Endoscopic ultrasound-guided fine needle aspiration and biopsy using a 22-gauge needle with side fenestration in pancreatic cystic lesions

BackgroundCytologic diagnosis by endoscopic ultrasound-guided fine needle aspiration is associated with low sensitivity and adequacy. A newly designed endoscopic ultrasound-guided fine needle biopsy device, endowed with a side fenestration, is now available.AimsWe carried out a study with the aim of evaluating the feasibility, safety, and diagnostic yield of the 22-gauge needle with side fenestration for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions.Methods58 patients with 60 pancreatic cystic lesions consecutively referred for endoscopic ultrasound guided-fine needle aspiration were enrolled in a prospective, dual centre study, and underwent fine needle aspiration and biopsy with the 22-gauge needle with side fenestration.ResultsFine needle aspiration and biopsy was technically feasible in all cases. In 39/60 (65%) pancreatic cystic lesions, the specimens were adequate for cyto-histologic assessment. In lesions with solid components, and in malignant lesions, adequacy was 94.4% (p = 0.0149) and 100% (p = 0.0069), respectively. Samples were adequate for histologic evaluation in 18/39 (46.1%) cases. There were only 2 (3.3%) mild complications.ConclusionsFine needle aspiration and biopsy with the 22-gauge needle with side fenestration is feasible, and superior to conventional endoscopic ultrasound-guided fine needle aspiration cytology from cystic fluid, particularly in pancreatic cystic lesions with solid component or malignancy, with a higher diagnostic yield and with no increase in complication rate.     

超声内镜下细针穿刺活检术对胰腺囊性病变的诊断价值

目的 探讨超声内镜引导下细针穿刺活检术(EUS-FNA)及细胞块对胰腺囊性病变的诊断价值.方法 回顾性分析2010年1月至2012年12月行传统影像学检查(CT、MRI、B超)、EUS-FNA的15例胰腺囊性病变的临床资料,其中8例行液基细胞学(LBC)、细胞块检查.同时,比较4种检查技术在胰腺囊性病变中的诊断价值.结果 假性囊肿7例,黏液性囊腺瘤2例,胰腺导管内乳头状黏液瘤(IPMN)1例,胰腺癌3例,囊腺癌2例.传统影像学、EUS-FNA、LBC、细胞块的诊断正确率为53.3％、86.7％、75.0％、100.0％,差异有统计学意义(P＜0.05).EUS-FNA较单纯传统影像学的灵敏度、特异度、约登指数均高(86.7％、75.0％、0.62与53.3％、58.3％、0.12),细胞块较LBC灵敏度高(100.0％与75.0％).结论 EUS-FNA及细胞块可提高诊断胰腺囊性病变的准确率.     

细针直径对内镜超声下胰腺实性占位穿刺诊断影响的研究

目的研究不同细针直径对内镜超声(EUS)引导下细针穿刺(FNA)胰腺实性占位诊断的影响。方法选择临床及影像学疑诊胰腺实性占位患者共37例,分别用19G和22G穿刺针进行穿刺。结果EUS检出全部37例胰腺占位,16例患者经22G穿刺针行FNA,11例获得满意标本;21例患者经19G穿刺针行FNA,均获得满意标本。32例获得病理诊断,其中3例误诊为慢性胰腺炎。结论EUS能有效检出胰腺占位,穿刺针大小为穿刺组织病理诊断成功的影响因素,慢性胰腺炎是影响病理诊断的重要因素。     

Comparison of cytologic preparation methods in endoscopic ultrasound-guided fine needle aspiration for diagnosis of pancreatic adenocarcinoma

BackgroundThere are few studies about the diagnostic yield of cytologic preparation method of pancreatic samples obtained by Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of this study was to compare the accuracy of ThinPrep^® and smear method in diagnosis of pancreatic cancer.MethodsA total of 125 EUS-FNA procedures were performed between July 2010 and June 2015. Patients in group I (n = 36; July 2010 to June 2014) had cytology slides prepared by consecutive allocation of samples. Patients in group II (n = 12; July 2014 to June 2015) had cytology slides prepared by alternately allocation of samples.ResultsThere were 24 men and 24 women (median age: 67 years; range 39–84). The median size of lesions was 3.9 cm (range; 1.4–7.2 cm). The locations of the pancreatic cancer were 10 in head (20.8%), 21 in body (43.8%), and 17 in tail (35.4%). The ThinPrep^® method confirmed malignancy in 35 of 48 cases (72.9%). On the other hand, the smear method confirmed malignancy in 44 of 48 cases (91.7%). The diagnostic yield of smear method was statistically higher than liquid method (P = 0.012). Also, smear method is superior to liquid method in both consecutive and alternative allocation method. ThinPrep^® provided a correct diagnosis in one case where the smear method was incorrect.ConclusionsSmear method was a superior preparation method to liquid method in diagnosis of pancreatic cancer, even if splitting method was not used and variable allocation method was used.     

Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer

INTRODUCTION: Endoscopic ultrasound (EUS) is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral CT scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than EUS-FNA and, therefore, more frequently used. In this study, we evaluated the use of EUS-FNA in conjunction with spiral CT for suspected pancreatic cancer. METHODS: We retrospectively evaluated 81 consecutive patients who underwent EUS and EUS-FNA for clinical suspicion of a pancreatic cancer from November 2000 to November 2001. All patients had spiral CT with a multiphasic pancreatic protocol using multidetector spiral CT scanners. In all patients, EUS-FNA and spiral CT examinations were performed less than 3 wk apart. RESULTS: Overall, the accuracy of spiral CT, EUS, and EUS-FNA was 74% (n = 60/81, CI 63-83%), 94% (n = 76/81, CI 87-98%), and 88% (n = 73/81, CI 81-96%), respectively, for diagnosing pancreatic cancer. In patients without an identifiable mass on spiral CT, the diagnostic accuracy of EUS and EUS-FNA for pancreatic tumors was 92% (n = 23/25, CI 74-99%). Absence of a focal "mass" lesion on EUS reliably excluded pancreatic cancer irrespective of clinical presentation (NPV 100% n = 5/5, CI 48-100%). The negative predictive value of EUS-FNA was only 22% (n = 2/9, CI 3-60%) in patients with obstructive jaundice and biliary stricture. However, in patients without obstructive jaundice at initial presentation, EUS-FNA was highly accurate (accuracy 97%, n = 33/34, CI 85-100%) and was reliable for ruling out malignancy (NPV 89%, n = 8/9, CI 52-100%). Cytologic assessment of EUS-FNA specimens was 89% accurate for identifying malignancy in suspicious lesions visualized on EUS. CONCLUSIONS: The EUS with FNA can be a valuable adjunct to newer high-resolution multidetector spiral CT for diagnostic evaluation of patients with suspected pancreatic cancer.     

超声内镜引导细针穿刺抽吸术在常规内镜活检诊断不明确 的胃肠道病变中的应用价值

目的 评价超声内镜引导细针穿刺抽吸术（EUS-FNA）在常规内镜活检诊断不明确的胃肠道病变中的应用价值。 方法 回顾性分析65例常规内镜活检诊断不明确的胃肠道病变且在我院行EUS-FNA的患者的诊断结果和随访情况,以手术病理和随访结果为最终诊断,评估EUS-FNA对此类病变的诊断价值。结果 本研究中男性患者41例,女性24例,中位年龄60岁。普通内镜下以弥漫浸润型病变最为多见（56.9%）,其次为黏膜下隆起型病变（21.7%）。54例（83.1%）患者诊断为肿瘤性病变,非肿瘤性病变11例（83.1%）。EUS-FNA总的诊断敏感度、特异度及准确性为76.8%（95%CI: 65.7%-87.8%）、100%（95%CI: 66.4%-100%）、及80.0%（95%CI: 70.3%-89.7%）。亚组分析显示EUS-FNA在弥漫浸润型病变中的诊断敏感度、特异度及准确性分别为70.6%（95%CI: 55.3%-85.9%）、100%（95%CI: 29.2%-100%）及73.0%（95%CI: 58.7%-87.3%）;在黏膜下隆起型病变中的诊断敏感度、特异度及准确性分别为68.8%（95%CI: 46.0%-91.5%）、100%（95%CI: 2.5%-100%）及70.6%（95%CI: 44.0%-89.7%）。结论 EUS-FNA对常规内镜活检诊断不明确的胃肠道病变具有中等强度的诊断价值,可作为此类病变在常规内镜活检无法确诊后的备选方案,但仍需结合其他手段或技术改进以进一步提高EUS-FNA的诊断效能。     

内镜超声引导下细针穿刺活检术在消化道管壁及其周围器官疾病诊断中的应用价值

目的 探讨内镜超声引导下细针穿刺活检在消化道管壁及其周围器官疾病诊断中的应用价值。方法 对2009年5月至2010年11月行EUS-FNA的133例患者(161处病灶)的临床和病理学资料进行回顾性总结。结果 161处穿刺部位中,实性病变142处,囊液性病变15处,胰腺囊实性病变4例。穿刺部位包括上消化道和直肠周围器官以...     

