Endoscopic ultrasound-guided fine-needle aspiration and cytology for differentiating benign from malignant lymph nodes

Okasha, Hussein Hassan; Elkholy, Shaimaa; Sayed, Mohamed; Salman, Ahmed; Elsherif, Yahia; El-Gemeie, Emad

doi:10.1016/j.ajg.2017.05.015

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…Our results agreed with previously performed studies who reported improved diagnostic accuracy of EUS when combined with FNAC and established the harmonizing role of EUS when added to EUS [5] [19] [20]. LV et al (2019) showed similar results to our study and confirmed the complementary role of EUS-FNAC in upgrading diagnostic accuracy of elastography [7].…”

Section: Discussionsupporting

confidence: 93%

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract Tumors and Related Organs: Predictive Factors for Accurate Cytopathological Diagnosis

Ameen¹,

Hafez²,

Yassen³

et al. 2020

OJPathology

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Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic guided fine needle aspiration cytology (EUS-FNAC) has improved the performance characteristics of EUS. Aim: Evaluate the validity of EUS-FNAC in diagnosis of gastrointestinal tract lesions and related organs and assess predictive factors for an accurate EUS-FNAC diagnosis. Methods: Our study included cytological sampling from one hundred sixty-six lesions obtained from gastrointestinal tract and related organs. Factors affecting EUS-FNA accuracy were analyzed. The histopathological results or clinical follow-up were used as the gold standard method. Results: Samples were obtained from: pancreatic masses (n = 80), gastric masses (n = 34), lymph nodes (n = 22), hepatobiliary masses (n = 18) and rectal masses (n = 2). Statistical analysis of sensitivity, specificity, Positive Predictive Value, Negative Predictive Value, and diagnostic accuracy of EUS alone was 80.4%, 51.6%, 75.8%, 76.2% and 75.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNAC are 78.8%, 96.8%, 97.6% and 73.2% respectively. Addition of FNAC to EUS improved diagnostic accuracy to 85.5%. Positive statistical association was present between cytological adequacy and adequate cell block preparations, larger lesion size, presence of rapid on site evaluation (ROSE) and obtaining at least two passes from target lesion. Conclusions: EUS is valuable diagnostic and cost effective tool for gastrointestinal tract lesions and related organs when combined with FNAC.

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Section: Discussionsupporting

confidence: 93%

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract Tumors and Related Organs: Predictive Factors for Accurate Cytopathological Diagnosis

Ameen¹,

Hafez²,

Yassen³

et al. 2020

OJPathology

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“…However, in the recent years, EUS-FNA has undergone an impressive development, which plays a major role in examining lymphadenopathy that can be observed from the gastrointestinal tract. EUS-FNA has a high diagnostic ability for lymphadenopathy, and recent reports have cited a sensitivity and specificity of 74–92% and 100%, respectively[6,8]. Even in 2004, Chen et al[8] demonstrated high sensitivity and specificity (98.3% and 100%, respectively), and concluded that EUS-FNA is superior to LN echo features in evaluating lymphadenopathy.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic ability of EUS-FNA is high, but not of 100%, so the final diagnosis must be made by considering the imaging results without a slavish adherence to the pathological diagnosis. Okasha et al[6] indicated that additional complementary EUS features could be added to this technique for a definitive diagnosis, although EUS-guided FNA cytology is a powerful modality in the diagnosis of benign and malignant LN. In addition, an understanding of the diagnostic imaging would lead to an avoidance of unnecessary EUS-FNA, which can be considered quite significant in terms of safety and economy.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, EUS-guided fine-needle aspiration (EUS-FNA) has been remarkably developing and is actively employed for obtaining definitive diagnoses of lymphadenopathy observable via EUS from the gastrointestinal tract. EUS-FNA has a great ability of diagnosing lymphadenopathy, with recent reports describing a sensitivity and specificity of 74–92% and 100%, respectively [6,7]. In 2004, Chen et al[8] described a high sensitivity and specificity (98.3% and 100%, respectively), and concluded that EUS-FNA is superior to lymph nodes (LN) echo features in evaluating lymphadenopathy.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the diagnostic potential of EUS-FNA, it is not 100% precise, so a final diagnosis must be carried out not only on the basis of pathological findings but also by considering diagnostic imaging. Okasha et al[6] indicated that additional complementary EUS features could be added to this technique for definitive diagnosis, although EUS-FNA is already a powerful tool in the diagnosis of benign and malignant LN. In addition, a greater understanding of the diagnostic imaging would facilitate ruling out unnecessary EUS-FNA, which can be considered important regarding safety and economy.…”

Section: Introductionmentioning

confidence: 99%

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New endoscopic ultrasonography criteria for malignant lymphadenopathy based on inter-rater agreement

et al. 2019

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Background and aims Various studies have been previously conducted on the diagnosis of lymphadenopathy as benign or malignant, but the results vary. These studies did not describe the inter-rater agreement on the EUS features of lymphadenopathy. In this study, we evaluate the inter-rater agreement on EUS features and propose EUS diagnostic norms for lymphadenopathy based on inter-rater agreement. Method A total of 68 lymph nodes subjected to EUS-fine needle aspiration (FNA) were reviewed by five endoscopic experts. The EUS features evaluated lymph node size, shape, border, margin, echogenicity, homogeneity, and the hilum of the lymph node. Inter-rater agreement (multi-rater kappa statics) was performed. We established new criteria using results with a high degree of inter-rater agreement from EUS features and compared them with the former criteria. Result There was a moderate agreement on shape, kappa ( K ) = 0.44 (95% confidence interval [CI]: 0.34–0.54), and fair agreement on echogenicity, homogeneity, border, and hilum of the lymph node, K (95% CI) = 0.33 (0.17–0.38), 0.34 (0.26–0.35), 0.22 (0.21–0.31), and 0.22 (0.11–0.26), respectively. This resulted in the establishment of new EUS diagnostic criteria using shape, long axis > 20 mm and short axis > 10 mm. New criteria were superior to old criteria (area under the curve 0.82 vs 0.52, P < 0.001). Conclusion EUS diagnostic criteria for lymphadenopathy based on inter-rater agreement were more accurate than old criteria. This result will be useful for the diagnosis of lymphadenopathy.

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Current perspectives on the diversification of endoscopic ultrasound-guided fine-needle aspiration and biopsy

Doi,

Adachi,

Watanabe

et al. 2023

J Med Ultrasonics

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Endoscopic ultrasound-guided fine-needle aspiration and cytology for differentiating benign from malignant lymph nodes

Cited by 12 publications

References 23 publications

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract Tumors and Related Organs: Predictive Factors for Accurate Cytopathological Diagnosis

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract Tumors and Related Organs: Predictive Factors for Accurate Cytopathological Diagnosis

New endoscopic ultrasonography criteria for malignant lymphadenopathy based on inter-rater agreement

Current perspectives on the diversification of endoscopic ultrasound-guided fine-needle aspiration and biopsy

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