Diagnosis of nonprimary pancreatic neoplasms by endoscopic ultrasound‐guided fine‐needle aspiration

Mesa, Hector; Stelow, Edward B.; Stanley, Michael W.; Mallery, Shawn; Lai, Rebecca; Bardales, Ricardo H.

doi:10.1002/dc.20142

Cited by 68 publications

(73 citation statements)

References 41 publications

(26 reference statements)

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“…lymphoma), as well as the possibility of using special stains [5,6] . In our series, obtaining a core specimen for histological evaluation allowed us to categorize malignant lesions that, although rare, were impossible to be diagnosed by cytology (i.e., pancreatic lymphomas, small cell lung cancer metastasis and endocrine carcinomas).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…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. …”

mentioning

confidence: 99%

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

Iglesias‐García

Domínguez‐Muñoz²,

Lozano-León³

et al. 2007

WJG

112

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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%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Iglesias‐García

Domínguez‐Muñoz²,

Lozano-León³

et al. 2007

WJG

112

View full text Add to dashboard Cite

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“…However, inflammation causes a reactive and regenerative process leading to cellular changes undistinguishable from well-differentiated neoplasia. Moreover, certain neoplasms such as lymphoma and stromal tumors require histological samples for diagnosis, since tissue architecture and cell morphology are essential in these cases for accurate pathological assessment and immunohistochemical analysis (5,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Iglesias‐García

Abdulkader

Lariño‐Noia

et al. 2014

Rev. esp. enferm. dig.

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Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an accurate technique for sampling intraintestinal and extraintestinal lesions. However, cytology possesses certain limitations, which may be overcome if histological specimens are provided to the pathologist.Aim: The aim of the study was to evaluate the accuracy of a newly developed 19G histology needle.Methods: Retrospective analysis of a prospectively collected data base including patients who underwent EUS-guided biopsy with the 19G ProCore TM histology needle for the evaluation of intraintestinal or extraintestinal lesions. Samples were obtained after one needle pass, recovered into ThinPrep ® and processed for histological analysis. Results were compared to the gold standard of surgical histopathology, or global pathological, clinical and radiological assessment, and follow-up in non-operated cases. Results are shown as mean ± SD. Percentage of optimal samples for histological evaluation and the overall diagnostic accuracy were evaluated.Results: 87 patients (mean age 62.9 years, range 25-88 years, 36 woman) were included. Lesions mean size was 41.6 ± 21.3 mm. 66 lesions (75.9 %) were considered as malignant and 21 (24.1 %) as benign. EUS-guided biopsy was feasible in all cases (100 %). Sample quality was adequate for histological assessment in 82 lesions (94.2 %). In the remaining cases the sample was adequate for cell-block evaluation. Sensitivity, specificity, PPV, NPV, and overall accuracy for malignancy were 93.4 %, 100 %, 100 %, 84 %, and 95.4 %, respectively. There were no complications related to the procedure. Conclusion:The EUS-guided biopsy with the 19G histology needle provides with an optimal core sample for histological evaluation allowing a high histopathologic diagnostic accuracy.

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“…However, EUS-FNA has a number of limitations. Certain neoplasms, including lymphomas, stromal tumors and well-differentiated neoplasias are difficult to diagnose without histological samples, since tissue architecture and cell morphology are essential for accurate pathological assessments, which include immunohistochemical analyses in such cases (12)(13)(14). In addition, the accuracy of EUS-FNA depends on the presence of an on-site cytopathologist or cytotechnician to assess the specimen adequacy (15), and to determine whether additional samples are required to perform ancillary studies (16,17).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracies of endoscopic ultrasound-guided fine-needle aspiration with distinct negative pressure suction techniques in solid lesions: A retrospective study

Wang

et al. 2017

Oncology Letters

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Abstract. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) is highly accurate in obtaining specific diagnoses for various diseases. The present study aimed to evaluate the diagnostic yields, accuracies and sampling adequacies, of slow-pull, 5 ml suction and 10 ml suction techniques in EUS-FNA of solid lesions. The present study was a retrospective comparative study, which was performed in tertiary academic centers, recognized for their expertise in EUS and EUS-guided FNA. The present study involved 149 patients who underwent EUS-FNA of solid masses. A total of 34 (22.8%), 37 (24.8%) and 78 (52.4%) patients underwent EUS-FNA with slow-pull, 5 ml suction and 10 ml suction techniques, respectively. The EUS-FNA cytology and histology results were compared with those from the gold standard of surgical histopathology [hematoxylin-eosin staining; immunohistochemical test of cluster of differentiation (CD) 79a, CD20 and flow cytometry test] or long-term clinical follow-up. The present retrospective comparative study demonstrated that the diagnostic yields and accuracies of EUS-FNA with slow-pull (86.1%) were significantly superior to those achieved with 5 ml suction (83.3%) or 10 ml suction (69.9%; P<0.0001; χ 2 test). Consistently, 86.5% (32/37) of the samples obtained from the 5 ml suction group were adequate for histological diagnosis. By contrast, 70.6 (24/34) and 85.9% (67/78) of samples from the slow-pull and 10 ml suction groups were adequate for histological diagnosis, respectively. The samples obtained using 10 ml suction contained more blood compared with those obtained via slow-pull and 5 ml suction (P=0.0056; χ 2 test). No complications were noted in any of the three groups. The samples that were obtained for histopathological diagnosis using 5 ml suction were superior to those obtained using slow-pull or 10 ml suction. Additional multi-central prospective studies in which EUS-FNA is performed with variable negative pressures are required to improve the defining of the diagnostic roles of those techniques. IntroductionEndoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) has been reported to be a sensitive method for tissue sampling of suspicious lesions of the gastrointestinal lumen and adjacent structures, including pancreaticobiliary and esophageal lesions, gastric malignancies and mediastinal and intra-abdominal lymphadenopathies (1-6). The diagnostic accuracy of EUS-FNA ranges between 60 and 90%, according to the site being evaluated (1,7-11). Cytological study of the material obtained by FNA allows for the evaluation of cellular findings that are indicative of malignancy. However, EUS-FNA has a number of limitations. Certain neoplasms, including lymphomas, stromal tumors and well-differentiated neoplasias are difficult to diagnose without histological samples, since tissue architecture and cell morphology are essential for accurate pathological assessments, which include immunohistochemical analyses in such cases (12)(13)(14). In addition, the accuracy of EUS-FNA depend...

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Diagnosis of nonprimary pancreatic neoplasms by endoscopic ultrasound‐guided fine‐needle aspiration

Cited by 68 publications

References 41 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

Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Diagnostic accuracies of endoscopic ultrasound-guided fine-needle aspiration with distinct negative pressure suction techniques in solid lesions: A retrospective study

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