Diagnostic yield and safety of EUS-FNA biopsy in sub-aortic and para-aortic lymph node stations with the trans-aortic approach: a case series and literature review

Ravaglia, Claudia; Colella, Sara; Tomassetti, Sara; Piciucchi, Sara; Dubini, Alessandra; Gurioli, Carlo; Poletti, Venerino

doi:10.1080/20018525.2018.1552064

Cited by 4 publications

(9 citation statements)

References 20 publications

(24 reference statements)

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“…23 Hence, during transarterial puncture, areas of significant atherosclerosis should be avoided. 14,19 Study by Naaman et al reported a total of four major adverse events in their series of 35 patients who underwent EBUS-guided TVNA, of which two were self-limited episodes of hemoptysis, one with acute exacerbation of COPD requiring ICU stay and one developed atrial fibrillation which was reversed with anti-arrythmics. 25 Von 24 This shows that E-TVNA can be performed with minimal adverse events, with spontaneous resolution of adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Giri

Harindranath

Angadi

et al. 2023

J of Clinical Ultrasound

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Background The diagnosis of intrathoracic and abdominal masses is challenging when lesions are located behind major vessels. Endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS)‐guided transvascular needle aspiration (TVNA) provides a potentially useful diagnostic tool for such lesions. Data with respect to the safety and outcome of E‐TVNA are scarce. Hence, this meta‐analysis was conducted to assess the critical role of E‐TVNA for diagnosis of various lesions. Methods and Material A meta‐analysis was performed by pooling the data from studies obtained from comprehensive search of Medline, Embase, and Scopus from January 2000 to September 2022. The outcomes analyzed included sample adequacy, diagnostic accuracy and adverse events including bleeding. Results A total of 17 studies (n = 411) were included in the final analysis. The pooled rate of sample adequacy was 91.5% [95% confidence interval (CI): 86.8–96.2], while the pooled rate of diagnostic accuracy was 85.0% (95% CI: 78.9–91.2). The pooled rate of bleeding with E‐TVNA was 1.4% (95% CI 0.0–3.1%). All the episodes of bleeding were mild and resolved without any further intervention. There was no significant heterogeneity with respect to various outcomes and results were comparable on sensitivity analysis. Conclusions E‐TVNA offers a safe and accurate diagnostic modality for the diagnosis of mediastinal and abdominal lesions located on the other side of major vessels. Selection of potential candidates and close periprocedural observation are essential to improve the outcome.

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Section: Discussionmentioning

confidence: 99%

“…The search strategy yielded 173 records of which 114 were screened after removal of duplicate records. After assessing for eligibility, a total of 17 studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] with 411 patients were included in the final analysis.…”

Section: Study Characteristics and Quality Analysismentioning

confidence: 99%

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Giri

Harindranath

Angadi

et al. 2023

J of Clinical Ultrasound

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“…Since Vincent et al and Wallace et al (2006 and 2007, respectively) published papers on the first transvascular (pulmonary artery and aorta) puncture guided by EBUS and EUS, respectively, only a few case reports and small case series have been published 7 8 . Much of the current literature on EUS-TV-FNA has paid special attention to intrathoracic lesions, and most of the knowledge about this technique comes from the EBUS field 9 10 11 12 . Many of the reports related to EUS-guided FNA involve the transaortic approach and focus on the study of lung cancer 4 8 13 14 15 .…”

Section: Discussionmentioning

confidence: 99%

“…An updated literature review is included ( Table 5 ), and three retrospective case series stand out for comparison to our results 4 8 9 11 12 13 14 15 16 20 21 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

et al. 2020

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Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact. Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88 % (95 %CI,0.74–0.96), 100 % (95 %CI,0.59–1), and 90 % (95 %CI,0.78–0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88 %). Arterial vessel and ASA-III had a trend with incidents (both, P < 0.08). Rapid on-site evlauation was found to be an independent predictor for obtaining a conclusive sample (OR 6.2; 95 %CI, 1.06–36.73, P < 0.04). Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.

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“…As transvascular access with a small gauge needle is now routinely being used in radiological and interventional vascular procedures, recent studies have reported the use of transvascular EBUS-TBNA [7] and EUS-FNA [8]. Subsequently, the feasibility and safety of these procedures have been evaluated in a series of clinical studies [9][10][11][12][13][14][15][16][17][18]. Furthermore, the important precautions and technical aspects of EBUS-TBNA and EUS-FNA have been discussed [19].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Endosonography-Guided Transvascular Needle Aspiration in the Diagnosis of Thoracic and Abdominal Lesions: A Meta-Analysis

Yang

Zhang

et al. 2023

Respiration

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Background: Endoscopic techniques, including endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS), are used as the initial approach for the diagnosis and staging of lung cancer and the diagnosis of thoracic and abdominal lesions. Historically, the transvascular approach has been avoided because of concerns about bleeding. Objectives: This article is a systematic review of studies evaluating the feasibility and safety of transvascular needle aspiration (TVNA) under the guidance of EBUS or EUS in the diagnosis of thoracic and abdominal lesions. Methods: We performed a systematic search of the MEDLINE, Embase, and Cochrane databases to identify studies evaluating the application of EBUS/EUS-guided TVNA (EBUS/EUS-TVNA) for lesions located at the contralateral side of the vessel for which the transvascular approach was the best puncture path. We performed a meta-analysis of diagnostic yield estimations. We also reviewed the complications related to the procedure. Results: Eleven observational studies were included in the final analysis. Meta-analysis yielded a pooled overall diagnostic yield of 82.10% (95% confidence interval, 0.74–0.89) for TVNA, with an I2 value of 52%. No publication bias was detected by Egger’s test (p = 0.8528). The overall complications included minor bleeding, minor hematoma, pseudoaneurysm of the aorta, hemoptysis, acute hypoxic respiratory failure, and moderate bleeding. The major complication rate was 2.71%. Conclusions: EBUS/EUS-TVNA is feasible and probably safe when performed by experienced endoscopists in carefully selected patients. In view of the potential risks associated with the transvascular approach, especially the development of hematoma and pseudoaneurysm, the fanning technique was avoided, and the area of aspiration should be assessed by EUS for 3 min after each aspiration. Most importantly, EBUS/EUS-TVNA should only be performed if the results will impact the clinical management.

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Diagnostic yield and safety of EUS-FNA biopsy in sub-aortic and para-aortic lymph node stations with the trans-aortic approach: a case series and literature review

Cited by 4 publications

References 20 publications

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

Feasibility and Safety of Endosonography-Guided Transvascular Needle Aspiration in the Diagnosis of Thoracic and Abdominal Lesions: A Meta-Analysis

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