EUS-guided FNA and FNB after on-site cytological evaluation in gastric subepithelial tumors

OBJECTIVE

Acquiring adequate tissue for immunohistochemical (IHC) analysis is important in the differential diagnosis of subepithelial tumors (SETs). In this study, we aimed to compare the diagnostic yield based on IHC analysis between endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and EUS-guided fine needle biopsy (EUS-FNB) after on-site cytological evaluation for cellularity in gastric SETs.

METHODS

In 22 patients with gastric SETs, EUS-guided tissue sampling was performed on the same SET in a randomized sequence, with EUS-FNA followed by EUS-FNB, or vice versa. After on-site cytological evaluation for cellularity, the cytological and histological examinations were performed.

RESULTS

There was a significant difference in the median number of needle passes to obtain adequate cellularity in the on-site cytological evaluation (2.0 for EUS-FNA vs 1.0 for EUS-FNB, P = 0.008). The proportion of adequate cellularity on the first needle pass was significantly higher in the EUS-FNB than in the EUS-FNA group (68.2% vs 31.8%, P = 0.034). However, diagnosis based on IHC examination was established in 15 (68.2%) and 18 (81.8%) cases by EUS-FNA and EUS-FNB, respectively (P = 0.488).

CONCLUSIONS

EUS-FNB decreases the number of needle passes to obtain adequate cellularity and yields a higher proportion of adequate cellularity during the first needle pass compared with EUS-FNA in gastric SETs. However, there was no significant difference in diagnostic yield with IHC stain between the two procedures after on-site cytological evaluation for adequate cellularity.

Cost comparison of radiologic versus surgical placement of long-term hemodialysis catheters

OBJECTIVE

The purpose of this study was to compare the cost of radiologic versus surgical placement of long-term hemodialysis catheters.

MATERIALS AND METHODS

Our cost analysis was based on 47 long-term hemodialysis catheters radiologically placed in 45 patients and 25 catheters surgically placed in 25 patients from October 1996 through March 1997. Variable and total costs were calculated using data from the hospital administrative computer system that records the actual costs incurred by the hospital in caring for patients.

RESULTS

The average total hospital cost was $926 for each radiologic placement and $1849 for each surgical placement of long-term hemodialysis catheters. The total cost saving for radiologic placement was $923 for each catheter.

CONCLUSION

Radiologic placement of long-term hemodialysis catheters resulted in substantial savings over surgical placement.

Cryptococcoma of the sacrum

Cryptococcoma of the sacrum was the initial presentation of systemic cryptococcosis in a patient on chronic steroid therapy for autoimmune hepatitis. The bone lesion was the only overt manifestation of systemic cryptococcal disease, which preceded other clinical manifestations and led to the subsequent diagnosis of systemic infection.

Isolated common iliac artery aneurysm rupturing into small bowel: CT appearance

We describe the findings of an isolated common iliac artery aneurysm that formed a fistulous tract with the terminal ileum diagnosed with dynamic computed tomography (CT). The role of CT in the diagnosis of arterioenteric fistula is addressed.

CT of the esophagus: spectrum of disease with emphasis on esophageal carcinoma

The esophagus is involved by a wide range of pathologic processes that can be detected, defined, and staged with computed tomography (CT). These processes include esophageal carcinoma; benign esophageal tumors; inflammatory and infectious diseases; miscellaneous conditions such as Barrett esophagus, achalasia, and varices; and trauma and perforation. CT is usually performed to clarify findings seen with other imaging modalities or to stage a pathologic condition; however, it may be the primary imaging modality in some cases. Because of the critical location of the esophagus, it can be involved secondarily by other disease processes or as part of a systemic process. By being aware of the appearances of the various entities that affect the esophagus, the radiologist can play an important role in detecting and staging esophageal disease. Although the role of CT in the evaluation of esophageal disease has been controversial, recent developments such as spiral CT have the potential to renew interest in this application.