Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis

Abstract

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.

A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review

“…An accurate diagnosis of pancreatic IMTs cannot be made by image examinations alone, as most cases mimic malignancies (Table 1) and no IMT serum markers are commercially available. EUS-FNA demonstrates a fairly high diagnostic ability (nearly 95% sensitivity and specificity) for solid malignant pancreatic lesions [42,43]. The use of thick core biopsy needles [44] and high-negative-pressure aspiration methods [45] has increased the acquisition rate for obtaining core tissue samples.…”

Diagnosis of Lymphoid Lesions in Limited Samples

“…This important decision is driven by three criteria: 7,8 In a recent large multicenter study with the SharkCore needle involving 18 large medical centers, the diagnostic yield was 93% for nodal lesions, 7 a result comparable to the 85% to 87% diagnostic yield of CNB specimens in recent studies. 2 The superior diagnostic yield of the EZ Shot 3 Plus needle has been shown for pancreatic tumors, 8 but studies on lymphomas are not available at this time. • Size and metabolic activity: A legitimate concern about definitively diagnosing low-grade lymphoid lesions in FNA and CNB specimens is the uncertainty that lowgrade lesions may have transformed to intermediate-or high-grade lymphomas in the unsampled portion of the biopsied node or extranodal site.…”

The diagnostic performance of novel torque technique for endoscopic ultrasound‐guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial

“…Endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (FNA) plays an essential role in making an accurate diagnosis and therapeutic plan for pancreatic solid mass with few major adverse events . However, the diagnostic yield, including sensitivity and specificity (75–92% and 82–100%, respectively), for pancreatic solid mass is limited especially considering the very low negative predictive value .…”

“…Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) plays an essential role in making an accurate diagnosis and therapeutic plan for pancreatic solid mass with few major adverse events. 1 However, the diagnostic yield, including sensitivity and specificity (75-92% and 82-100%, respectively), for pancreatic solid mass is limited especially considering the very low negative predictive value. 2,3 To overcome this limitation, some attempts for the improvement of diagnostic outcomes in EUS-guided tissue acquisition were conducted; these include the use of fanning technique, the use or elimination of suction, and the use or elimination of stylet.…”