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Kumar P, Rana SS, Kundu R, Gupta P, Rohilla M, Gupta N, Srinivasan R, Dey P. Endoscopic ultrasound-guided fine-needle aspiration cytology in diagnosing intra-abdominal lesions. Cytojournal 2022; 19:56. [DOI: 10.25259/cytojournal_31_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 04/10/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives:
Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is an effective method to acquire tissue from the mucosal, submucosal, and peri-intestinal structure with the pancreas being the most common organ to be targeted. This study is aimed to evaluate the role of EUS-FNAC in pancreatic lesions as well as other gastrointestinal (GI) structures including lymph nodes, upper GI tract, liver, and spleen.
Material and Methods:
A total of 71 cases were taken in which EUS FNAC was performed over 19 months (2018–July 2019). The details analysis of the cytological features was performed in all these cases along with the clinical outcome. The diagnostic efficacy of the EUS-FNAC was evaluated in these cases.
Results:
Out of 71 cases, 36 (50.7%) were male. The most common site being the pancreas 45 (60%) followed by intra-abdominal lymph nodes in 13(17.3%) cases and stomach 7 (9.3%). The neoplastic aspirate was noted in 38 (50.7%) cases. Among malignant lesion, adenocarcinoma was the most common; however, uncommon malignancies such as metastatic malignant melanoma and acinar cell carcinoma were also noted. Malignant lesion in pancreas includes adenocarcinoma (n = 11, 24.4%) followed by neuroendocrine tumor (n = 7, 15.6%). Tuberculosis was one of the common benign lesions to be reported.
Conclusion:
EUS-FNAC is an effective tool in the diagnosis of GI lesion particularly in the pancreas where it can avoid unnecessary surgical intervention in advanced malignancies. It can effectively obtain samples for molecular markers for pancreatic cancers. Nonetheless, diagnosing tuberculosis in inaccessible lymph nodes with its help is a lifesaving approach especially in developing countries.
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Affiliation(s)
- Pankaj Kumar
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Reetu Kundu
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Parikshaa Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Manish Rohilla
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Nalini Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Radhika Srinivasan
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Pranab Dey
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
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2
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Lange A, Muniraj T, Aslanian HR. Endoscopic Ultrasound for the Diagnosis and Staging of Liver Tumors. Gastrointest Endosc Clin N Am 2019; 29:339-350. [PMID: 30846157 DOI: 10.1016/j.giec.2018.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endoscopic ultrasound examination may provide complementary information to cross-sectional imaging in lesions of the liver, portal vein, and surrounding lymph nodes. With fine needle aspiration, endoscopic ultrasound examination is a powerful tool for the diagnosis of focal liver lesions and has usefulness in the evaluation of indeterminate liver lesions. Endoscopic ultrasound examination may influence hepatocellular cancer staging and Endoscopic ultrasound examination with fine needle aspiration of locoregional nodes and portal vein thromboses changes management. Contrast-enhanced endoscopic ultrasound examination and endoscopic ultrasound examination elastography are likely to expand the usefulness of endoscopic ultrasound examination in evaluating liver malignancy with technologic improvements.
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Affiliation(s)
- Andrew Lange
- Department of Internal Medicine, Yale University School of Medicine, Yale Primary Care Center, 789 Howard Avenue, New Haven, CT 06511, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Laboratory for Medicine and Pediatrics, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Yale University School of Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520, USA.
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3
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Cazacu IM, Luzuriaga Chavez AA, Saftoiu A, Vilmann P, Bhutani MS. A quarter century of EUS-FNA: Progress, milestones, and future directions. Endosc Ultrasound 2018; 7:141-160. [PMID: 29941723 PMCID: PMC6032705 DOI: 10.4103/eus.eus_19_18] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open
Abstract
Tissue acquisition using EUS has considerably evolved since the first EUS-FNA was reported 25 years ago. Its introduction was an important breakthrough in the endoscopic field. EUS-FNA has now become a part of the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of the organs in its proximity, including lung diseases. This review aims to present the history of EUS-FNA development and to provide a perspective on the recent developments in procedural techniques and needle technologies that have significantly extended the role of EUS and its clinical applications. There is a bright future ahead for EUS-FNA in the years to come as extensive research is conducted in this field and various technologies are continuously implemented into clinical practice.