内镜超声引导下胰腺病灶细针穿刺抽吸术的安全性分析

目的 探讨胰腺病灶内镜超声引导下细针穿刺抽吸术(EUS-FNA)的安全性.方法 选择2005年1月至2007年6月间行胰腺EUS-FNA的患者,记录并发症情况,结合文献资料,分析可能的相关危险因素.结果 总共119例患者行胰腺EUS-FNA,其中1例出现术后急性轻症胰腺炎,经治疗后治愈,9例患者(7.6%)术后3 h出现高淀粉酶血症,血淀粉酶197～835 U/L,平均(327±200)U/L,6例(5.0%)患者术后24 h血淀粉酶仍持续升高.经Logistic回归分析发现既往急性胰腺炎病史、性别、穿刺针大小及穿刺针数、囊性病灶、术前血淀粉酶值以及病灶部位可能均不是高淀粉酶血的危险因素.结论 胰腺EUS-FNA术后总的并发症发生率较低,是一项安全的操作技术.     

Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic cysts by combined cytopathology and cystic content analysis

Recent advances in imaging technology have resulted in an increase in incidental discoveries of pancreatic cystic lesions. Pancreatic cysts comprise a wide variety of lesions and include non-neoplastic cysts and neoplastic cysts. Because some pancreatic cysts have more of a malignant potential than others, it is absolutely essential that an accurate diagnosis is rendered so that effective care can be given to each patient. In many centers, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has emerged as the modality of choice that enables one to distinguish between mucinous and non-mucinous lesion, diagnose malignancy and collect cyst fluid for further diagnostic studies, such as pancreatic enzyme levels, molecular analysis and other tumor biomarkers. The current review will focus on EUS-guided FNA and the cytological diagnosis for pancreatic cysts.     

Endoscopic ultrasound fine needle aspiration vs fine needle biopsy for pancreatic masses,subepithelial lesions,and lymph nodes

Endoscopic ultrasound tissue acquisition, in the form of both fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), is utilized for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA has potential limitations associated with cytological aspirations, including inability to determine histologic architecture, and a small quantitative sample for further immunohistochemical staining. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. However, it remains unclear which technique should be used and for which lesions. Comparative trials are plagued by heterogeneity at every stage of comparison; including variable needles used, and different definitions of endpoints, which therefore limit generalizability. Thus, we present a review of prospective trials, systematic reviews, and meta-analyses on studies examining EUS-FNA vs EUS-FNB. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions, and yield conflicting results in terms of demonstrating the superiority of one method. However, consistent among trials is the potential for diagnosis with fewer passes, and a larger quantity of sample achieved for next generation sequencing. With regard to subepithelial lesions and lymph node biopsy, fewer prospective trials exist, and larger prospective studies are necessary. Based on the available literature, we would recommend EUS-FNB for peri-hepatic lymph nodes.     

Push vs pull method for endoscopic ultrasound-guided fine needle aspiration of pancreatic head lesions: Propensity score matching analysis

AIM To evaluate the efficacy of endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) of pancreatic head cancer when pushing(push method) or pulling the echoendoscope(pull method).METHODS Overall, 566 pancreatic cancer patients had their first EUS-FNA between February 2001 and December 2017. Among them, 201 who underwent EUS-FNA for pancreatic head lesions were included in this study. EUS-FNA was performed by the push method in 85 patients, the pull method in 101 patients and both the push and pull methods in 15 patients. After propensity score matching(age, sex, tumor diameter, and FNA needle), 85 patients each were stratified into the push and pull groups. Patient characteristics and EUSFNA-related factors were compared between the two groups.RESULTS Patient characteristics were not significantly different between the two groups. The distance to lesion was significantly longer in the push group than in the pull group(13.9 ± 4.9 mm vs 7.0 ± 4.9 mm, P 0.01). The push method was a significant factor influencing the distance to lesion(≥ median 10 mm)(P 0.01). Additionally, tumor diameter ≥ 25 mm(OR = 1.91, 95%CI: 1.02-3.58, P = 0.043) and the push method(OR = 1.91, 95%CI: 1.03-3.55, P = 0.04) were significant factors contributing to the histological diagnosis of malignancy.CONCLUSION The pull method shortened the distance between the endoscope and the lesion and facilitated EUS-FNA of pancreatic head cancer. The push method contributed to the histological diagnosis of pancreatic head cancer using EUS-FNA specimens.     

Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions

OBJECTIVE: Preoperative diagnosis of cystic lesions of the pancreas remains difficult despite improvement in imaging modalities and cystic fluid analysis. The aim of our study was to assess the performance of endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (FNA) in the diagnosis of pancreatic cystic lesions. METHODS: Data from a series of 127 consecutive patients with pancreatic cystic lesions were prospectively studied. EUS and EUS-guided FNA were performed in all patients, and cystic material was used for cytological and histological analysis as well as for biochemical and tumor markers analysis. Performance of EUS diagnosis, biochemical and tumor markers, and FNA diagnosis were compared with the final histological diagnosis obtained at surgery or postmortem examination. Sixty-seven patients underwent surgery and therefore constituted our study group. RESULTS: EUS provided a tentative diagnosis in 113 cases (89%). Cytohistological FNA provided a diagnosis in 98 cases (77%). When the results of EUS and EUS-guided FNA were compared with the final diagnosis (67 cases), EUS correctly identified 49 cases (73%), whereas FNA correctly identified 65 cases (97%). Sensitivity, specificity, positive predictive value, and negative predictive value of EUS and EUS-guided FNA to indicate whether a lesion needed further surgery were 71% and 97%, 30% and 100%, 49% and 100%, and 40% and 95%, respectively. Carbohydrate antigen 19-9 > 50,000 U/ml had a 15% sensitivity and a 81% specificity to distinguish mucinous cysts from other cystic lesions, whereas it had a 86% sensitivity and a 85% specificity to distinguish cystadenocarcinoma from other cystic lesions. CONCLUSIONS: EUS-guided FNA is a valuable tool in the preoperative diagnostic assessment of pancreatic cystic lesions.     

内镜超声引导下细针穿刺抽吸术在纵隔病变诊断中的应用

目的 初步探讨内镜超声引导下细针穿刺抽吸术(EUS-FNA)在纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期中的应用价值.方法 应用22 G穿刺针对61例患者经食管行EUS.FNA,穿刺物均行病理及细胞学检查.结果 EUS·FNA诊断阳性率为93.4%(57/61),细胞学及病理诊断阳性率分别为85.2%(52/61)和83.6%(51/61).100.0%(26/26)临床疑诊肺癌纵隔淋巴结转移而经支气管镜等检查未能提供病理或细胞学证据者均通过EUS-FNA得到诊断,其中21例诊断为肺癌、5例排除肺癌诊断为良性疾病;86.4%(19/22)纵隔不明原因占位明确定性;85.7%(6/7)有恶性肿瘤病史影像学检查疑诊纵隔淋巴结转移者,EUS-FNA病理及细胞学结果 支持转移;6例经支气管镜检查已获得明确病理细胞学诊断的肺癌病例但影像学提示纵隔淋巴结肿大,为明确N分期行EUS-FNA,结果 均为阳性,改变了原计划治疗方案.本组无一例EUS-FNA相关并发症发生.结论 对于明确纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期,EUS-FNA是一种较为安全、有效的诊断方法.     

不同细胞病理学分级标准对超声内镜引导下细针穿刺诊断胰腺癌的影响

目的探讨不同细胞病理学分级标准对超声内镜引导下细针穿刺(EUS-FNA)诊断胰腺癌效能的影响。方法收集2011年5月—2019年3月于安徽医科大学第一附属医院行EUS-FNA检查的256例胰腺占位患者的临床资料和胰腺细胞病理学诊断结果,以手术病理结果和随访情况作为最终诊断,评估影响EUS-FNA诊断效能的相关因素。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验;计数资料两组间比较采用χ^2检验。应用受试者工作特征曲线(ROC曲线)评价不同细胞病理学分级标准对胰腺癌的诊断价值。结果剔除失访患者67例,共189例患者纳入研究,按巴氏细胞病理学标准,EUS-FNA诊断细胞病理学结果为异型细胞47例,疑癌细胞25例,癌细胞20例,未见肿瘤细胞97例。133例经术后病理和随访结果证实为胰腺癌,其中细胞病理学检查结果分别为:未见肿瘤细胞52例,异型细胞36例,疑癌细胞25例,癌细胞20例。EUS-FNA诊断胰腺癌的真阳性率为60.90%(81例),假阴性率为39.10%(52例);非胰腺癌56例,假阳性率为19.64%(11例),真阴性率为80.36%(45例)。EUS-FNA诊断胰腺癌的ROC曲线下面积为0.643(95%CI:0.561~0.724)。联合不同细胞病理学分级标准,分别以“发现异型细胞或可疑癌细胞或癌细胞均为阳性”“发现可疑癌细胞或癌细胞均为阳性”和“发现癌细胞为阳性”为诊断标准进行分析,结果显示,以“发现异型细胞或可疑癌细胞或癌细胞均为阳性”为诊断标准,EUS-FNA诊断胰腺癌的效能提高,敏感度为50.38%,特异度为75.00%。189例患者EUS-FNA术后并发症发生率为6.88%(13例),主要为高淀粉酶血症和腹痛。结论联合不同细胞病理学分级标准有助于提高EUS-FNA对胰腺癌的诊断效能。     

