Rapid on-site evaluation during endoscopic ultrasoundguided fine-needle aspiration of lymph nodes does not increase diagnostic yield: A randomized, multicenter trial

Purpose: The aim of this prospective study was to determine the incidence of enlarged supraclavicular lymph nodes by US and the diagnostic yield of US-guided aspiration cytology in the diagnosis of sarcoidosis. Methods: During a 54-month period, all consecutive patients with a clinical suspicion of sarcoidosis underwent supraclavicular US at the Kiljava Hospital, Finland. All patients with enlarged supraclavicular lymph nodes underwent US-guided fine-needle aspiration biopsy (FNAB) of the lymph node. Results: Of a total of 250 patients, 27 (10.8%) had enlarged supraclavicular lymph nodes at US. All these were non-palpable at clinical examination. The cytological specimen was quantitatively sufficient in 25 of the 27 cases (93%). In 22 (88%) of these, the cytological diagnosis was granulomatous inflammation suggestive of sarcoidosis. Three aspirates yielded reactive hyperplasia and 2 specimens were insufficient. No complications occurred. The patients were followed for 2–42 months (mean 19 months), and the diagnosis of sarcoidosis was confirmed clinically in all cases. Conclusion: Supraclavicular US detects non-palpable enlarged lymph nodes in 1/10 of the patients with suspected sarcoidosis. In this subgroup of patients, US combined with aspiration cytology may give cytological evidence of granulomatous disease similar to sarcoidosis and more invasive diagnostic methods can be avoided.

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Gastrointestinal Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy Specimens: Adequate Diagnostic Yield and Accuracy Can Be Achieved without On-Site Evaluation

Acta Cytologica ◽

10.1159/000439398 ◽

2015 ◽

Vol 59 (4) ◽

pp. 305-310 ◽

Cited By ~ 6

Author(s):

Kate O'Connor ◽

Danny G. Cheriyan ◽

Hector H. Li-Chang ◽

Steven E. Kalloger ◽

John Garrett ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Ultrasound Guided ◽

Fine Needle ◽

Site Evaluation ◽

Needle Aspiration Biopsy

Background: Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is the preferred method for biopsying the gastrointestinal tract, and rapid on-site cytological evaluation is considered standard practice. Our institution does not perform on-site evaluation; this study analyzes our overall diagnostic yield, accuracy, and incidence of nondiagnostic cases to determine the validity of this strategy. Design: Data encompassing clinical information, procedural records, and cytological assessment were analyzed for gastrointestinal EUS-FNA procedures (n = 85) performed at Vancouver General Hospital from January 2012 to January 2013. We compared our results with those of studies that had on-site evaluation and studies that did not have on-site evaluation. Results: Eighty-five biopsies were performed in 78 patients, from sites that included the pancreas, the stomach, the duodenum, lymph nodes, and retroperitoneal masses. Malignancies were diagnosed in 45 (53%) biopsies, while 24 (29%) encompassed benign entities. Suspicious and atypical results were recorded in 8 (9%) and 6 (7%) cases, respectively. Only 2 (2%) cases received a cytological diagnosis of ‘nondiagnostic'. Our overall accuracy was 72%, our diagnostic yield was 98%, and our nondiagnostic rate was 2%. Our results did not significantly differ from those of studies that did have on-site evaluation. Conclusion: Our study highlights that adequate diagnostic accuracy can be achieved without on-site evaluation.

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Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology of Porta Hepatis Lesions: A Retrospective Study

Acta Cytologica ◽

10.1159/000445764 ◽

2016 ◽

Vol 60 (2) ◽

pp. 154-160 ◽

Cited By ~ 3

Author(s):

Krister Jones ◽

Laura Biederman ◽

Rossitza Draganova-Tacheva ◽

Charalambos Solomides ◽

Marluce Bibbo

Keyword(s):

Retrospective Study ◽

Lymph Nodes ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Porta Hepatis ◽

Fine Needle ◽

The Masses

Objective: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has recently been used for the evaluation of various lesions arising in the porta hepatis. The purpose of this study is to evaluate the diagnostic yield of this increasingly utilized approach to porta hepatis lesions. Study Design: A retrospective study of 72 consecutive samples of porta hepatis lesions obtained via EUS-FNA between 2004 and 2015 was conducted. Clinical histories and endoscopic findings were available prior to the diagnostic interpretation. The diagnosis of each lesion was based on its cytologic features on smears, its histologic features on cell block, a comparison with any relevant prior specimens, immunohistochemistry and flow cytometric studies when applicable. Results: A total of 72 lesions (59 lymph nodes, 2 cysts and 11 masses) were biopsied in 70 patients. Adequate specimens were obtained in 65/72 cases (90%). Most of the lymph nodes were benign (n = 40, 67%) and most of the masses were malignant or suspicious (n = 8, 73%). A variety of diagnoses, primary and metastatic, were made, including hepatocellular carcinoma, cholangiocarcinoma and lymphoma. In addition, we have noted a significant increase in the number of EUS-FNAs in recent years. Conclusion: EUS-FNA is an effective and increasingly utilized diagnostic approach for the evaluation of multiple types of lesions in the porta hepatis.