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Affiliation(s)
- Irina Mihaela Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Gastrounit, Division of Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
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4
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Koduru P, Suzuki R, Lakhtakia S, Ramchandani M, Makmun D, Bhutani MS. Role of endoscopic ultrasound in diagnosis and management of hepatocellular carcinoma. J Hepatocell Carcinoma 2015; 2:143-9. [PMID: 27508203 PMCID: PMC4918294 DOI: 10.2147/jhc.s60868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive tumor and a leading cause of cancer-related deaths globally. The mortality rate remains high despite many advances in treatment. HCC is frequently diagnosed late in its course due to lack of classical symptoms at earlier stages. Endoscopic ultrasound (EUS) has emerged as an important diagnostic tool for the diagnostic evaluation, staging, and treatment of gastrointestinal tract disorders. EUS-guided fine needle aspiration has been a valuable addition to EUS by being able to obtain tissue under direct visualization. Here, we review the potential role of EUS in the diagnosis and management of HCC. EUS seems to be a safe and reliable alternative method for obtaining tissue for diagnosis of liver cancer, especially for lesions that are inaccessible by traditional methods. EUS could play an important role in the diagnosis and management of HCC.
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Affiliation(s)
- Pramoda Koduru
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rei Suzuki
- Department of Gastroenterology and Rheumatology, Fukushima University School of Medicine, Fukushima, Japan
| | | | | | - Dadang Makmun
- University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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5
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Nieuwoudt M, Lameris R, Corcoran C, Rossouw TM, Slavik T, Du Plessis J, Omoshoro-Jones JAO, Stivaktas P, Potgieter F, Van der Merwe SW. Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2031-2038. [PMID: 25023118 DOI: 10.1016/j.ultrasmedbio.2014.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 06/03/2023]
Abstract
Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7%, and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity, whereas PCR identified 90% of mycobacterial infections. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.
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Affiliation(s)
- Martin Nieuwoudt
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa; DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Roeland Lameris
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Craig Corcoran
- Department of Molecular Pathology, Ampath Laboratories, Pretoria, South Africa
| | - Theresa M Rossouw
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Tomas Slavik
- Department of Pathology, Ampath laboratories, Pretoria, South Africa; Department of Anatomical Pathology, University of Pretoria, Pretoria, South Africa
| | - Johannie Du Plessis
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Jones A O Omoshoro-Jones
- Department of Surgery, Chris Hani-Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Paraskevi Stivaktas
- MRC Unit of Inflammation and Immunity, Department of Immunology, University of Pretoria, Pretoria, South Africa; Tshwane Academic Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Fritz Potgieter
- Interventional GI Unit, Pretoria East Hospital, Pretoria, South Africa
| | - Schalk W Van der Merwe
- Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa.
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Performance of K-ras mutation analysis plus endoscopic ultrasoundguided fine-needle aspiration for differentiating diagnosis of pancreatic solid mass: a meta-analysis. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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7
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Loya A, Nadeem M, Yusuf MA. Use of ancillary techniques in improving the yield of samples obtained at endoscopic ultrasound-guided fine needle aspiration of thoracic and abdominal lymph nodes. Acta Cytol 2014; 58:192-7. [PMID: 24503737 DOI: 10.1159/000357768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/05/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Thoracic and abdominal lymph nodes may be enlarged in a variety of disorders. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established technique for sampling such nodes, but samples obtained are small, which may make definitive diagnosis difficult. We conducted a retrospective review to determine the contribution of ancillary techniques, such as special histochemistry (SHC), immunohistochemistry (IHC) and flow cytometry, in increasing the diagnostic yield of EUS-FNA carried out at our institution. STUDY DESIGN Between November 2005 and December 2012, 278 patients underwent EUS-FNA of enlarged thoracic and abdominal nodes at our institution. All specimens obtained were subjected to rapid on-site evaluation. Data were reviewed in all patients requiring ancillary techniques for definitive diagnosis. RESULTS Ancillary techniques were performed in 111 of 278 cases. IHC was performed in 24, flow cytometry in 3 and SHC staining in 84. IHC and SHC aided in reaching a definitive diagnosis in 19 of 24 and 3 cases, respectively. Flow cytometry led to a definitive diagnosis in 3 cases. A total of 80 cases were also submitted to culture for tuberculosis with 6 positive for Mycobacterium tuberculosis. CONCLUSIONS Ancillary studies in EUS-FNA of thoracic and abdominal lymph nodes can significantly improve the yield of EUS-FNA.
