Tissue Acquisition for Histologic Diagnosis

Background & Aims: Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. Methods: From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. Results: The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). Conclusions: CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.. Abbreviations: CEUS: contrast-enhanced ultrasound; CT: computed tomography; HCC: hepatocellular carcinoma;MRI: magnetic resonance; NPV: negative predictive value; PPV: positive predictive value; US: ultrasonography.

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Gastrointestinal Stromal Tumor of the Ampulla of Vater: A Narrative Review

Gastrointestinal Tumors ◽

10.1159/000514613 ◽

2021 ◽

pp. 1-6

Author(s):

Bita Geramizadeh ◽

Alireza Shojazadeh

Keyword(s):

Gastrointestinal Stromal Tumor ◽

Spindle Cell ◽

English Literature ◽

Ampulla Of Vater ◽

Good Prognosis ◽

Stromal Tumor ◽

Treatment Modalities ◽

Histologic Diagnosis ◽

Lower Gi Bleeding ◽

Mitotic Figures

Background: Gastrointestinal stromal tumor (GIST) of the ampulla of Vater is a rare occurrence. To the best of our knowledge, there has been no published review on this rare tumor in the English literature so far. Summary: In this review, we will discuss all the reported details of the published cases, including demography, clinical presentation, imaging, gross pathology and histopathology, immunohistochemical findings, treatment modalities, and outcome of cases with the diagnosis GIST from the ampulla of Vater in the last 20 years. Key Message: Twenty-five cases of GIST in the ampulla of Vater have been reported in the last 20 years in the English literature. GIST in the ampulla of Vater are usually small tumors (<5 cm) in middle-age patients. The majority of the patients present with lower GI bleeding and abdominal pain. Imaging findings are not characteristic, and most of the patients without biopsy and with no histologic diagnosis were operated with the primary impression of adenocarcinoma, neuroendocrine tumor, and GIST. Perioperative tissue biopsy has been accurate in <70% of the cases. The majority of the reported cases of GISTs in the ampulla of Vater have been low risk with spindle-cell morphology, low mitotic figures, and minimal atypia; reactive for C-KIT and DOG-1; and nonreactive for SMA, desmin, and S100. In the majority of the cases, duodenectomy with or without Whipple’s operation has been performed, and most of the cases showed good prognosis.

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ID: 3524162 RETROSPECTIVE REVIEW FOR TISSUE ACQUISITION OF BILE DUCT IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.967 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB143

Author(s):

Kang Won Lee ◽

Jae Min Lee ◽

Hyuk Soon Choi ◽

Eun Sun Kim ◽

Bora Keum ◽

...

Keyword(s):

Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Retrospective Review ◽

Endoscopic Retrograde ◽

Tissue Acquisition

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Comparison of the Diagnostic Performance of Novel Slim Biopsy Forceps with Conventional Biopsy Forceps for Biliary Stricture: A Multicenter Retrospective Study

Journal of Personalized Medicine ◽

10.3390/jpm11010055 ◽

2021 ◽

Vol 11 (1) ◽

pp. 55

Author(s):

Eun Suk Jung ◽

Se Woo Park ◽

Jung Hee Kim ◽

Jang Han Jung ◽

Min Jae Yang ◽

...

Keyword(s):

Adverse Events ◽

Predictive Value ◽

Diagnostic Performance ◽

Biliary Stricture ◽

Accurate Diagnosis ◽

The Novel ◽

Biopsy Forceps ◽

Tertiary Hospitals ◽

Tissue Acquisition ◽

Histological Confirmation

Novel slim biopsy forceps provide some technical advantages to facilitate a more accurate diagnosis, although we are not aware of any comparative studies. Therefore, we compared tissue acquisition and diagnostic accuracy between novel slim biopsy forceps and conventional biopsy forceps in cases with a biliary stricture. We reviewed 341 patients who underwent endoscopic retrograde cholangiopancreatography for the histological confirmation of biliary stricture at two tertiary hospitals between 2013 and 2020. The primary endpoint was the forceps’ diagnostic accuracies. We included 276 patients who underwent biopsy using the novel forceps (n = 130) or conventional forceps (n = 146). The novel forceps provided 81.7% sensitivity, 100.0% specificity, positive-predictive value (PPV) of 100.0%, and negative-predictive value (NPV) of 57.8%, with an accuracy of 85.4% when the diagnosis by endobiliary biopsy included suspected or positive malignancy. The conventional forceps provided 61.7% sensitivity, 100.0% specificity, PPV of 100.0%, and NPV of 36.1%, with an accuracy of 68.5%. Only novel forceps use was significantly associated with an accurate diagnosis (odds ratio: 2.70, 95% confidence interval: 1.52–5.00). There were no significant inter-group differences in the procedure-related rates of adverse events. Endobiliary biopsy using novel forceps offered better diagnostic performance and more acceptable procedure-related adverse events than conventional forceps.

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