Endoscopic ultrasonography‐guided fine‐needle aspiration biopsy: A safe method for accurate diagnosis

Abstract

Endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS FNAB) is a relatively new technique for obtaining specimens with excellent imaging power. The convex type of echoendoscope used with EUS FNAB provides images perpendicular to the endoscope, which differ from those of popular radial echoendoscopes and, hence, require different usage techniques. Color flow imaging is used to avoid the vessels in and around the mass during puncturing. EUS FNAB for submucosal tumors is sometimes difficult because the needle slips easily, and the gastrointestinal wall tends to be stretched when pushing the needle, which can be solved by making a dimple on the wall before puncturing. Lesions of the pancreas head, especially those at the uncus, and lymph nodes near the superior mesenteric artery are also difficult because of their distance from the endoscope and the resultant bending of the needle. Tissue sampling is more successful when the angle between the endoscope and the needle is kept at just less than 45 degrees, as this helps to transmit the hand force to the needle effectively. The complication rate of EUS FNAB is reportedly 1-2%, and so the technique is considered a safe modality, except for cystic lesions of the pancreas. Recent histological evidence is needed before applying medical therapies, such as chemoradiation and surgery, especially when imaging modalities alone cannot supply the evidence of malignancy; hence increasing importance of EUS FNAB is expected.

Endoscopic Ultrasound‐guided Fine‐needle Aspiration Biopsy for the Diagnosis of Gastrointestinal Submucosal Tumors

“…described how discrimination between malignant and benign GIST was possible by EUS‐FNAB with the addition of MIB‐1 stain, and all the histological malignant GIST showed an MIB‐1 index greater than 3%. In our study, 27 the MIB‐1 LI of high‐grade malignancy GIST were significantly higher than those of low‐grade malignancy GIST. Because there was a significant difference, a MIB‐1 LI of 5% might be an appropriate division between low‐grade and high‐grade GIST.…”

“…Performing EUS‐FNAB and immunohistochemical staining for the cases of suspected GIST is important 26 . A precise diagnosis of high‐grade malignant GIST is essential since two cases of recurrent GIST appeared to be of high‐grade GIST in our study and the low‐grade GIST might not need treatment because of their slow growth 27 . Even with EUS‐FNAB, some of the high‐grade malignant GIST are diagnosed as low‐grade malignancy by EUS‐FNAB specimens.…”

Two resected cases of esophageal leiomyoma diagnosed with preoperative endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB)

“…Hunt et al reported the rate was 42% (15 of 36 patients) [7]. On the other hand, Okubo et al reported that the EUS-FNAB accuracy rate in 76 submucosal lesions was 95.7%, sensitivity was 95%, specifi city was 97.5%, and that the complication rate of EUS-FNAB in 507 cases was only 0.4% [8]. According to our experiences with EUS-FNAB in 26 esophageal submucosal tumors, a successful diagnostic rate of 89% was achieved, with a complication rate of 0% [9].…”

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future

“…84 The precise diagnosis of high-grade malignant GISTs is essential, because two cases of recurrent GISTs appeared to be high-grade GISTs in one of our studies, and low-grade GISTs may not need treatment because of their slow growth. 85 In a series of surgically excised GISTs, Carrillo et al 86 reported that the MIB-1 labelling index (LI) was an independent parameter in predicting clinical outcome. Ando et al 84 and Okubo et al 85 described the possibility of discrimination between malignant and benign, or and between high-grade malignant or low-grade malignant GISTs by EUS-FNAB with the addition of MIB-1 staining.…”

“…85 In a series of surgically excised GISTs, Carrillo et al 86 reported that the MIB-1 labelling index (LI) was an independent parameter in predicting clinical outcome. Ando et al 84 and Okubo et al 85 described the possibility of discrimination between malignant and benign, or and between high-grade malignant or low-grade malignant GISTs by EUS-FNAB with the addition of MIB-1 staining. Recently, mutational analysis of c-kit was performed on EUS-FNAB specimens, 87,88 and the relationship of c-kit mutation to the degree of malignancy was examined.…”