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Affiliation(s)
- Asif Loya
- Department of Pathology and Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
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8
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Sinna EA, Ezzat N, Sherif GM. Role of thyroid transcription factor-1 and P63 immunocytochemistry in cytologic typing of non-small cell lung carcinomas. J Egypt Natl Canc Inst 2013; 25:209-18. [PMID: 24207093 DOI: 10.1016/j.jnci.2013.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/20/2013] [Accepted: 05/27/2013] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Evaluation of the value of thyroid transcription factor (TTF-1) and P63 in subtyping of non-small cell lung cancer in cytologic material. PATIENTS AND METHODS This is a retrospective study including 40 cases of primary lung lesions who underwent image guided FNAC from pulmonary nodules. The final histopathologic diagnosis was the gold standard. Cell blocks were stained with anti-TTF-1, and P63. Nuclear immunoreactivity for both markers was considered specific. Sensitivity, specificity, positive and negative predictive values, of the cytologic diagnosis and of the two markers, as well as the accuracy of the combined markers were calculated. RESULTS Cytomorphology achieved a sensitivity of 83.3%, specificity of 91%, PPV of 91%, and NPV of 83.3%, for the diagnosis of AC, and 91% sensitivity, 83.3% specificity, 83.3% PPV, and 91% NPV, for the diagnosis of SCC. The concordance between cytologic and histopathologic diagnoses of AC and SCC was 87%. TTF-1 achieved 87.5% sensitivity, 94.7% specificity, 95.5% PPV, and 85.7% NPV for AC, while P63 achieved 94.7% sensitivity, 95.8% specificity, 94.7% PPV, and 95.8% NPV for SCC. TTF-1 enhanced the sensitivity of cytomorphology for AC from 83.3% to 87.5%, and specificity from 91% to 94.7%. Similarly P63 enhanced the sensitivity for SCC from 91% to 94.7%, and specificity from 83.3% to 95.8%. CONCLUSION TTF-1 achieved moderate sensitivity, and high specificity in the diagnosis of AC, while P63 was highly sensitive and specific for the diagnosis of SCC. Immunocytochemistry raised the sensitivity and specificity of FNAC in diagnosing AC and SCC using TTF-1 and P63, respectively.
