scholarly journals Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound

2021 ◽  
Vol 10 (5) ◽  
pp. 1076
Author(s):  
Akashi Fujita ◽  
Shomei Ryozawa ◽  
Masafumi Mizuide ◽  
Yuki Tanisaka ◽  
Tomoya Ogawa ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Treatment Strategies ◽  
Complication Rates ◽  
Diagnostic Ability ◽  
Tissue Acquisition ◽  
Resolution Imaging ◽  
Subepithelial Lesions ◽  
Solid Lesions ◽  
Selection Of

Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis.

Forward-viewing echoendoscope versus standard echoendoscope for endoscopic ultrasound-guided tissue acquisition of solid lesions: a randomized, multicenter study

Endoscopy ◽  
2018 ◽  
Vol 51 (05) ◽  
pp. 444-451 ◽  
Author(s):  
Alberto Larghi ◽  
Mostafa Ibrahim ◽  
Lorenzo Fuccio ◽  
Selma Lekkerkerker ◽  
Pierre Eisendrath ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Ultrasound Guided ◽  
Tissue Acquisition ◽  
And Performance ◽  
Subepithelial Lesions ◽  
Sensitivity Specificity ◽  
Solid Lesions

Abstract Background A forward-viewing linear (FVL) echoendoscope has been developed with the aim of overcoming some of the limitations of standard curved linear-array (CLA) echoendoscopes. There are no existing studies comparing the performance of the two echoendoscopes for endoscopic ultrasound-guided tissue acquisition (EUS-TA) of solid lesions other than subepithelial lesions. Methods This was a prospective, multicenter, randomized trial with a noninferiority design comparing FVL vs. CLA echoendoscopes in patients with solid lesions of the gastrointestinal tract or adjacent organs. Primary outcomes were successful identification of the lesion and success of EUS-TA. Secondary outcomes were safety, sensitivity, specificity, and diagnostic accuracy of the two different scopes for EUS-TA. Results 126 patients with solid lesions were randomly assigned to the CLA group (63 patients) or the FVL group (63 patients). The two groups were homogeneous with no differences in terms of needle type used, mean number of passes, and site of EUS-TA. No differences were observed between the FVL vs. CLA scopes in identification of the lesion (96.8 % vs. 98.4 %; P > 0.99) and technical success of EUS-TA (92.1 % vs. 96.8 %; P = 0.44). No adverse events occurred. Overall, diagnostic accuracy (77.8 % vs. 84.1 %), sensitivity (76.6 % vs. 84.1 %), and specificity (81.3 % vs. 84.2 %) did not differ between the two groups. Conclusions Our results strongly suggest that the FVL echoendoscope is noninferior to the CLA scope for the detection and performance of EUS-TA in patients with solid lesions of the gastrointestinal tract and adjacent organs. In addition, the FVL scope has the same diagnostic yield, accuracy, and safety as the CLA scope.

Histological diagnostic ability of rapid on-site evaluation in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid lesions

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S75
Author(s):  
Takashi Hirayama ◽  
Kazuo Hara ◽  
Nobumasa Mizuno ◽  
Susumu Hijioka ◽  
Hiroshi Imaoka ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Diagnostic Ability ◽  
Fine Needle ◽  
Site Evaluation ◽  
Solid Lesions

scholarly journals Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation

2019 ◽  
Vol 07 (02) ◽  
pp. E189-E194 ◽  
Author(s):  
En-Ling Leung Ki ◽  
Anne-Isabelle Lemaistre ◽  
Fabien Fumex ◽  
Rodica Gincul ◽  
Christine Lefort ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Final Diagnosis ◽  
Fine Needle Biopsy ◽  
Fine Needle ◽  
Tissue Acquisition ◽  
Site Evaluation ◽  
Sensitivity Specificity ◽  
Solid Lesions

Abstract Background and aims This study aimed to evaluate the performance of Macroscopic On-site Evaluation (MOSE) using a novel endoscopic ultrasound (EUS) fine needle biopsy (FNB) needle (22-G Franseen-tip needle, Acquire, Boston Scientific Incorporated, Boston, Massachusetts, United States), and without using Rapid On-Site Evaluation (ROSE). Method Between May 2016 and August 2016, all consecutive patients referred to our center for EUS tissue acquisition (TA) for solid lesions underwent EUS-FNB with the 22-G Franseen-tip needle unless contra-indicated. The operator performed MOSE. If no macroscopic core was visualized, a second pass was performed. The final diagnosis was defined as unequivocal histology from EUS-TA with compatible 18 months follow-up, surgical resection, or both. We retrospectively analyzed the performance of MOSE. Results A total of 46 consecutive patients was included, and 54 solid lesions were biopsied. The endosonographer visualized core tissue in 93 % (50/54) of targets with a single pass, of which the pathologist confirmed histologic core fragments in 94 % (47/50). Four lesions required two passes, and the overall correlation between MOSE and histologic core fragments was 94 % (48/51). Diagnostic adequacy was 98 % (53/54) with one biliary target biopsied without significant material. The overall diagnostic accuracy was 94 %. Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy were 92 %, 100 %, 100 %, and 81 %, respectively. No adverse events were reported. Conclusion Our study demonstrated that MOSE using the 22-G Franseen-tip needle could limit needle passes by accurately estimating histologic core fragments. It also demonstrated that high diagnostic adequacy and accuracy of > 90 % could be achieved without ROSE.

