Endoscopic ultrasonography as an adjunct to fine needle aspiration cytology of the upper and lower gastrointestinal tract

Wiersema, Maurits J.; Hawes, Robert H.; Tao, Liang Che; Wiersema, Lisa M.; Kopecky, Kenyon K.; Rex, Douglas K.; Kumar, S. Satish; Lehman, Glen A.

doi:10.1016/s0016-5107(92)70327-7

Cited by 132 publications

(51 citation statements)

References 8 publications

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“…Less than 5% of reported pancreas fine-needle aspirates contain metastatic disease [1,2]. When the pancreas does host a metastatic tumor, cytopathological evaluation of fine-needle aspiration (FNA) material - usually obtained by endoscopic ultrasound guidance [3] - is usually a crucial part in the diagnostic process. While the tumor most likely to develop pancreatic metastases used to be squamous cell or small cell carcinoma from the lung [4], by most recent accounts it is now clear cell renal cell carcinoma [1,2,5].…”

Section: Introductionmentioning

confidence: 99%

Metastases to the Pancreas Diagnosed by Fine-Needle Aspiration

Olson¹,

Wakely²,

Ali³

2013

Acta Cytologica

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Background: Metastatic cancer infrequently involves the pancreas. When the pancreas hosts a metastatic tumor, cytopathological evaluation of fine-needle aspirate material is a crucial part of the diagnostic process. In this study, we show two institutions' experience with cytopathological diagnosis of pancreatic metastasis. Methods: Databases of institutional experience at The Johns Hopkins Hospital and Ohio State University Medical Center were queried for cases of metastatic tumors in the pancreas that underwent fine-needle aspiration. Demographic and pathological features were compiled and the cytomorphology was reviewed. Results: Forty-two cases of tumor metastasis to the pancreas were found. Over the time of this review, 5,495 aspirates were performed, and 43% (2,389/5,495) had malignant cytological findings. Thus, the 42 cases of metastatic disease to the pancreas comprised 0.8% of all pancreas aspirates and 1.8% of the malignant ones. Renal cell carcinoma was the most common metastasis, followed by melanoma and non-small cell lung carcinoma. Among the other tumors in this series, 2 cases each of rare metastases such as the fibrolamellar variant of hepatocellular carcinoma and solitary fibrous tumor were also seen. Conclusion: The pancreas is rarely involved with metastatic disease, but when it is involved the most common tumor is renal cell carcinoma followed by melanoma and non-small cell lung cancer. Clinical history and awareness of the primary pancreatic mimickers are necessary for arriving at the correct diagnosis. As conventional pancreatic adenocarcinoma is uncommon in children and young adults, history of other tumors - even ones that usually follow an indolent course - is essential.

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Section: Introductionmentioning

confidence: 99%

Metastases to the Pancreas Diagnosed by Fine-Needle Aspiration

Olson¹,

Wakely²,

Ali³

2013

Acta Cytologica

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“…Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the pancreas [1,2,3,4] enables a single diagnostic procedure for evaluating and staging pancreatic neoplasms. Compared with percutaneous sampling, this procedure yields high resolution imaging in addition to aspirated material for morphological examination and allows for safe aspiration of more than one site in the same procedure [5].…”

Section: Introductionmentioning

confidence: 99%

Cytotechnologist On-Site Evaluation of Pancreas Fine Needle Aspiration Adequacy: Comparison with Cytopathologists and Correlation with the Final Interpretation