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2801 Does Rapid On-Site Evaluation by a Cytopathologist During Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS FNA) of Pancreatic Masses Improve Diagnostic Yield and Accuracy? A Systematic Review and Meta-Analysis

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000600736.79367.28 ◽

2019 ◽

Vol 114 (1) ◽

pp. S1547-S1547

Author(s):

Faisal Kamal ◽

Muhammad Ali Khan ◽

Raseen Tariq ◽

Mahmoud Bayoumi ◽

Hemnishil K. Marella ◽

...

Keyword(s):

Systematic Review ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Diagnostic Yield ◽

Meta Analysis ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle ◽

Pancreatic Masses ◽

Site Evaluation

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EUS-guided fine needle biopsy alone vs. EUS-guided fine needle aspiration with rapid on-site evaluation of cytopathology in pancreatic lesions: a multicenter randomized trial

Endoscopy ◽

10.1055/a-1375-9775 ◽

2021 ◽

Author(s):

Yen-I Chen ◽

Avijit Chatterjee ◽

Robert Berger ◽

Yonca Kanber ◽

Jonathan M Wyse ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Fine Needle Aspiration ◽

Diagnostic Yield ◽

Fine Needle Biopsy ◽

Needle Aspiration ◽

Procedure Time ◽

Fine Needle ◽

Site Evaluation ◽

Sensitivity Specificity ◽

Solid Lesions

Background and Study Aims: EUS-guided fine needle aspiration (EUS-FNA) is the standard in the diagnosis of pancreatic solid lesions, in particular when combined with rapid on-site evaluation of cytopathology (ROSE). More recently, a fork-tip needle for core biopsy (FNB) has been shown to be associated with excellent diagnostic yield. EUS-FNB alone; however, has not been compared to EUS-FNA+ROSE in a large clinical trial. Our aim is to compare EUS-FNB alone to EUS-FNA+ROSE in solid pancreatic lesions. Patients and Methods: Multicenter non-inferiority RCT involving 7 centers. Solid pancreatic lesions referred for EUS were considered for inclusion. The primary endpoint is diagnostic accuracy. Secondary endpoints include sensitivity/specificity, mean number of needle passes, and cost. Results: 235 patients were randomized: 115 EUS-FNB alone and 120 EUS-FNA+ROSE. Overall, 217 patients had a malignant histology. The diagnostic accuracy for malignancy of EUS-FNB alone was non-inferior to EUS-FNA+ROSE 92.2% (95% CI: 86.6-96.9%) and 93.3% (95% CI: 88.8-97.9%), respectively p=0.72. Diagnostic sensitivity for malignancy was 92.5% (95% CI: 85.7-96.7%) EUS-FNB alone vs. 96.5% (93.0-98.6%) EUS-FNA+ROSE (p=0.46) while specificity was 100% in both. Adequate histology yield was obtained in 87.5% of the EUS-FNB alone samples. Mean number of needle of passes and procedure time favored EUS-FNB alone (2.3±0.6 passes vs. 3.0±1.1 passes p≤0.01 and 19.3±8.0 minutes vs. 22.7±10.8 minutes p <0.01). EUS-FNB alone cost on average 45USD more than EUS-FNA+ROSE. Conclusion: EUS-FNB alone is non-inferior to EUS-FNA+ROSE and is associated with fewer needle passes, shorter procedure time, and excellent histological yield at comparable cost. (clinicaltrials.gov: NCT03435588).

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Optimal Diagnostic Yield Achieved With On-site Pathology Evaluation of Fine-Needle Aspiration–Assisted Core Biopsies for Pediatric Osseous Lesions: A Single-Center Experience

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0269-oa ◽

2017 ◽

Vol 141 (5) ◽

pp. 678-683 ◽

Cited By ~ 4

Author(s):

Kalyani Patel ◽

Darryl Kinnear ◽

Norma M. Quintanilla ◽

John Hicks ◽

Eumenia Castro ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Diagnostic Procedure ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Fine Needle ◽

Single Center Experience ◽

Site Evaluation ◽

Appropriate Therapy ◽

Malignant Lesions

Context.— Image-guided, fine-needle aspiration–assisted core needle biopsy with an on-site evaluation by a pathologist (FNACBP) of osseous lesions is not a common practice in pediatric institutions. Objectives.— To evaluate the diagnostic adequacy and accuracy of FNACBP for pediatric osseous lesions and to compare the adequacy with procedures that do not use fine-needle aspiration. Design.— Six-year, retrospective review of 144 consecutive children biopsied for osseous lesions with and without fine-needle aspiration assistance. Results.— Pathologic diagnosis was achieved in 79% (57 of 72) of the core biopsies without an on-site evaluation, 78% (32 of 41) of the open biopsies (9 with intraoperative consultation), and 97% (30 of 31) of the FNACBPs as the initial diagnostic procedure. Three FNACBP cases were preceded by nondiagnostic open biopsies. Among 34 lesions sampled by FNACBP, 33 (97%) succeeded with diagnostic tissue, with most (30 of 33; 91%) being neoplasms, including 16 malignant (48%), 13 benign (39%), and 1 indeterminate (3%) lesions. The most-common diagnoses were osteosarcoma (9 of 33; 27%) and Langerhans cell histiocytosis (7 of 33; 21%). In cases with follow-up information available, 93% (28 of 30) of the FNACBP-rendered diagnoses were clinically useful, allowing initiation of appropriate therapy. The FNACBP procedure had 100% specificity, sensitivity, and positive predictive value for all 14 malignant lesions, with the sensitivity being 88% in benign lesions. Most FNACBP procedures (32 of 34; 94%) yielded adequate material for ancillary testing. A gradual upward trend was observed for the choice of FNACBP as an initial diagnostic procedure for osseous lesions. Conclusions.— The FNACBP procedure yields sufficient material for diagnosis and ancillary studies in pediatric, osseous lesions and may be considered an initial-diagnostic procedure of choice.