scholarly journals Bisphosphonates and parathyroid hormone analogs for improving bone quality in spinal fusion: State of evidence

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Kivanc Atesok ◽  
Martina Stippler ◽  
Brendan Striano ◽  
Grace Xiong ◽  
Matthew Lindsey ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Spinal Fusion ◽  
Bone Quality ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Complication Rates ◽  
Disc Disease ◽  
Potential Benefits ◽  
Hormone Analogs ◽  
Selection Of

Spinal fusion is among the most commonly performed surgical procedures for elderly patients with spinal disorders – including degenerative disc disease with spondylolisthesis, deformities, and trauma. With the large increase in the aging population and the prevalence of osteoporosis, the number of elderly osteoporotic patients needing spinal fusion has risen dramatically. Due to reduced bone quality, postoperative complications such as implant failures, fractures, post-junctional kyphosis, and pseudarthrosis are more commonly seen after spinal fusion in osteoporotic patients. Therefore, pharmacologic treatment strategies to improve bone quality are commonly pursued in osteoporotic cases before conducting spinal fusions. The two most commonly used pharmacotherapeutics are bisphosphonates and parathyroid hormone (PTH) analogs. Evidence indicates that using bisphosphonates and PTH analogs, alone or in combination, in osteoporotic patients undergoing spinal fusion, decreases complication rates and improves clinical outcomes. Further studies are needed to develop guidelines for the administration of bisphosphonates and PTH analogs in osteoporotic spinal fusion patients in terms of treatment duration, potential benefits of sequential use, and the selection of either therapeutic agents based on patient characteristics.

Endoscopic Ultrasound Features Associated with Malignancy and Aggressiveness of Nonhypovascular Solid Pancreatic Lesions: Results from a Prospective Observational Study

2019 ◽  
Author(s):  
Stefano Francesco Crinó ◽  
Alessandro Brandolese ◽  
Filippo Vieceli ◽  
Salvatore Paiella ◽  
Maria Cristina Conti Bellocchi ◽  
...  
Keyword(s):  
Observational Study ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Prospective Observational Study ◽  
Distant Metastases ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Tissue Acquisition

Abstract Background and Study Aims On contrast-enhanced imaging studies, nonhypovascular (i. e., isovascular and hypervascular) patterns can be observed in solid pancreatic lesions (SPLs) of different nature, prognosis, and management. We aimed to identify endoscopic ultrasound (EUS) features of nonhypovascular SPLs associated with malignancy/aggressiveness. The secondary aims were EUS tissue acquisition (EUS-TA) outcome and safety in this setting of patients. Patients and Methods This prospective observational study included patients with nonhypovascular SPLs detected on cross-sectional imaging and referred for EUS-TA. Lesion features (size, site, margins, echotexture, vascular pattern, and upstream dilation of the main pancreatic duct) were recorded. Malignancy/aggressiveness was determined by evidence of carcinoma at biopsy/surgical pathology, signs of aggressiveness (perineural invasion, lymphovascular invasion, and/or microscopic tumor extension/infiltration or evidence of metastatic lymph nodes) in the surgical specimen, radiologic detection of lymph nodes or distant metastases, and/or tumor growth > 5 mm/6 months. Uni- and multivariate analyses were performed to assess the primary aim. Results A total of 154 patients with 161 SPLs were enrolled. 40 (24.8 %) lesions were defined as malignant/aggressive. Irregular margins and size > 20 mm were independent factors associated with malignancy/aggressiveness (p < 0.001, OR = 5.2 and p = 0.003, OR = 2.1, respectively). However, size > 20 mm was not significant in the subgroup of other-than-neuroendocrine tumor (NET) lesions. The EUS-TA accuracy was 92 %, and the rate of adverse events was 4 %. Conclusion Irregular margins on EUS are associated with malignancy/aggressiveness of nonhypovascular SPLs. Size > 20 mm should be considered a malignancy-related feature only in NET patients. EUS-TA is safe and highly accurate for differential diagnosis in this group of patients.

scholarly journals Endoscopic ultrasound in the diagnosis of mediastinal diseases