Olson¹,

Ali²

2012

Acta Cytologica

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Objective: To compare on-site evaluations of adequacy (OSEA) of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the pancreas performed by cytotechnologists and cytopathologists. Study Design: A 10-year retrospective review of 2,426 OSEA from 2,223 procedures in 1,984 patients was performed. Adequacy statistics were calculated along with the accuracy of the OSEA for each OSEA provider. The effect of other variables, including the lifetime number of EUS pancreatic OSEA, the number of years of experience at the time of each case, the institutional number of EUS FNA, and the number of smears was evaluated with ANOVA. Results: There was no difference in the adequacy downgrade rate for cytotechnologists versus cytopathologists during this study period (38.2 vs. 32.2%, p = 0.13). Neither individual cytologist experience with EUS-guided pancreatic FNA (p = 0.25) nor years in practice (p = 0.86) was correlated with the accuracy of the OSEA. The experience of the institution with EUS-guided pancreatic FNA was correlated with both adequacy (p = 0.003) and accuracy (p = 0.000001). Conclusion: Cytotechnologists and cytopathologists are comparably accurate in OSEA of EUS-guided pancreatic FNA. The adequacy and accuracy of the OSEA increase with institutional experience, and this increase is not solely attributable to cytologist factors.

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“…In that study, all patients were previously surveyed with radial EUS to examine the SMT and to rule out a vascular lesion. Wiersema et al 14 described combined EUS and transendoscopic FNA of lesions such as SMTs, extrinsic masses, and gastric ulcers with negative conventional biopsy results. First a radial endosonography study was done.…”

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confidence: 99%

Endoscopic Sonographically Guided Fine-Needle Aspiration Yield in Submucosal Tumors of the Gastrointestinal Tract

Arantes

Logroño

Faruqi

et al. 2004

Journal of Ultrasound in Medicine

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Objective. To study the yield of endoscopic ultrasonographically guided fine-needle aspiration cytologic examination in the diagnosis of submucosal masses. Methods. From 1999 to 2003, 10 patients underwent ultrasonographically guided fine-needle aspiration for the cytologic diagnosis of submucosal masses in our institution. The endoscopic ultrasonography records and the cytology database were consulted, and the reports were analyzed, as were slide material and the technical aspects related to these procedures. All procedures were performed under conscious sedation and cardiorespiratory monitoring on an outpatient basis. Ten patients (4 men and 6 women; mean age, 60.8 years) were studied. Results. Eight lesions were located in the stomach, and 2 were located in the esophagus, with a mean diameter of 3.3 cm. An experienced cytopathologist was present on-site during all procedures for assessment of adequacy and preliminary cytologic examination. Cytologic diagnoses were obtained in 8 cases as follows: 6 gastrointestinal stromal tumors, 1 organizing submucosal hematoma, and 1 low-grade mucosa-associated lymphoid tissue-associated lymphoma. Two cases consisted of scant gastric epithelium only and were considered nondiagnostic. The cytologic diagnoses guided further clinical treatment. Conclusions. Ultrasonographically guided fine-needle aspiration with cytopathologic analysis has a high accuracy rate (80%) for diagnosing submucosal lesions. These findings potentially affect clinical decision making. Key words: endoscopic ultrasonography; fineneedle aspiration; submucosal tumors. he term submucosal tumor (SMT) refers to any protrusion or indentation observed through the gastrointestinal lumen having an intact mucosal surface and discovered either incidentally during routine endoscopy or because of associated symptoms such as abdominal pain, dysphagia, and gastrointestinal bleeding.1 These symptoms can be related either to the presence of intramural masses or to external compression of the gastrointestinal tract wall.Endoscopy alone has suboptimal accuracy of as low as 40% for identifying the cause of submucosal bulges. 2Usually the mucosal surface is normal, and conventional forceps biopsy results are frequently negative. Other noninvasive imaging methods such as transabdominal ultrasonography and computed tomography are also suboptimal for evaluating submucosal indentations. 3Endoscopic ultrasonography (EUS) combines the endoscopic view with ultrasonographic images generated by a

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Endoscopic ultrasonography as an adjunct to fine needle aspiration cytology of the upper and lower gastrointestinal tract

Cited by 132 publications

References 8 publications

Metastases to the Pancreas Diagnosed by Fine-Needle Aspiration

Metastases to the Pancreas Diagnosed by Fine-Needle Aspiration

Cytotechnologist On-Site Evaluation of Pancreas Fine Needle Aspiration Adequacy: Comparison with Cytopathologists and Correlation with the Final Interpretation

Endoscopic Sonographically Guided Fine-Needle Aspiration Yield in Submucosal Tumors of the Gastrointestinal Tract

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