Comparison of Ultrasound-Guided Core Needle Biopsy Under the Assistance of Hydrodissection With Fine Needle Aspiration in the Diagnosis of High-Risk Cervical Lymph Nodes: A Randomized Controlled Trial

A randomized comparison of ultrasound (US)-guided core needle biopsy (CNB) under the assistance of hydrodissection with fine needle aspiration (FNA) was performed to evaluate the feasibility, safety and effectiveness for the diagnosis of high-risk cervical lymph nodes. Patients from December 2018 to May 2020 were randomly assigned to the CNB group and the FNA group at a ratio of 1:1. This study protocol was approved by the Ethics Committee of our hospital and registered in the Chinese Clinical Trial Registry (ChiCTR1800019370). The feasibility of CNB for high-risk cervical lymph nodes was evaluated by observing and recording the separation success rate (SSR) and technical success rate (TSR) of the CNB group. Safety was evaluated by comparing the incidence of major complications in the two groups. The diagnostic efficacy was evaluated by comparing the diagnostic accuracy, sensitivity, and specificity of the two groups. A total of 84 patients (84 lymph nodes) were randomized into the CNB (n = 42) and FNA (n = 42) groups. All patients in the CNB group achieved successful hydrodissection and biopsy. The SSR and TSR were both 100% in the CNB group. There were no major complications during or after the process in the two groups. Compared with the FNA group, the CNB group was significantly superior in terms of diagnostic accuracy and sensitivity (100% vs. 81.0%, P = 0.009; 100% vs. 79.2%, P = 0.035, respectively). The specificity of the two groups was 100%, and there was no significant difference. Compared with FNA, CNB under the assistance of hydrodissection is a feasible and safe method but is more effective for the diagnosis of high-risk cervical lymph nodes.Clinical Trial Registrationhttp://www.medresman.org, ChiCTR1800019370.

Retroperitoneal Mass: Lymphoma as Differential Diagnosis to Retroperitoneal Fibrosis: Case Report

The etiology of solid retroperitoneal mass may be autoimmune or neoplastic and should be investigated by imaging and histology. The spectrum of differential diagnoses includes retroperitoneal fibrosis and retroperitoneal tumors. As treatment for these entities differs substantially, early and accurate diagnosis is essential. We present a case of a 54-year-old woman admitted to our hospital with stroke-like symptoms. Suspecting vasculitis, magnetic resonance imaging of the head and abdomen was performed, which revealed circular enhancement of the internal carotid artery as well as retroperitoneal and periaortic masses. In light of the radiographic findings, an autoimmune process, such as retroperitoneal fibrosis, was hypothesized. Steroid treatment was initiated but did not lead to significant remission. Re-evaluation of the mass with fine-needle aspiration did not show malignant cells while diagnostic surgery and histological assessment revealed neoplastic lymphoproliferation. The final diagnosis was a non-Hodgkin B-cell lymphoma. Chemo- and immunotherapy were initiated. Follow-up abdominal computed tomography revealed significant remission of the retroperitoneal mass. Initially, the retroperitoneal mass was highly suspicious for RF. While imaging can be useful, obtaining histology should always be considered when there is an uncertain clinical presentation. Without histology, we would have missed a non-Hodgkin B-cell lymphoma in this case. Minimally invasive techniques such as fine-needle aspiration may be practical but can give false-negative results.

Establishment of organoids using residual samples from saline flushes during endoscopic ultrasound-guided fine-needle aspiration in patients with pancreatic cancer

Background and study aims In patients with pancreatic cancer (PC), patient-derived organoid cultures can be useful tools for personalized drug selection and preclinical evaluation of novel therapies. To establish a less invasive method of creating organoids from a patient’s tumor, we examined whether PC organoids can be established using residual samples from saline flushes (RSSFs) during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Methods Five patients with PC who underwent EUS-FNA were enrolled in a prospective study conducted at our institution. RSSFs obtained during EUS-FNA procedures were collected. An organoid culture was considered as established when ≥ 5 passages were successful. Organoid-derived xenografts were created using established organoids. Results EUS-FNA was performed using a 22- or 25-gauge lancet needle without complications. Patient-derived organoids were successfully established in four patients (80.0 %) with the complete medium and medium for the selection of KRAS mutants. Organoid-derived xenografts were successfully created and histologically similar to EUS-FNA samples. Conclusions Patient-derived PC organoids were successfully established using EUS-FNA RSSFs, which are produced as a byproduct of standard manipulations, but are usually not used for diagnosis. This method can be applied to all patients with PC, without additional invasive procedures, and can contribute to the development of personalized medicine and molecular research.

Implementation of Videos Captured by Static Telecytological Applications for Obtaining Expert Opinions

Published studies compare static and dynamic telecytology systems. Still, no study has focused on implementing short videos captured by static telecytology stations for telemedical applications. The chapter aims to evaluate the diagnostic reproducibility of telecytology in thyroid fine-needle aspiration specimens prepared using liquid-based cytology among four cytopathologists using representative short duration videos captured by a static telecytology station. It also examines the agreement between the contributor's and the reviewer's diagnoses.