Beyond Cytology

Fuente, Sebastián G. de la; Arnoletti, J. Pablo

doi:10.1016/j.giec.2013.08.001

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…In contrast, a thicker aspiration needle and a Trucut needle (19G) lack flexibility and maneuverability, but can obtain a large piece of tissue, which provides more information for pancreatic pathology. For instance, pancreatic tissues obtained by a 19G FNA needle or core biopsy needle are useful in the diagnosis of pancreatic tumors other than pancreatic adenocarcinoma, tumors surrounded by chronic pancreatitis, lymphoma [61] , and autoimmune pancreatitis [28] . However, a flexible 19G needle made of nitinol has recently been used on pancreatic head lesions and enabled satisfactory tissue acquisition from the pancreatic head in 95% of the cases [62] .…”

Section: Selection Of the Fna Needlementioning

confidence: 99%

Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

Matsubayashi

Matsui

Yabuuchi

et al. 2016

WJG

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Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.

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Section: Selection Of the Fna Needlementioning

confidence: 99%

Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

Matsubayashi

Matsui

Yabuuchi

et al. 2016

WJG

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“… 16 As molecular profiling and personalized oncologic therapy are becoming important concepts nowadays, a histologic core biopsy sample is necessary for ancillary testing. 17 Tissue core can be obtained with a conventional aspiration needle or a specialized FNB needle. A study reported that satisfactory histologic specimens were procured in 94.7% and tissue acquisition for cytological assessment was successful in 100%, including the transduodenal route, when an Expect 19 G Flex aspiration needle was used.…”

Section: Outcome Of Eus-guided Tissue Acquisitionmentioning

confidence: 99%

“…Usually, a cytological sample is enough to establish a diagnosis; however, histologic assessment may be useful in some cases such as pancreatic tumors other than pancreatic adenocarcinoma, tumors surrounded by chronic pancreatitis, submucosal and intramural gastrointestinal tumors, and for the biopsy of lesions or lymph nodes in which lymphoma is suspected. 17 Certain diseases such as autoimmune pancreatitis, well-differentiated adenocarcinoma, and highly desmoplastic pancreatic neoplasm may also require tissue core samples for a definitive diagnosis. Histological samples can often be obtained with a standard FNA needle, and addition of cell block examination can provide good information that is comparable to an FNB sample.…”

Section: Which Needle Is the Best Choice?mentioning

confidence: 99%

“… 27 Therefore, EUS-FNB can be a recommendable supplementary technique when additional tissue and histologic section are necessary for an accurate diagnosis and if molecular characterization of tumors is required. 8 , 17 The stiffness of the needle is a large obstacle to overcome in harvesting core tissues with the transduodenal approach. Certainly, cost-effectiveness is another factor to be considered.…”

Section: Which Needle Is the Best Choice?mentioning

confidence: 99%

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Fine-Needle Biopsy: Should This Be the First Choice in Endoscopic Ultrasound-Guided Tissue Acquisition?

Kim

2014

Clin Endosc

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Endoscopic ultrasound (EUS)-guided tissue acquisition is an indispensable technique for the diagnosis of many diseases of the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) is known for its high accuracy and low complication rate. However, the outcome of EUS-FNA highly depends on several factors such as the location and characteristics of the lesion, endosonographer's experience, technique of sampling and sample preparation, type and size of the needle used, and presence of a cytopathologist for rapid on-site examination. EUS-guided fine-needle biopsy is useful to obtain core tissue samples with relatively fewer passes. Aspiration of core tissue with preserved architecture is beneficial for the diagnosis of certain diseases and the performance of ancillary testing such as tumor molecular profiling. Issues related to needle size, type, and their acquired samples for cytologic and histologic evaluation are discussed here.

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Ki‐67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification

Wang

Abi‐Raad

Tang

et al. 2022

Cancer Cytopathology

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BACKGROUND: Risk assessment of gastrointestinal stromal tumor (GIST) is challenging on cytology specimens. This stud y aims to determine whether Ki-67 index evaluated on fine-needle aspiration (FNA) specimens can correlate with the mitotic rate of GIST in surgical specimens and provide further risk assessment. METHODS: Cases with cell blocks containing adequate tumor cells and surgical resections were included. Ki-67 immunostain was retrospectively performed on cell block sections, and Ki-67 index was calculated on the "hot spot" areas. RESULTS: This study included 50 GIST cases from stomach (n = 45; 90%), duodenum (n = 4; 8%), and distal esophagus (n = 1; 2%). The tumor size ranged from 1.5 cm to 21 cm (mean, 5.4 cm). Based on the mitotic count, 37 GISTs (74%) had low mitotic rate (LMR) and 13 GISTs (26%) had high mitotic rate (HMR). The spindle cell, epithelioid, and mixed types accounted for 60%, 14%, and 26% of GIST, respectively. Ki-67 index counted on cell block sections correlated well with mitotic count evaluated in surgical specimens (r = 0.8031). Mean Ki-67 index was higher in HMR than LMR groups (3.5% vs. 1%, p < .001). The receiver operating characteristic curve using Ki-67 index to predict mitotic rate was further analyzed, and area under the curve was 0.839. Using a cutoff of 2.5% yielded a sensitivity of 70% at 92% specificity. CONCLUSIONS:This study demonstrates good correlations between Ki-67 index and mitotic count or risk stratification, suggesting that Ki-67 index evaluated on cytology specimens may offer a promising approach to preoperatively predict the mitotic rate and risk of GIST.

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Beyond Cytology

Cited by 8 publications

References 45 publications

Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

Fine-Needle Biopsy: Should This Be the First Choice in Endoscopic Ultrasound-Guided Tissue Acquisition?

Ki‐67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification

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