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Diagnostic Yield of Fine-Needle Aspiration for Axillary Lymph Nodes During Screening Breast Ultrasound

Ultrasound Quarterly ◽

10.1097/ruq.0000000000000236 ◽

2016 ◽

Vol 32 (2) ◽

pp. 144-150 ◽

Cited By ~ 2

Author(s):

Inyoung Youn ◽

Eun-Kyung Kim ◽

Jung Hyun Yoon ◽

Hee Jung Moon ◽

Min Jung Kim

Keyword(s):

Lymph Nodes ◽

Fine Needle Aspiration ◽

Diagnostic Yield ◽

Needle Aspiration ◽

Breast Ultrasound ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Fine Needle

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Evaluation of endoscopic ultrasound fine-needle aspiration versus fine-needle biopsy and impact of rapid on-site evaluation for pancreatic masses

Endoscopy International Open ◽

10.1055/a-1122-8674 ◽

2020 ◽

Vol 08 (06) ◽

pp. E738-E747 ◽

Cited By ~ 1

Author(s):

Diogo T.H. de Moura ◽

Thomas R. McCarty ◽

Pichamol Jirapinyo ◽

Igor B. Ribeiro ◽

Kelly E. Hathorn ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Fine Needle Biopsy ◽

Needle Aspiration ◽

Cell Block ◽

Fine Needle ◽

Pancreatic Masses ◽

Site Evaluation ◽

Sensitivity Specificity

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is traditionally considered a first-line strategy for diagnosing pancreatic lesions; however, given less than ideal accuracy rates, fine-needle biopsy (FNB) has been recently developed to yield histological tissue. The aim of this study was to compare diagnostic yield and safety between EUS-FNA and EUS-FNB in sampling of pancreatic masses. Patients and methods This was a multicenter retrospective study to evaluate efficacy and safety of EUS-FNA and EUS-FNB for pancreatic lesions. Baseline characteristics including sensitivity, specificity, and accuracy, were evaluated. Rapid on-site evaluation (ROSE) diagnostic adequacy, cell-block accuracy, and adverse events were analyzed. Subgroup analyses comparing FNA versus FNB route of tissue acquisition and comparison between methods with or without ROSE were performed. Multivariable logistic regression was also performed. Results A total of 574 patients (n = 194 FNA, n = 380 FNB) were included. Overall sensitivity, specificity, and accuracy of FNB versus FNA were similar [(89.09 % versus 85.62 %; P = 0.229), (98.04 % versus 96.88 %; P = 0.387), and 90.29 % versus 87.50 %; P = 0.307)]. Number of passes for ROSE adequacy and cell-block accuracy were comparable for FNA versus FNB [(3.06 ± 1.62 versus 3.04 ± 1.88; P = 0.11) and (3.08 ± 1.63 versus 3.35 ± 2.02; P = 0.137)]. FNA + ROSE was superior to FNA alone regarding sensitivity and accuracy [91.96 % versus 70.83 %; P < 0.001) and (91.80 % versus 80.28 %; P = 0.020)]. Sensitivity of FNB + ROSE and FNB alone were superior to FNA alone [(92.17 % versus 70.83 %; P < 0.001) and (87.44 % versus 70.83 %; P < 0.001)]. There was no difference in sensitivity though improved accuracy between FNA + ROSE versus FNB alone [(91.96 % versus 87.44 %; P = 0.193) and (91.80 % versus 80.72 %; P = 0.006)]. FNB + ROSE was more accurate than FNA + ROSE (93.13 % versus 91.80 %; P = 0.001). Multivariate analysis showed ROSE was a significant predictor of accuracy [OR 2.60 (95 % CI, 1.41–4.79)]. One adverse event occurred after FNB resulting in patient death. Conclusion EUS-FNB allowed for more consistent cell-block evaluation as compared to EUS-FNA. EUS-FNA + ROSE was found to have a similar sensitivity to EUS-FNB alone suggesting a reduced need for ROSE as part of the standard algorithm of pancreatic sampling. While FNB alone produced similar diagnostic findings to EUS-FNA + ROSE, FNB + ROSE still was noted to increase diagnostic yield. This finding may favor a unique role for FNB + ROSE, suggesting it may be useful in cases when previous EUS-guided sampling may have been indeterminate.

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