Endoscopic ultrasound-guided fine needle core biopsy versus aspiration for gastrointestinal mass lesions: A randomized trial.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 161-161 ◽  
Author(s):  
Nam Q. Nguyen
Keyword(s):  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Histologic Diagnosis ◽  
Fine Needle ◽  
Guided Biopsy ◽  
Increased Risk ◽  
Core Tissue ◽  
Mass Lesions

161 Background: Endoscopic ultrasound (EUS) guided biopsy allows cytologic and/or histologic diagnosis of lesions within or adjacent to the gastrointestinal tract (GIT). However, the amount of tissue obtained with a regular aspirating needle is not always satisfactory. A newly developed Coo Pro-Core 22G needle has been proposed to obtain core tissue and may improve diagnostic yield. This study aimed to compare the performance of two EUS guided biopsy systems, Coo 22G fine needle aspiration (FNA) versus Coo 22G Pro-Core (PC) needle, in the evaluation of mass lesions within or adjacent to the GIT. Methods: 61 consecutive patients, who were referred for EUS guided biopsy of mass lesions within or adjacent to the upper GIT, were randomized to either the use of 22G FNA or 22G PC needle. The procedures were performed by a single experienced EUS-endoscopist. Four needle passes were taken from each lesion and all specimens were prepared as cell-block for histo-cytological analysis. Measured outcomes were diagnostic yield and complication. Results: EUS guided biopsy was performed with 22G FNA needle in 31patients and with 22G PC needle in 30 patients. There were no differences in age, gender, site or size of biopsied lesion between the groups. Diagnostic yield from the PC group was significantly higher than that of the FNA groups (27/30 vs. 22/31, P=0.04). The ability to obtain core-like tissue and provide “histological” detail were also higher in the PC group (16/30 vs. 0/31, P<0.001). Although no patients with FNA biopsy had complications, the first 4 cases of PC needle biopsy had abdominal pain (with 1 proven pancreatitis), requiring overnight admission. No further complications occurred after the number of PC passes was reduced to 2 per lesion. Conclusions: EUS guided biopsy with Pro-Core needles had a substantially higher diagnostic yield than that with FNA needles, with the ability to provide "histological" information in the majority of cases. Initial use of the Pro-Core needle, however, is associated with an increased risk of abdominal pain, which is reduced with fewer passes and more experience.

scholarly journals Accuracy of endoscopic ultrasound-guided biopsy of focal liver lesions

2020 ◽  
Vol 1 (1) ◽  
pp. 20 ◽  
Author(s):  
Vlad Andrei Ichim ◽  
Romeo Ioan Chira ◽  
Petru Adrian Mircea ◽  
Georgiana Anca Nagy ◽  
Doinita Crisan ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Primary Tumor ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Fine Needle ◽  
Guided Biopsy ◽  
Common Diagnosis

Aim: Endoscopic ultrasound (EUS) has become an indispensable method for diagnosis in gastroenterology and new indications for EUS continue to emerge. However, there are limited data regarding the accuracy of EUS-guided biopsy of hepatic focal lesions. The aim of this study was to assess the diagnostic yield of EUS-guided fine needle aspiration (FNA) of focal liver lesions.Material and methods: We conducted a prospective study in which patients with focal liver lesions, detected by transabdominal ultrasound and computed tomography or magnetic resonance imaging, underwent EUS-guided FNA to determine the diagnostic yield of the procedure.Results: In 47/48 of patients, the results of EUS-FNA were positive for malignancy, while in one case the acquired fragment was insufficient for appropriate histological analysis. Diagnostic yield was 0.98. In 83% of the cases biopsies were taken from the left lobe and in 17% from the right lobe with the same technical success rate. The most common diagnosis was metastatic adenocarcinoma of the pancreas (26% cases) followed by cholangiocarcinoma (17% cases). Concurrent sampling of other sites in addition to the liver and/or primary tumor was realized in 35% of the cases, with results that correlated with the liver biopsy and with the primary tumor biopsy. We reported no immediate or long-term complications in any of the patients.Conclusions: EUS guided fine needle aspiration/biopsy of focal liver lesions is safe, provides a very high diagnostic accuracy and should not be considered only as a rescue method after failure of percutaneous guided biopsies.