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhiguo Wang ◽  
Chunmeng Jiang
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Mediastinal Lymph Node ◽  
Lymph Node Status ◽  
Mediastinal Lymph Nodes ◽  
Mediastinal Diseases ◽  
Mediastinal Lymphoma ◽  
Tissue Acquisition

AbstractEUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS.

scholarly journals A Pilot Randomized Crossover Trial of Wet Suction and Conventional Techniques of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Upper Gastrointestinal Subepithelial Lesions

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Mika Takasumi ◽  
Takuto Hikichi ◽  
Minami Hashimoto ◽  
Jun Nakamura ◽  
Tsunetaka Kato ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Crossover Trial ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Randomized Crossover Trial ◽  
Subepithelial Lesions ◽  
Solid Lesions

Background and Aim. A wet suction technique (“wet” technique) has been developed to improve the quality of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for sampling various solid lesions. However, no studies have reported on the wet technique for EUS-FNA for gastrointestinal (GI) subepithelial lesions (SELs). We conducted a pilot randomized crossover trial to explore whether the wet technique could be useful with regard to tissue adequacy of upper GI-SELs (UGI-SELs) compared to the conventional EUS-FNA technique (“dry” technique). Methods. Twenty-six patients with UGI-SELs indicated for EUS-FNA were randomly assigned to the dry-first arm using the dry technique for the first two passes or the wet-first arm using the wet technique for the first two passes using a cross-over design with a ratio of 1 : 1. The primary endpoint was the cellularity score of the EUS-FNA specimens rated on a 4-point scale (0-3). The secondary endpoints were the factors influencing cellularity in each suction technique. Results. The mean cellularity score was 1.65 ± 1.20 for the wet technique and 2.00 ± 0.98 for the dry technique ( p = 0.068 ). Logistic regression analysis showed that higher cellularity may be related to the final diagnosis of gastrointestinal stromal tumors in the dry technique and the SEL location in the upper stomach in the wet technique. Conclusion. The wet EUS-FNA technique failed to show a potential for improved cellularity of specimens compared to the dry technique for UGI-SELs.

scholarly journals Accuracy of endoscopic ultrasound-guided tissue acquisition in the evaluation of lymph nodes enlargement in the absence of on-site pathologist

2017 ◽  
Vol 23 (31) ◽  
pp. 5755 ◽  
Author(s):  
Yung Ka Chin ◽  
Julio Iglesias-Garcia ◽  
Daniel de la Iglesia ◽  
Jose Lariño-Noia ◽  
Ihab Abdulkader-Nallib ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Ultrasound Guided ◽  
Tissue Acquisition

scholarly journals Accuracy and other quality indicators of solid pancreatic mass endoscopic ultrasound-guided fine needle aspiration and biopsy in two academic endoscopy centers

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
M Figueiredo ◽  
M Arvanitakis ◽  
A Zaarour ◽  
E Toussaint ◽  
J Devière ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Predictive Value ◽  
High Specificity ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Tissue Acquisition ◽  
Final Interpretation ◽  
Solid Lesions ◽  
Acquisition Method

Background and aims : Endoscopic ultrasound fine-needleaspiration/biopsy (EUS-FNA/FNB) is highly accurate, but dis-crepancies between cytological and surgical diagnoses are stillobserved. We aimed to determine its accuracy and monitor qualityindicators in our facilities. Patients and methods : We performed a retrospective review ofall cases of pancreatic solid lesions evaluated by EUS-FNA/FNB,between July 2015 and June 2018, in two centers. Cytologicaland surgical findings were categorized into five groups: benign,malignant, suspect of malignancy, undetermined and insufficientfor diagnosis. Final diagnosis was based on surgical diagnosis and,in patients who did not undergo surgery, on clinical outcome after6 months follow-up. Results : Altogether, 142 patients were included. FNA was thepreferred tissue acquisition method (88%), with a predilection forthe FNA 22G needle (57%). Cytology was insufficient for diagnosisin 2 cases, therefore a full diagnostic sample was available in 98.6%of the patients (>90%, ESGE target). Fifty-five (38.7%) patientsunderwent surgery. In term of cancer diagnosis, comparison withfinal surgical pathology (n=55) revealed 89% true positives, 5.5%true negatives, 3.6% false positives and 1.8% false negatives. Whencombining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was92.3% (74.9-99.1), positive predictive value was 98.2% (93.6-99.5),negative predictive value was 88.9% (72.3-96.1) and accuracy was96.4% (91.9-98.8). Post-procedural acute pancreatitis was reportedin 2 patients (1.4%). Conclusions : These results reveal a performance for diagnostictissue sampling well above the ESGE proposed target standard.Also, the uncommon high specificity illustrates the determiningrole of the pathologist’s final interpretation and diagnosis.

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