Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 22-G Needle for Hepatic Lesions: Single-Center Experience

Abstract

Background/Aims Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively. Methods Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed. Results A total of 25 patients (10 females) were included in the study. The mean age was 62.73±15.2 years. The mean size of the masses was 34.50±16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications. Conclusions For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates.

Hepatic Squamous Cell Carcinoma Diagnosed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration

“…In contrast, a prospective study reported the diagnostic accuracy of EUS-FNA in hepatic masses to be between 82% and 100% and the sensitivity, specificity, NPV, and PPV to be 94%, 100%, 78%, and 100%, respectively [ 13 ]. Additionally, EUS-FNA can produce specimens at the most comparable to the specimens obtained in percutaneous liver biopsy [ 13 ].…”

“…In contrast, a prospective study reported the diagnostic accuracy of EUS-FNA in hepatic masses to be between 82% and 100% and the sensitivity, specificity, NPV, and PPV to be 94%, 100%, 78%, and 100%, respectively [ 13 ]. Additionally, EUS-FNA can produce specimens at the most comparable to the specimens obtained in percutaneous liver biopsy [ 13 ]. One study that directly compared percutaneous liver biopsy (60 patients) and EUS-FNA (30 patients) revealed that EUS-FNA has equivalent feasibility of histological diagnosis (percutaneous liver biopsy = 100% and EUS-FNA = 93%, p =0.841).…”

“…If the liver tissue sampling is aimed at a “benign-malignant assessment,” a 22-gauge aspiration needle can obtain an adequate specimen for diagnosis [ 2 , 13 ]. However, to visualize and target the right lobe mass with EUS-FNA is actually difficult [ 14 ], and it is suggested that percutaneous biopsy would be a better option for lesions that are located in the right lobe of the liver.…”

Role of Endoscopic Ultrasound in Liver Disease: Where Do We Stand?

“…Transgastric and transduodenal approaches are used to visualize the left and right liver lobe, respectfully, bearing in mind that the right posterior segments are inaccessible for examination using this method [105]. The value of EUS in detecting and providing tissue diagnosis for liver lesions, most prominently metastases of solid tumors, as well as primary hepatic malignancies, has been shown in multiple studies [4] (Table 3) [106][107][108][109][110][111][112][113][114][115][116][117][118][119][120][121]. A recent review by Sbeit et al [122] reports the diagnostic yield of EUS-guided biopsy of focal liver lesions ranging from 89.7-100%, confirming the superiority of EUS sampling.…”

Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Focal Liver Lesions: The Expanding Light Over the Shadow

“…In this issue of Clinical Endoscopy, a study by Akay et al [ 5 ] evaluated the diagnostic capability of a single EUS-FNA puncture using a 22-gauge needle for focal liver lesions, which included 25 patients with liver lesions and a technical success rate of 88% (22/25). Of the 22 patients with successful EUS-FNA, the aspirate sufficiency and biopsy sufficiency rates were 94% (21/22) and 86% (19/22), respectively, even with a single pass of FNA.…”