Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination

Storch, Ian; Jordà, Mercè; Thurer, Richard; Raez, Luis E.; Rocha-Lima, Caio; Vernon, Stephen E.; Ribeiro, Afonso

doi:10.1016/j.gie.2006.02.056

Cited by 100 publications

(107 citation statements)

References 21 publications

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“…A histologic yield of 95% using this needle was similar to the 90% achieved in EUS-FNB using 19 G Pro-Core (Cook Endoscopy, Wilson-Salem, NC, USA) needles [26]. EUS-FNA with an on-site cytopathologist (rapid on-site cytopathological examination) resulted in a 10-29% increase in the adequacy rates of EUS-FNA specimens and a 10-15% increase in the diagnostic rate [27,28]. Recently, EUS-FNB using reverse bevel cheese slicer technology has been introduced [29].…”

Section: Endoscopic Ultrasoundsupporting

confidence: 57%

“…However, EUS findings are not sufficient to accurately predict malignancy [10]. If tissue was obtained from EUS-guided fine-needle aspiration (EUS-FNA), the diagnostic accuracy increased markedly, ranging from 63 to 98% [1,[26][27][28]. EUS-FNA for SETs using a forward-viewing linear EUS has provided good results: full histologic assessment rate of 93.4%, sensitivity of 92.8%, specificity of 100% [20,42].…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

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Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Al-Lehibi¹,

Bamakhrama²

2017

Endoscopic Ultrasound - From Usual to Special

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A subepithelial lesion (SET) is defined as a lesion, bulge or impression visible within the lumen of the gastrointestinal tract that is covered by normally appearing mucosa and usually found incidentally during routine endoscopy. Such a lesion could be either an intramural mass or an impression caused by extramural structures. The old terminology has recently been replaced by the term "subepithelial lesion" because intramural lesions may arise and can be located in any layer of the GI wall underneath the epithelium. The most common SELs are gastrointestinal stromal tumors (GISTs), leiomyomas, lipomas, granular cell tumors (GCTs), pancreatic rests and carcinoid tumors. The prognosis varies from benign to potentially malignant. While the majority of the lesions are considered benign, some tumors such as GISTs and carcinoids have a strong propensity for malignant transformation. Endoscopic ultrasonography (EUS) is the most accurate diagnostic method for distinguishing between extraluminal compressions and intramural lesions and plays a critical role in the detection and management of SELs. This is because EUS can reveal the precise sonographic nature of the lesion even though sometimes there are complex cases, which are difficult to diagnose by EUS alone. Performing routine biopsies and obtaining tissue samples for diagnosis can be difficult because SELs are located beneath the normal epithelial layer. Mostly, EUS allows the practitioner to extract an optimal tissue sample since it allows fine-needle aspiration (FNA) and fine-needle biopsy (FNB) both of which provide good results. With immunocytochemical staining, all these techniques increase the accuracy of the diagnosis. Evaluation of subepithelial lesions by means of EUS imaging will provide further characterization of the lesion to help guide us in appropriate differential diagnosis and further management. In this chapter, we provide a systematic EUS-guided approach to the diagnosis, management and later surveillance for SELs, as well as presenting updated diagnostic techniques that may help physicians to appropriately manage these subepithelial lesions.

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Section: Endoscopic Ultrasoundsupporting

confidence: 57%

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Al-Lehibi¹,

Bamakhrama²

2017

Endoscopic Ultrasound - From Usual to Special

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“…EUS-CNB might also provide useful information for gene or immuno-histochemical analysis by providing a core biopsy, especially in the cases of well-differentiated tumors and tumors with substantial desmoplasia. [170][171][172][173] …”

Section: Eus-cnbmentioning

confidence: 99%

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

Săftoiu

Vilmann

2008

J of Clinical Ultrasound

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Early diagnosis of pancreatic cancer remains a difficult task, and multiple imaging tests have been proposed over the years. The aim of this review is to describe the current role of endoscopic ultrasound (EUS) for the diagnosis and staging of patients with pancreatic cancer. A detailed search of MEDLINE between 1980 and 2007 was performed using the following keywords: pancreatic cancer, endoscopic ultrasound, diagnosis, and staging. References of the selected articles were also browsed and consulted. Despite progress made with other imaging methods, EUS is still considered to be superior for the detection of clinically suspected lesions, especially if the results of other cross-sectional imaging modalities are equivocal. The major advantage of EUS is the high negative predictive value that approaches 100%, indicating that the absence of a focal mass reliably excludes pancreatic cancer. The introduction of EUS-guided fine needle aspiration allows a preoperative diagnosis in patients with resectable cancer, as well as a confirmation of diagnosis before chemoradiotherapy for those that are not. This comprehensive review highlighted the diagnostic capabilities of EUS including the newest refinements such as contrast-enhanced EUS, EUS elastography, and 3-dimensional EUS. The place of EUSguided biopsy is also emphasized, including the addition of molecular marker techniques.

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“…Moreover, increased accuracy is possible with CNB samples when an on-site cytopathologist is unavailable and when there is a large amount of necrosis. 15 CNB samples are also desirable for analyzing a patient's biomarker profile, because larger amounts of tissue are required for this purpose.…”

mentioning

confidence: 99%

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Avritscher

Krishnamurthy

Ensor

et al. 2010

Cancer

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BACKGROUND: Because of their proximity to the pulmonary artery or vein, hilar lymph nodes are routinely biopsied with endobronchial or endoscopic ultrasonography (EUS)-guided fine-needle aspiration biopsy (FNAB). Computed tomography (CT)-guided percutaneous needle biopsy (PNB) allows the operator to acquire a larger core needle biopsy (CNB) when initial samples are inconclusive, when the suspected disease is not optimally diagnosed with FNAB, or when biomarkers are required. The purpose of this study was to retrospectively evaluate the sensitivity and accuracy of CT-guided PNB in patients with hilar adenopathy. METHODS: The authors identified 80 patients who underwent 81 CT-guided PNBs of pulmonary hilar lesions from October 2002 through December 2006 and retrospectively reviewed their medical and imaging records. The PNB sensitivity and accuracy were calculated in each case, and each case was reviewed for complications, including pneumothorax and subsequent thoracostomy tube insertion. RESULTS: PNB included FNAB and CNB in 81 (100%) and 14 (17%) procedures, respectively. Data on 69 PNB specimens (67 FNAB specimens and 13 CNB specimens) were available for statistical analysis. Overall, PNB had a sensitivity of 91.4% (95% confidence interval [CI], 81.0%-97.1%) and an accuracy rate of 92.8% (95% CI, 83.9%-97.1%). Pneumothoraxes occurred in 39 patients (48%), 26 (32%) of whom required thoracostomy tube insertion. CONCLU-SIONS: CT-guided PNB of pulmonary hilar lesions has high sensitivity and accuracy and represents a viable alternative for endobronchial ultrasound-or EUS-guided FNAB when larger biopsy samples are required for diagnosis or biomarker analysis. However, the procedure can result in high rates of pneumothorax.

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Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination

Cited by 100 publications

References 21 publications

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

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