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Affiliation(s)
- Eman Abu Sinna
- The Department of Pathology, Cytopathology Unit, NCI, Cairo University, Egypt
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9
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Eloubeidi MA, Khan AS, Luz LP, Linder A, Moreira DM, Crowe DR, Eltoum IA. Combined use of EUS-guided FNA and immunocytochemical stains discloses metastatic and unusual diseases in the evaluation of mediastinal lymphadenopathy of unknown etiology. Ann Thorac Med 2012; 7:84-91. [PMID: 22558013 PMCID: PMC3339209 DOI: 10.4103/1817-1737.94527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/22/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. We report our experience with the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with immunocytochemical stains in patients being evaluated for ML. METHODS Retrospective analysis of patients with ML of unknown origin who underwent EUS-FNA. On-site evaluation was performed by experienced cytologist, and special immunocytochemical stains were requested as indicated. RESULTS A total of 116 patients were included, and a total of 136 mediastinal LN were sampled. Prior malignancy was present in 45%. The most common site of examined lymph node (LN) were subcarinal (76%, 103 LN). The median long and short axis diameters were 28 mm and 13 mm, respectively. FNA was read on-site as malignant, 21 (16%); benign, 100 (76.9%); suspicious, six (4%); atypical, 3 (2%); and inadequate sample, six (4%). Sixty-four LN were deferred for additional studies; 22 for immunocytochemical and 26 for Gimesa (GMS) stain and 21 for flow cytometry. Final FNA read was malignant in 28 (21%), benign in 103 (76%), suspicious in three (2%), and atypical in two (1%). Metastatic malignancies disclosed included Hodgkin's and Non-Hodgkin's lymphoma, melanoma, hepatoma, breast, lung, colon, renal, endometrial, Fallopian tube, and unknown carcinoma. The sensitivity, specificity, and accuracy of the final FNA read to predict malignancy were 100%. CONCLUSION EUS-guided FNA with additional ancillary studies is useful in disclosing metastatic ML from a variety of neoplasms. Due to its safety and accuracy profile, it should be considered the test of choice in evaluating abnormal ML in appropriately selected patients.
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Affiliation(s)
- Mohamad A Eloubeidi
- Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama, Lebanon
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Bournet B, Pointreau A, Souque A, Oumouhou N, Muscari F, Lepage B, Senesse P, Barthet M, Lesavre N, Hammel P, Levy P, Ruszniewski P, Cordelier P, Buscail L. Gene expression signature of advanced pancreatic ductal adenocarcinoma using low density array on endoscopic ultrasound-guided fine needle aspiration samples. Pancreatology 2011; 12:27-34. [PMID: 22487470 DOI: 10.1016/j.pan.2011.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS The purpose of this study was to investigate the clinical feasibility and utility of low-density array analysis on samples obtained from endoscopic ultrasound-guided fine needle aspiration biopsy in locally advanced and/or metastatic pancreatic ductal adenocarcinoma and chronic pancreatitis. PATIENTS AND METHODS In this prospective multicenter study, we quantified candidate gene expression in biopsies sampled from 44 locally advanced and/or metastatic pancreatic carcinoma and from 17 pseudotumoural chronic pancreatitis using dedicated low-density array microfluidic plates. RESULTS We first demonstrated that 18S gene expression is stable and comparable in normal pancreas and pancreatic cancer tissues. Next, we found that eight genes (S100P, PLAT, PLAU, MSLN, MMP-11, MMP-7, KRT7, KRT17) were significantly over expressed in pancreatic cancer samples when compared to pseudotumoural chronic pancreatitis (p value ranging from 0.0007 to 0.0215): Linear discriminative analysis identified S100P, PLAT, MSLN, MMP-7, KRT7 as highly explicative variables. The area under receiver operating curve establishes the clinical validity of the potential diagnostic markers identified in this study (values ranging from 0.69 to 0.76). In addition, combination of S100P and KRT7 gave better diagnosis performances (Area Under Receiver Operating Curve 0.81, sensitivity 81%, specificity 77%). CONCLUSION We demonstrate that molecular studies on EUS-guided FNA material are feasible for the identification and quantification of markers in PDAC patients diagnosed with non-resectable tumours. Using low-density array, we isolated a molecular signature of advanced pancreatic carcinoma including mostly cancer invasion-related genes. This work stems for the use of novel biomarkers for the molecular diagnosis of patient with solid pancreatic masses.
