EUS-guided tissue acquisition: an evidence-based approach (with videos)

Wani, Sachin; Muthusamy, V. Raman; Komanduri, Srinadh

doi:10.1016/j.gie.2014.07.066

Cited by 115 publications

(124 citation statements)

References 284 publications

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“…False-negative diagnoses during EUS-FNA have been reported in 4 % to 45 % of solid pancreatic masses and 6 % to 14 % of lymph nodes [46]. False-negative cytology is most often due to inaccurate tissue sampling, lesion characteristics (e. g. necrosis), insufficient endosonographer experience, or misinterpretation of specimens [3]. Our study not only highlights the value of EUS-FNB in non-pancreatic lesions, but also demonstrates the value of an FNB specimen as salvage for inadequate FNA.…”

Section: Discussionmentioning

confidence: 99%

“…However, EUS-FNB should be considered as the initial sampling technique for non-pancreatic masses and as a salvage technique when on-site assessment of cytology samples is inadequate. Based on these results, the investigators propose an algorithmic approach to EUS-TA in patients with pancreatic and nonpancreatic masses [3]. These results and the approach to EUS-TA need to be validated in future prospective, multicenter, randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

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2016

Endosc Int Open

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Endosc Int Open

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“…Here, the mean frequency of diagnosed pancreatic carcinomas was 71% [71]. The authors suggested that a work-up of the complete diagnostic process should be performed if the cytological diagnose rate was <52% (1st quartile) [72]. This quality parameter was used by the ASGE [72] but cannot be transferred to the German situation as the indicators for the biopsy of solid pancreatic carcinomas in Germany clearly differ from those used in routine practice in the USA [73].…”

Section: Quality Indicators/parameters For Specific Proceduresmentioning

confidence: 99%

“…The authors suggested that a work-up of the complete diagnostic process should be performed if the cytological diagnose rate was <52% (1st quartile) [72]. This quality parameter was used by the ASGE [72] but cannot be transferred to the German situation as the indicators for the biopsy of solid pancreatic carcinomas in Germany clearly differ from those used in routine practice in the USA [73]. The percentage of diagnostically adequate material (acceptable: ≥85%), the portion of conclusive results (diagnostic categories: malignant, neoplasm, benign) and the portion of specific diagnoses with regards to the total number of malignant findings may be used as quality parameters [72,74,75].…”

Section: Quality Indicators/parameters For Specific Proceduresmentioning

confidence: 99%

Quality Assurance in Endoscopy: Which Parameters?

Denzer

2016

Visc Med

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Background: The verbalisation of quality standards and parameters by medical societies are relevant for qualitative improvement but may also be an instrument to demand more resources for health care or be a unique characteristic. Within the health care system 3 different quality levels can be defined: structure, process and result quality. Methods: The current S2k guideline of the German Society for Gastroenterology (quality requirements for gastrointestinal endoscopy) AWMF registry no. 021-022 provides recommendations based on the available evidence for the structure quality (requirements for equipment, human resources) as well as for the process quality (patient preparation, conduct, documentation) and result quality (follow-up of specific endoscopic procedures). Results: Based on these recommendations, measurable quality indicators/parameters for the endoscopy have been selected and formulated. General quality parameters for endoscopic examinations are given as well as quality parameters for specific procedures for the preparation, conduct, and follow-up of specific endoscopic interventions. Conclusion: Only the regular review of processes and courses by means of defined measurement parameters builds up the basis for corrections based on facts. In addition, the implementation of recommended standards may be an instrument in demanding more resources from the health care system and, therefore, should be embedded as routine.

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confidence: 99%

EUS-FNA for Pelvic Lesions: Is This the Final Answer?

Fusaroli

Caletti

2015

Dig Dis Sci

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Soon after the first report in 1992 [1], EUS-FNA became an indispensable tool to obtain tissue diagnosis in the majority of the lesions within its reach [2]. The two main benefits of endoscopic ultrasound (EUS) are its superior accuracy in the detection of lesions \2-3 cm in diameter within 4 cm from the transducer, compared with extracorporeal imaging techniques, and the possibility of tissue acquisition by EUS-guided fine needle aspiration (FNA). EUS-FNA can facilitate diagnosis when tissue is acquired from the primary tumor and is useful for staging when tissue is acquired from suspicious lymph nodes or suspected metastatic lesions. Pancreatic solid and cystic masses and gastrointestinal subepithelial tumors are typical targets of diagnostic EUS-FNA. Non-peritumoral lymph nodes, liver, and adrenal gland lesions are examples of the utility of EUS-FNA for staging. Moreover, EUS-FNA of either a lymph node or a suspected metastasis (e.g., in the liver) may enable simultaneous diagnosis and staging in a patient whose primary tumor cannot be sampled.EUS-FNA is particularly useful in the lower gastrointestinal tract where few alternatives exist, such as extracorporeal or laparoscopic sampling, for tissue acquisition from pelvic lesions, as opposed to upper gastrointestinal and mediastinal lesions, where percutaneous and surgical techniques are still in use.The main indications for pelvic EUS include rectal cancer preoperative staging and post-surgical surveillance, the differential diagnosis of subepithelial tumors, the diagnosis and sampling of perirectal solid and cystic masses, and the evaluation of fecal incontinence and perianal disease. Since male and female abnormalities of the genitourinary tract are not usually part of gastroenterologist's armamentarium, they will not be included in the discussion.In this issue of Digestive Diseases and Sciences, Han et al.[3] draw attention to the accuracy and safety of pelvic EUS-FNA. By means of systematic literature review and meta-analysis during 2000-2014, data were obtained from 10 studies deemed of high quality according to the method of quality assessment of studies and data extraction (QUADAS). Evidently, the investigators scrupulously contacted the corresponding authors of the selected articles in order to extract the individual data for pelvic lesions or to calculate the specific operating characteristics in 7 of the 10 studies. Overall, 246 patients were included in the analysis. The pooled sensitivity and specificity of EUS-FNA were 89 % (95 % confidence interval, 83-94 %) and 93 % (95 % confidence interval, 86-97 %), respectively, and the area under the summary receiver operating characteristic (SROC) curve was 0.96. Nonetheless, the authors stressed a potential publication bias indicated by the significant asymmetry of the Deek's funnel plot, as it is often the case in the EUS literature. In other words, since studies with positive results are more likely to be published than the negative ones, the real sensitivity and specificity of EUS-FNA in practice may ...

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EUS-guided tissue acquisition: an evidence-based approach (with videos)

Cited by 115 publications

References 284 publications

Untitled

Untitled

Quality Assurance in Endoscopy: Which Parameters?

EUS-FNA for Pelvic Lesions: Is This the Final Answer?

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