Transvascular endosonographic-guided needle biopsy of intrathoracic lesions

Molina, Juan Carlos; Chaudry, Fawad; Menezes, Vanessa; Ferraro, Pasquale; Lafontaine, Edwin; Martin, Jocelyne; Nasir, Basil S.; Liberman, Moïshe

doi:10.1016/j.jtcvs.2019.10.017

Cited by 23 publications

(27 citation statements)

References 47 publications

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“…Since Vincent et al and Wallace et al (2006 and 2007, respectively) published papers on the first transvascular (pulmonary artery and aorta) puncture guided by EBUS and EUS, respectively, only a few case reports and small case series have been published 7 8 . Much of the current literature on EUS-TV-FNA has paid special attention to intrathoracic lesions, and most of the knowledge about this technique comes from the EBUS field 9 10 11 12 . Many of the reports related to EUS-guided FNA involve the transaortic approach and focus on the study of lung cancer 4 8 13 14 15 .…”

Section: Discussionmentioning

confidence: 99%

“…An updated literature review is included ( Table 5 ), and three retrospective case series stand out for comparison to our results 4 8 9 11 12 13 14 15 16 20 21 .…”

Section: Discussionmentioning

confidence: 99%

“…No immediate AEs were reported, and only one delayed aortic pseudoaneurysm. One possible explanation for this lower diagnostic performance is that the number of passes made in a transvascular approach is less than with standard EUS-FNA, and this might affect sample adequacy 12 .…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, three immediate hematomas have been described after transaortic punctures guided by EUS, without the need for interventional therapy. One case of pseudo-aneurysm was detected 3 weeks after a transaortic EUS-FNA that was managed conservatively 4 8 12 .…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

et al. 2020

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Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact. Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88 % (95 %CI,0.74–0.96), 100 % (95 %CI,0.59–1), and 90 % (95 %CI,0.78–0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88 %). Arterial vessel and ASA-III had a trend with incidents (both, P < 0.08). Rapid on-site evlauation was found to be an independent predictor for obtaining a conclusive sample (OR 6.2; 95 %CI, 1.06–36.73, P < 0.04). Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.

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Section: Discussionmentioning

confidence: 99%

“…An updated literature review is included ( Table 5 ), and three retrospective case series stand out for comparison to our results 4 8 9 11 12 13 14 15 16 20 21 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

et al. 2020

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“…Notably, no hematoma formation was detected on ultrasound immediately after the initial procedure per the protocol of Molina and colleagues. 1 This case clearly illustrates why further studies are crucial in defining the safety and role of any new surgical technique, even when initial results appear promising.…”

Section: Reply: Further Studies Are Required Reply To the Editormentioning

confidence: 91%

Reply: Further studies are required

Sihoe¹

2022

The Journal of Thoracic and Cardiovascular Surgery

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Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Giri

Harindranath

Angadi

et al. 2023

J of Clinical Ultrasound

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Background The diagnosis of intrathoracic and abdominal masses is challenging when lesions are located behind major vessels. Endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS)‐guided transvascular needle aspiration (TVNA) provides a potentially useful diagnostic tool for such lesions. Data with respect to the safety and outcome of E‐TVNA are scarce. Hence, this meta‐analysis was conducted to assess the critical role of E‐TVNA for diagnosis of various lesions. Methods and Material A meta‐analysis was performed by pooling the data from studies obtained from comprehensive search of Medline, Embase, and Scopus from January 2000 to September 2022. The outcomes analyzed included sample adequacy, diagnostic accuracy and adverse events including bleeding. Results A total of 17 studies (n = 411) were included in the final analysis. The pooled rate of sample adequacy was 91.5% [95% confidence interval (CI): 86.8–96.2], while the pooled rate of diagnostic accuracy was 85.0% (95% CI: 78.9–91.2). The pooled rate of bleeding with E‐TVNA was 1.4% (95% CI 0.0–3.1%). All the episodes of bleeding were mild and resolved without any further intervention. There was no significant heterogeneity with respect to various outcomes and results were comparable on sensitivity analysis. Conclusions E‐TVNA offers a safe and accurate diagnostic modality for the diagnosis of mediastinal and abdominal lesions located on the other side of major vessels. Selection of potential candidates and close periprocedural observation are essential to improve the outcome.

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Transvascular endosonographic-guided needle biopsy of intrathoracic lesions

Cited by 23 publications

References 47 publications

Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

Reply: Further studies are required

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

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