INDICATIONS OF ENDOSCOPIC ULTRASOUND IN THE DIAGNOSIS AND TREATMENT OF GASTROINTESTINAL AND PANCREATICO – BILIARY DISEASES

2014 ◽  
pp. 116-122
Author(s):  
Khanh Vinh ◽  
Van Huy Tran
Keyword(s):  
Endoscopic Ultrasound ◽  
Early Period ◽  
Needle Aspiration ◽  
Medical Procedure ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Biliary Diseases ◽  
Specificity And Sensitivity ◽  
Important Significance

The gastrointestinal and pancreatico-biliary diseases are very common in Vietnam and lead to severe complications. In the 1980s, Endoscopic Ultrasound (EUS) was invented, and then rapidly EUS has become an useful diagnosis in gastrointestinal and pancreatico-biliary diseases. Most of scientific researches in the word has demonstrated the sensitivity and specificity of EUS in diagnosis for gastrointestinal and pancreatico-biliary diseases. In addition, Endoscopic ultrasound therapy such as: Endoscopic ultrasound - Fine Needle Aspiration (EUS-FNA), Endoscopic ultrasound drainage and Endoscopic ultrasound-guided celiac plexus neurolysis/block were evaluated to have the highest specificity and sensitivity in diagnosis, treatment and follow up gastrointestinal and pancreatico-billiary diseases. Therefore, EUS has an important significance in development and completion of the EUS procedure in Vietnam. This new medical procedure is highly practicable in the gastrointestinal and pancreatico- biliary diagnosis in the early period. The aim of this review was to describe some current indications of EUS in gastrointestinal and pancreatico-billiary diseases.

scholarly journals Performance of endoscopic ultrasound-guided fine needle aspiration in diagnosing pancreatic neuroendocrine tumors

CytoJournal ◽  
2013 ◽  
Vol 10 ◽  
pp. 10 ◽  
Author(s):  
Jane Bernstein ◽  
Berrin Ustun ◽  
Ahmed Alomari ◽  
Fang Bao ◽  
Harry R. Aslanian ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
False Negative ◽  
Needle Aspiration ◽  
Cystic Neoplasm ◽  
Pancreatic Neuroendocrine Tumors ◽  
Ultrasound Guided ◽  
Fine Needle

Background: Pancreatic neuroendocrine tumors (PNETs) are rare tumors of the pancreas, which are increasingly diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In this retrospective study, we assessed the performance of EUS-FNA in diagnosing PNETs. Materials and Methods: We identified 48 cases of surgically resected PNETs in which pre-operative EUS-FNA was performed. The clinical features, cytological diagnoses, and surgical follow-up were retrospectively reviewed. The diagnostic performance of EUS-FNA was analyzed as compared to the diagnosis in the follow-up. The cases with discrepancies between cytological diagnosis and surgical follow-up were analyzed and diagnostic pitfalls in discrepant cases were discussed. Results: The patients were 20 male and 28 female with ages ranging from 15 years to 81 years (mean 57 years). The tumors were solid and cystic in 41 and 7 cases, respectively, with sizes ranging from 0.5 cm to 11 cm (mean 2.7 cm). Based on cytomorphologic features and adjunct immunocytochemistry results, when performed, 38 patients (79%) were diagnosed with PNET, while a diagnosis of suspicious for PNET or a diagnosis of neoplasm with differential diagnosis including PNET was rendered in the 3 patients (6%). One case was diagnosed as mucinous cystic neoplasm (2%). The remaining 6 patients (13%) had non-diagnostic, negative or atypical diagnosis. Conclusions: Our data demonstrated that EUS-FNA has a relatively high sensitivity for diagnosing PNETs. Lack of additional materials for immunocytochemical studies could lead to a less definite diagnosis. Non-diagnostic or false negative FNA diagnosis can be seen in a limited number of cases, especially in those small sized tumors.

scholarly journals Lymphoepithelial Cysts of the Pancreas: The Use of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Diagnosis

2010 ◽  
Vol 24 (6) ◽  
pp. 348-350 ◽  
Author(s):  
Zamil Karim ◽  
Blair Walker ◽  
Eric C Lam
Keyword(s):  
Surgical Resection ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Lower Abdominal Pain ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Cystic Neoplasms ◽  
Fine Needle ◽  
Lymphoepithelial Cysts

Lymphoepithelial cysts (LECs) are rare non-neoplastic lesions that can appear as a complex cyst or a mass in the pancreas. Cytology from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can be helpful in making a diagnosis with the aim of avoiding unnecessary surgical resection. A case involving a 51-year-old woman with lower abdominal pain who was found to have a multiloculated cystic lesion at the junction of the pancreatic body and tail is described. Cytology from EUS-FNA was consistent with a pancreatic LEC. The lesion was managed conservatively and follow-up imaging of the cyst over the following two years was unchanged. The patient remains clinically well. Cytology from EUS-FNA can help distinguish LECs from cystic neoplasms, thus preventing radical surgical resection of this benign pancreatic cyst.

The Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients with Endoscopic Biopsy Negative Upper Gastrointestinal Lesions

2021 ◽  
Vol 17 (2) ◽  
pp. 188-193
Author(s):  
Muhammad Najm ul Hasan Shafi ◽  
Irfan Ali ◽  
Muhammad Ismail ◽  
Hassam Zulfiqar ◽  
Izatullah ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Upper Gi ◽  
Endoscopic Biopsies ◽  
Gastrointestinal Lesions

Objective To determine the diagnostic accuracy of endoscopic ultrasound guided (EUS) fine needle aspiration in patients who had inconclusive endoscopic biopsies of the same lesion Methodology This retrospective study was conducted at Pak Emirates Military Hospital, Rawalpindi, Pakistan from Jan 2018 to July 2020. Patients who underwent EUS guided FNAC from June 2017 to July 2020 were screened. The FNAC results of patients satisfying the inclusion ciritera were compared with either a surgical biopsy in patients in whom surgeries were done, while in the remaining patients, EUS FNAC results were compared with a 3 months radiological and/or 6 months clinical follow-up. The final diagnosis was defined based on the following criteria: (1) Malignant lesions (n=36), histopathologic diagnosis obtained based on surgery resected samples (n=18) or clinical diagnosis as neoplasm based on clinical follow-up of symptoms (n=30) or radiologic diagnosis based on imaging follow-up at 3 months (n=13) (2) Benign lesions (n=18), benign cytopathologic histopathologic findings and clinical follow-up with no evidence of malignant progression or metastasis. Results EUS-guided FNA cytology turned out to be malignant in 60 percent (n=36) of the specimens. 30 percent of the samples showed benign epithelial cytology ( n=18) while in 10 percent  of the cases (n=6), the tissue samples were deemed insufficient for cytological diagnosis. The accuracy came out to be 66.6 percent (n=10 were true negative), sensitivity 93.4 percent, and specificity 100 percent.  Conclusion EUS guided-FNA cytology of the sub-mucosal upper GI lesions is highly sensitive and specific for upper GI lesions, which are negative on endoscopic biopsies.

scholarly journals Pancreatic Tuberculosis or Autoimmune Pancreatitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ayesha Salahuddin ◽  
Muhammad Wasif Saif
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Autoimmune Pancreatitis ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Immunoglobulin G4 ◽  
Fine Needle ◽  
Pancreatic Tuberculosis

Introduction. Isolated pancreatic and peripancreatic tuberculosis is a challenging diagnosis due to its rarity and variable presentation. Pancreatic tuberculosis can mimic pancreatic carcinoma. Similarly, autoimmune pancreatitis can appear as a focal lesion resembling pancreatic malignancy. Endoscopic ultrasound-guided fine needle aspiration provides an effective tool for differentiating between benign and malignant pancreatic lesions. The immune processes involved in immunoglobulin G4 related systemic diseases and tuberculosis appear to have some similarities.Case Report. We report a case of a 59-year-old Southeast Asian male who presented with fever, weight loss, and obstructive jaundice. CT scan revealed pancreatic mass and enlarged peripancreatic lymph nodes. Endoscopic ultrasound-guided fine needle aspiration confirmed the presence ofmycobacterium tuberculosis. Patient also had high immunoglobulin G4 levels suggestive of autoimmune pancreatitis. He was started on antituberculosis medications and steroids. Clinically, he responded to treatment. Follow-up imaging showed findings suggestive of chronic pancreatitis.Discussion. Pancreatic tuberculosis and autoimmune pancreatitis can mimic pancreatic malignancy. Accurate diagnosis is imperative as unnecessary surgical intervention can be avoided. Endoscopic ultrasound-guided fine needle aspiration seems to be the diagnostic test of choice for pancreatic masses. Long-term follow-up is warranted in cases of chronic pancreatitis.

scholarly journals Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of space occupying lesions of the pancreas

2014 ◽  
Vol 05 (03) ◽  
pp. 110-113 ◽  
Author(s):  
S. Palaniappan ◽  
M. A. Arvind ◽  
Jothimani Dinesh ◽  
Srinivas Melpakam ◽  
Srinivasan Vijaya ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Definitive Diagnosis ◽  
Benign Lesions ◽  
Ultrasound Guided ◽  
Predictive Values ◽  
Fine Needle

Abstract Introduction: Space occupying lesions (SOLs) of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT)/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%). The median age of presentation was 48 years (range: 11–82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1%) and nonneoplastic lesions (78.3% vs. 73.9%) and was similar to CT/MRI for benign lesions (76.9% for both). EUS-FNA had a higher specificity (87.8% vs. 80.5%) with a good PPV for benign lesions (66.7% vs. 55.6%). CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2%) and nonneoplastic lesions (79.6% vs. 81.5%) compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to both –. Conclusions: Endoscopic ultrasound-guided fine-needle aspiration had a higher specificity, but low sensitivity for the both neoplastic and nonneoplastic lesion of the pancreas compared to the world literature. The overall EUS-FNA yield was low when compared to the follow-up definitive diagnosis.

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