scholarly journals Stylet slow-pull versus standard suction for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic lesions: a multicenter randomized trial

Endoscopy ◽  
2017 ◽  
Vol 50 (05) ◽  
pp. 497-504 ◽  
Author(s):  
Payal Saxena ◽  
Mohamad El Zein ◽  
Tyler Stevens ◽  
Ahmed Abdelgelil ◽  
Sepideh Besharati ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
First Pass ◽  
Core Tissue ◽  
Mass Lesions ◽  
Number Of Passes

Abstract Background and study aim Standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedures involve use of no-suction or suction aspiration techniques. A new aspiration method, the stylet slow-pull technique, involves slow withdrawal of the needle stylet to create minimum negative pressure. The aim of this study was to compare the sensitivity of EUS-FNA using stylet slow-pull or suction techniques for malignant solid pancreatic lesions using a standard 22-gauge needle. Patients and methods Consecutive patients presenting for EUS-FNA of pancreatic mass lesions were randomized to the stylet slow-pull or suction techniques using a 22-gauge needle. Both techniques were standardized for each pass until an adequate specimen was obtained, as determined by rapid on-site cytology examination. Patients were crossed over to the alternative technique after four nondiagnostic passes. Results Of 147 patients screened, 121 (mean age 64 ± 13.8 years) met inclusion criteria and were randomized to the stylet slow-pull technique (n = 61) or the suction technique (n = 60). Technical success rates were 96.7 % and 98.3 % in the slow-pull and suction groups, respectively (P > 0.99). The sensitivity for malignancy of EUS-FNA was 82 % in the slow-pull group and 69 % in the suction group (P = 0.10). The first-pass diagnostic rate (42.6 % vs. 38.3 %; P = 0.71), acquisition of core tissue (60.6 % vs. 46.7 %; P = 0.14), and the median (range) number of passes to diagnosis (2 1 2 3 vs. 1 1 2; P = 0.71) were similar in the slow-pull and suction groups, respectively. Conclusions The stylet slow-pull and suction techniques both offered high and comparable diagnostic sensitivity with a mean of 2 passes required for diagnosis of solid pancreatic lesions. The endosonographer may choose either technique during FNA.

scholarly journals Infected Pancreatic Necrosis Mimicking Pancreatic Cancer

2020 ◽  
Vol 14 (2) ◽  
pp. 436-442
Author(s):  
Jun Heo
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Needle Aspiration ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided ◽  
Fine Needle

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.

scholarly journals Pull vs. wet: rendimiento diagnóstico y calidad de las muestras de las PAAF guiadas por USE en las masas sólidas del páncreas

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Cecilia Curvale ◽  
Ignacio Málaga ◽  
Paloma Rojas Saunero ◽  
Viviana Tassi ◽  
Enrique Martins ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Double Blind Study ◽  
Cell Block ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Fine Needle ◽  
Significant Difference

Differential diagnosis of pancreatic masses is challenging. The endoscopic ultrasound-guided fine-needle aspiration method with the highest diagnostic yield has not been established. It was realized a prospective, randomized, double-blind study of the endoscopic ultrasound-guided fine-needle aspiration in solid lesions of the pancreas to compare and evaluate diagnostic yield and aspirate quality between wet and pull technique. Forty-one patients were enrolled. The wet technique presented a sensitivity, a specificity, a positive and negative predictive value, and a diagnostic accuracy of 58.3%, 100%, 100%, 25% and 63.4%, respectively. In the capillary technique they were: 75%, 100%, 100%, 35.7% and 78.1%, respectively. Comparing the diagnostic yield between both techniques, there was no statistically significant difference (McNemar’s test p = 0.388). Regarding the cellularity of the specimen, both in cytology and the cell block samples, no significant difference was observed between the techniques (p = 0.84 and 0.61, respectively). With respect to contaminating blood in the specimen, there was no difference in cytology samples (p = 0.89) and no difference in cell block samples (p = 0.08). The suitability of cytology samples for diagnosis was similar in both techniques (wet = 57.5% and capillary = 56.7%, p = 0.94) and there was no difference in cell block samples (wet = 75% and capillary = 66.1%, p = 0.38). In this study we did not observe differences in diagnostic yield or sample quality. Since both techniques are effective, we suggest the simultaneous and alternate use of both methods.

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