Tissue acquisition in pancreatic cystic lesions

Despite the progress achieved by scientific research in recent years, pancreatic cystic lesions (PCLs) remain a challenging clinical problem. A significant percentage of benign PCLs are still wrongly sent to surgery, with all the related risks of a high number of surgery-related complications and mortality. Diagnosis of the type of PCL, and risk stratification for malignancy are essential for a correct management of these lesions. Several guidelines have identified some clinical and morphological aspects suggesting the need for more accurate exams. Endoscopic ultrasound fine needle aspiration (EUS-FNA) of cystic fluid for cytology is the advised method of tissue acquisition in several guidelines, and the most used technique around the world. However sensitivity and adequacy of this technique are limited by the low amount of cells dispersed in cystic fluid. Alternative techniques have been tested to target the cystic walls in an attempt to obtain microhistologic specimens in order to augment the probability of obtaining an adequate diagnostic sample.The aim of this review is to offer a critical overview of the existing literature on tissue acquisition in PCLs, and emphasize advantages and disadvantages of each technique, and unclear areas that need to be investigated with future research.     

Endoscopic ultrasound-guided through-the-needle microforceps biopsy and needle-based confocal laser-endomicroscopy increase detection of potentially malignant pancreatic cystic lesions: A single-center study

BACKGROUNDCurrently, there is insufficient data about the accuracy in the diagnosing of pancreatic cystic lesions (PCLs), especially with novel endoscopic techniques such as with direct intracystic micro-forceps biopsy (mFB) and needle-based confocal laser-endomicroscopy (nCLE).AIMTo compare the accuracy of endoscopic ultrasound (EUS) and associated techniques for the detection of potentially malignant PCLs: EUS-guided fine needle aspiration (EUS-FNA), contrast-enhanced EUS (CE-EUS), EUS-guided fiberoptic probe cystoscopy (cystoscopy), mFB, and nCLE.METHODSThis was a single-center, retrospective study. We identified patients who had undergone EUS, with or without additional diagnostic techniques, and had been diagnosed with PCLs. We determined agreement among malignancy after 24-mo follow-up findings with detection of potentially malignant PCLs via the EUS-guided techniques and/or EUS-guided biopsy when available (EUS malignancy detection). RESULTSA total of 129 patients were included, with EUS performed alone in 47/129. In 82/129 patients, EUS procedures were performed with additional EUS-FNA (21/82), CE-EUS (20/82), cystoscopy (27/82), mFB (36/82), nCLE (44/82). Agreement between EUS malignancy detection and the 24-mo follow-up findings was higher when associated with additional diagnostic techniques than EUS alone [62/82 (75.6%) vs 8/47 (17%); OR 4.35, 95%CI: 2.70-7.37; P < 0.001]. The highest malignancy detection accuracy was reached when nCLE and direct intracystic mFB were both performed, with a sensitivity, specificity, positive predictive value, negative predictive value and observed agreement of 100%, 89.4%, 77.8%, 100% and 92.3%, respectively (P < 0.001 compared with EUS-alone). CONCLUSIONThe combined use of EUS-guided mFB and nCLE improves detection of potentially malignant PCLs compared with EUS-alone, EUS-FNA, CE-EUS or cystoscopy.     

内镜超声引导下细针穿刺对胰腺占位病变的诊断价值

目的 通过超声内镜结合细针穿刺活检确定胰腺占位病变的性质，并评价该法对胰腺病变的诊断价值。方法 对经CT、MRI、体表腹部超声及内镜超声发现的23例胰腺局限性占位病变进行内镜超声检查，以明确病变大小、形态、位置，并观察有无淋巴结转移。在内镜超声引导下对病变行细针穿刺活检。结果 23例患者中，21例得到了充足的细胞量，15例得到组织块，12例最终确定为胰腺肿瘤的患者，经组织细胞学检查10例为阳性（其中胰腺癌8例；胰腺囊腺瘤癌1例；无功能神经内分泌肿瘤1例），敏感性为83％，特异性为100％。全部结果经手术（16例）及临床随访（7例）证实。无1例出现不良反应。结论 超声内镜结合细针穿刺是诊断胰腺病变安全、有效的方法。