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.

scholarly journals Utility and diagnostic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration cytology of mediastinal lesions: Saudi Arabian experience

CytoJournal ◽  
2014 ◽  
Vol 11 ◽  
pp. 19 ◽  
Author(s):  
Emad Raddaoui ◽  
Esam H Alhamad ◽  
Shaesta Naseem Zaidi ◽  
Fatmah F Al-Habeeb ◽  
Maha Arafah
Keyword(s):  
Fine Needle Aspiration ◽  
Mediastinal Mass ◽  
Needle Aspiration ◽  
Histological Diagnosis ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Predictive Values ◽  
Fine Needle ◽  
Nodular Lesions

Objective: The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions. Study Design: Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up. Results: Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively. Conclusion: Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist.

Dynamic telecytopathology for on-site preliminary diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

2012 ◽  
Vol 18 (5) ◽  
pp. 253-259 ◽  
Author(s):  
Kamal K Khurana ◽  
Rong Rong ◽  
Dongliang Wang ◽  
Ajoy Roy
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Neuroendocrine Neoplasms ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Preliminary Diagnosis ◽  
Site Evaluation ◽  
Conventional Microscopy

We evaluated dynamic telecytopathology for on-site-evaluation of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of the pancreas. Realtime images of stained cytology smears were assessed by a cytopathologist while communicating with the on-site operator by telephone. A total of 55 consecutive cases was assessed; preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 69%, 7% and 24%. We also reviewed 55 consecutive cases of EUS-guided FNA of pancreas which had had conventional microscopic on-site evaluation prior to the introduction of telecytopathology. Preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 60%, 9% and 31%. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Neuroendocrine neoplasms and well-differentiated adenocarcinoma were diagnostically challenging for both telecytopathology and conventional microscopy. Telecytopathology was similar in accuracy of preliminary diagnosis to conventional microscopy during EUS-FNA of pancreas.

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.

Endoscopic ultrasound-guided fine needle aspiration cytology in the mediastinum

2013 ◽  
Vol 154 (9) ◽  
pp. 338-344 ◽  
Author(s):  
Zsolt Dubravcsik ◽  
Péter Serényi ◽  
László Madácsy ◽  
Attila Szepes
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Needle Aspiration ◽  
Safe Procedure ◽  
Benign Lesions ◽  
Ultrasound Guided ◽  
Fine Needle

Introduction: Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the posterior mediastinum is technically a relatively simple and safe procedure, and it can provide important information for the further management of patients. Aim: To analyze and compare the results of mediastinal endoscopic ultrasound-guided fine needle aspiration with the data available in the literatue. Patients and methods: The authors retrospectively analyzed their prospective database on mediastinal endoscopic ultrasound-guided fine needle aspiration of 49 patients referred to their endoscopy centre between 1 November 2009 and 1 November 2012. For the fine needle aspiration 22 and 25 G needles were used. Two to six needle passes were performed in each patient. All slides were prepared at the endoscopy unit and analyzed at the cytology laboratory. Results: The authors performed mediastinal endoscopic ultrasound-guided fine needle aspiration for enlarged lymph nodes or suspected mediastinal malignancy in all but 4 patients (2 suspected oesophageal cancers, 1 suspected benign oesophageal stenosis with wall thickening and 1 cardia tumour, all with non-diagnostic endoscopic biopsies). Five patients were excluded from the analysis since fine needle aspiration was not performed in them. Benign lesions were suspected based on the endoscopic ultrasound morphology in 7, and malignant disease in 37 patients. In 3 cases samples obtained by biopsy were not informative for cytological analysis. Cytology confirmed all benign lesions and showed malignancy in 28 cases. Cytology failed to reveal malignancy in 6 patients, although it was suspected based upon endoscopic ultrasound finding. Furthermore, endoscopic ultrasound-guided fine needle aspiration provided the diagnosis in 15 of the 17 patients when bronchoscopy was non-diagnostic. The diagnostic accuracy of the EUS-FNA was the following: sensitivity 82%, specificity 100%, positive predictive value 1.0, negative predictive value 0.54. Only one infectious complication was encountered after fine needle aspiration despite antibiotic prophylaxis. Discussion: Endoscopic ultrasound-guided fine needle aspiration of mediastinal pathology is an accurate, safe and technically relatively easy procedure, however it requires practice and skills in mediastinal anatomy. It has an excellent positive predictive value, a very good sensitivity, but slightly poor negative predictive value. The results of this study are concordant with the literature data. The authors suggest that at least 4 needle passes in the absence of on-site pathologist should be performed in order to minimize the number of false-negative results. Orv. Hetil., 2013, 154, 338–344.

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 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.

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