Endoscopic ultrasound-guided fine needle aspiration: From the past to the future

Abstract

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained through aspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung, etc. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is superior to computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detection of malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist during EUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently the procedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses.

Molecular Analysis of Vascular Endothelial Growth Factor (VEGF) Receptors in EUS-guided Samples Obtained from Patients with Pancreatic Adenocarcinoma*

“…Our study confirmed that EUS is a very effective technique for the diagnosis and staging of pancreatic cancer, with an accuracy that can reach 93.2%, using a combination of contrast-enhancement and elastography. EUS-FNA offers the additional advantage of providing cytological samples with an accuracy for the diagnosis of pancreatic ductal adenocarcinoma which ranges from 80-95% according to a recently published meta-analysis [10]. Moreover, EUS-FNA provides enough material to determine gene expression (by qRT_PCR) of molecular markers of angiogenesis (e.g.…”

Phosphoproteome Analysis of Invasion and Metastasis-Related Factors in Pancreatic Cancer Cells

“…In recent years, many researchers have used endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) as a preoperative diagnostic method to reduce unnecessary surgical procedures in an effort to achieve higher survival rates [ 14 , 15 ]; however, results have been unsatisfactory. How to reduce invasion and metastasis of pancreatic cancer is still an intense area of research and ongoing problem.…”

Endoscopic ultrasound-guided drainage of pancreatic pseudocysts

“…The first procedure that opened up the possibility of therapeutic interventions was EUS-guided FNA, which allows direct access to the organs and structures situated in the vicinity of the GI tract including pseudocysts. [ 10 11 ] Initial reports also showed favorable results with EUS-guided drainage as compared with non-EUS-guided drainage, especially when using a Seldinger (guidewire) technique as compared with needle knife entry techniques. [ 12 13 14 ] Furthermore, even collections not amenable to direct transmural endoscopic drainage can be safely drained with EUS-guided drainage.…”