID: 23053424 DOI: 10.1007/s00535-012-0684-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/07/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cytological examination of pancreatic juice obtained during endoscopic retrograde cholangiopancreatography (ERCP) is well established, but its sensitivity for pancreatic cancer has not been satisfactory. The aim of this study was to evaluate the usefulness of repeated pancreatic juice cytology (PJC) via the endoscopic naso-pancreatic drainage (ENPD) tube in patients with pancreatic cancer compared with conventional PJC. METHODS We retrospectively investigated 139 patients with pancreatic disease. Between April 2004 and November 2007, conventional PJC was performed in 56 patients with pancreatic cancer and 23 with benign pancreatic stricture. Between January 2008 and November 2010, ENPD was used in 40 patients with pancreatic cancer and 20 with benign pancreatic stricture. The ENPD tube was placed into the main pancreatic duct for up to 3 days, and cytological samples of pancreatic juice were collected up to 6 times in total. RESULTS Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ENPD method for pancreatic cancer were 80, 100, 100, 71, and 87 %, respectively, revealing significantly higher sensitivity than the conventional method (p = 0.0001). Sensitivities according to tumor location and size were 90 % (19/21), 69 % (9/13), and 67 % (4/6) in the head, body, and tail of the pancreas, 88 % (7/8), 79 % (19/24), and 75 % (6/8) in tumors with a diameter less than 20 mm including carcinoma in situ, 21-40, and greater than 41 mm, respectively. CONCLUSIONS The ENPD method was found to have high diagnostic yield, especially for tumors less than 20 mm or located in the pancreatic head, and might be useful for the diagnosis of early-stage pancreatic cancer.
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Affiliation(s)
- Rintaro Mikata
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo Ward, Chiba 260-8670, Japan.
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Weston BR, Bhutani MS. Optimizing Diagnostic Yield for EUS-Guided Sampling of Solid Pancreatic Lesions: A Technical Review. Gastroenterol Hepatol (N Y) 2013; 9:352-63. [PMID: 23935542 PMCID: PMC3736792] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has a higher diagnostic accuracy for pancreatic cancer than other techniques. This article will review the current advances and considerations for optimizing diagnostic yield for EUS-guided sampling of solid pancreatic lesions. Preprocedural considerations include patient history, confirmation of appropriate indication, review of imaging, method of sedation, experience required by the endoscopist, and access to rapid on-site cytologic evaluation. New EUS imaging techniques that may assist with differential diagnoses include contrast-enhanced harmonic EUS, EUS elastography, and EUS spectrum analysis. FNA techniques vary, and multiple FNA needles are now commercially available; however, neither techniques nor available FNA needles have been definitively compared. The need for suction depends on the lesion, and the need for a stylet is equivocal. No definitive endosonographic finding can predict the optimal number of passes for diagnostic yield. Preparation of good smears and communication with the cytopathologist are essential to optimize yield.
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Affiliation(s)
- Brian R Weston
- Dr. Weston is an Assistant Professor and Dr. Bhutani is a Professor in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas
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Larghi A, Iglesias-Garcia J, Poley JW, Monges G, Petrone MC, Rindi G, Abdulkader I, Arcidiacono PG, Costamagna G, Biermann K, Bories E, Doglioni C, Dominguez-Muñoz JE, Hassan C, Bruno M, Giovannini M. Feasibility and yield of a novel 22-gauge histology EUS needle in patients with pancreatic masses: a multicenter prospective cohort study. Surg Endosc 2013; 27:3733-8. [DOI: 10.1007/s00464-013-2957-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/02/2013] [Indexed: 12/14/2022]
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Schmidt RL, Witt BL, Matynia AP, Barraza G, Layfield LJ, Adler DG. Rapid on-site evaluation increases endoscopic ultrasound-guided fine-needle aspiration adequacy for pancreatic lesions. Dig Dis Sci 2013; 58:872-82. [PMID: 23053888 DOI: 10.1007/s10620-012-2411-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 09/10/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) has the potential to improve adequacy rates and affect other outcomes; however, there have been few comparative studies to assess the impact of ROSE in the setting of ultrasound-guided endoscopic fine-needle aspiration cytology for pancreatic lesions. AIMS To determine whether ROSE improves adequacy rates of endoscopic fine-needle aspiration cytology for pancreatic lesions. METHODS Systematic review and meta-analysis of studies reporting a head-to-head comparison of adequacy or diagnostic accuracy (with ROSE vs. without ROSE) at a single site. RESULTS ROSE was associated with a statistically significant (p < 0.001) improvement in the adequacy rate (average 10 %, 95 % CI: 5-24 %). The impact of ROSE depends on the per-pass adequacy rate without ROSE. ROSE had no impact on diagnostic yield (p < 0.76). CONCLUSIONS ROSE is associated with an improvement in adequacy rates when implemented at sites where the per-case adequacy rate without ROSE is low (<90 %). It is unclear whether the type of assessor (pathologist vs. non-pathologist) has a significant impact on the success rate of ROSE. ROSE has no impact on diagnostic yield. Studies should employ head-to-head comparisons of cohorts with and without ROSE at a single location.
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Affiliation(s)
- Robert L Schmidt
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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