Clinical Impact of on-Site Cytopathology Interpretation on Endoscopic Ultrasound-Guided Fine Needle Aspiration

Klapman, Jason; Logroño, Roberto; Dye, Charles; Waxman, Irving

doi:10.1111/j.1572-0241.2003.07472.x

Cited by 451 publications

(173 citation statements)

References 27 publications

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“…In previous studies showing high diagnostic yields of cytology, 3 to 6 needle passes through the lesion [16][17][18][19][20][21][22][23]26] and on-site evaluation of the FNA sample adequacy by a cytopathologist [10,[27][28][29] was considered essential. We were able to obtain an adequate sample in 90% of cases by performing three passes, two for cytological evaluation and one for histological evaluation.…”

Section: Discussionmentioning

confidence: 99%

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

Iglesias‐García

Domínguez‐Muñoz²,

Lozano-León³

et al. 2007

WJG

109

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INTRODUCTIONDifferential diagnosis of pancreatic masses is a frequent clinical challenge. Therapeutic decision in this context is mainly based on the ability to establish or exclude malignancy [1] . Although ductal adenocarcinoma is the most frequent cause of pancreatic masses, other neoplasms (e.g. lymphoma, cystic tumours) and benign conditions (e.g. chronic pancreatitis) with different prognoses and treatment options can arise within the pancreas. A histological diagnosis becomes therefore highly relevant for an optimal therapeutic decision [2] . Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been proved to be a safe and useful method for tissue sampling of intramural and extramural gastrointestinal lesions including the pancreas [3,4] . Cytological study of the materials obtained by FNA allows the evaluation of cellular findings suggestive of malignancy, such as anisonucleosis, nuclear membrane irregularity and nuclear enlargement. Unfortunately, inflammation causes a reactive and regenerative process leading to cellular changes that can be difficult to distinguish from well-differentiated neoplasias. Histological study of tissue samples allows the assessment of tissue architecture and cell morphology, as well as the performance of immunohistochemical analysis [5,6] , thus usually providing with a higher diagnostic accuracy than cytology.Retrieving Abstract AIM: To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) material in the differential diagnosis of pancreatic solid masses. METHODS:Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs (22G needle) were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Materials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS:Length of the core specimen obtained for histological analysis was 6.5 ± 5.3 mm (range 1-22 mm). Cytological and histological samples were considered as adequate in 51 (82.3%) and 52 cases (83.9%), respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Contrary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases (90.3%), with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%. CONCLUSION:Adequate pancreatic core specimens for

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Section: Discussionmentioning

confidence: 99%

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

Iglesias‐García

Domínguez‐Muñoz²,

Lozano-León³

et al. 2007

WJG

109

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“…[144][145][146] The presence of a cytopathologist in the examination room is also debated, although most published studies showed an increased accuracy when a cytopathologist is available during the procedure. [147][148][149][150] An experienced cytopathologist, as well as the direct communication with the endoscopists, are essential for the success of the procedure. 151 Several large reports reported a complication rate of 1-2% for EUS-FNA.…”

Section: Eus-fnamentioning

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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“…38 -41 FNA by an on-site cytopathologist for the assessment of adequacy and preliminary evaluation of aspirates has been associated with improvements in overall accuracy. [42][43][44][45] The current series consisted of 13 patients who had CC diagnoses established by FNA cytology only (3 of 13 patients) or by FNA cytology and core biopsy (10 of 13 patients) ( Table 1). Aspirates were adequate for diagnosis of CC in 12 of 13 patients (92%) overall and in 9 of 10 patients (90%) who had concomitant core biopsies.…”

Section: Discussionmentioning

confidence: 99%

Phenotypic diversity of intrahepatic and extrahepatic cholangiocarcinoma on aspiration cytology and core needle biopsy

Chaudhary

Bhanot

Logroño

2005

Cancer

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Clinical Impact of on-Site Cytopathology Interpretation on Endoscopic Ultrasound-Guided Fine Needle Aspiration

Abstract: On-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA. EUS centers should allocate resources to cover for on-site cytopathology evaluation.

Cited by 451 publications

References 27 publications

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

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

Phenotypic diversity of intrahepatic and extrahepatic cholangiocarcinoma on aspiration cytology and core needle biopsy

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