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Affiliation(s)
- B Bournet
- INSERM UMR1037, Cancer Research Center of Toulouse, CHU Rangueil, 1 avenue Jean Poulhès, Bât. L3, BP 84225, 31432 Toulouse Cedex 4, France3
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11
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Díaz Roca AB, Calderón García ÁJ, Menéndez Blázquez F, Blanco Sampascual S, Orive Cura VM, Ibarra Ugarte S. [Role of endoscopic ultrasonography in the diagnosis of lymph node tuberculosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:437-438. [PMID: 21414689 DOI: 10.1016/j.gastrohep.2010.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 05/30/2023]
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12
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Abramovitz L, Rubinek T, Ligumsky H, Bose S, Barshack I, Avivi C, Kaufman B, Wolf I. KL1 internal repeat mediates klotho tumor suppressor activities and inhibits bFGF and IGF-I signaling in pancreatic cancer. Clin Cancer Res 2011; 17:4254-66. [PMID: 21571866 DOI: 10.1158/1078-0432.ccr-10-2749] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Klotho is a transmembrane protein which can be shed, act as a circulating hormone and modulate the insulin-like growth factor (IGF)-I and the fibroblast growth factor (FGF) pathways. We have recently identified klotho as a tumor suppressor in breast cancer. Klotho is expressed in the normal pancreas and both the IGF-I and FGF pathways are involved in pancreatic cancer development. We, therefore, undertook to study the expression and activity of klotho in pancreatic cancer. EXPERIMENTAL DESIGN Klotho expression was studied using immunohistochemistry and quantitative RT-PCR. Effects of klotho on cell growth were assessed in the pancreatic cancer cells Panc1, MiaPaCa2, and Colo357, using colony and MTT assays and xenograft models. Signaling pathway activity was measured by Western blotting. RESULTS Klotho expression is downregulated in pancreatic adenocarcinoma. Overexpression of klotho, or treatment with soluble klotho, reduced growth of pancreatic cancer cells in vitro and in vivo, and inhibited activation of the IGF-I and the bFGF pathways. KL1 is a klotho subdomain formed by cleavage or alternative splicing. Compared with the full-length protein, KL1 showed similar growth inhibitory activity but did not promote FGF23 signaling. Thus, its administration to mice showed favorable safety profile. CONCLUSIONS These studies indicate klotho as a potential tumor suppressor in pancreatic cancer, and suggest, for the first time, that klotho tumor suppressive activities are mediated through its KL1 domain. These results suggest the use of klotho or KL1 as potential strategy for the development of novel therapeutic interventions for pancreatic cancer.
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Affiliation(s)
- Lilach Abramovitz
- Institute of Oncology, The Chaim Sheba Medical Center, Ramat-Gan, Tel Aviv, Israel
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13
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EUS-FNA for the Diagnosis of Retroperitoneal Primitive Neuroectodermal Tumor. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:198029. [PMID: 21603018 PMCID: PMC3095240 DOI: 10.1155/2011/198029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/12/2011] [Indexed: 02/03/2023]
Abstract
Primitive neuroectodermal tumor (PNET) is a rare "small round blue cell tumor" that is diagnosed by open biopsy or percutaneous biopsy of the lesion under radiologic guidance. In this case report, we present a novel approach to the diagnosis of a retroperitoneal PNET by endoscopic ultrasound- (EUS-) guided fine needle aspiration (FNA). A 35-year-old man presented with the history of left-sided flank pain and swelling of 3-weeks duration. Computerized tomography (CT) scan of his abdomen revealed a 12.8 × 13 × 12.5 cm cystic and solid mass arising from the retroperitoneum and displacing the third and fourth portions of the duodenum. He underwent EUS which revealed a well-circumscribed heterogeneous mass abutting the inferior portion of the stomach. EUS-FNA of the mass revealed malignant cells consistent with primitive neuroectodermal tumor (PNET)/Ewing's sarcoma. EUS-guided FNA is an appropriate technique for diagnosing retroperitoneal PNET/Ewing's sarcoma.
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14
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Bournet B, Pointreau A, Delpu Y, Selves J, Torrisani J, Buscail L, Cordelier P. Molecular endoscopic ultrasound for diagnosis of pancreatic cancer. Cancers (Basel) 2011; 3:872-82. [PMID: 24212643 PMCID: PMC3756393 DOI: 10.3390/cancers3010872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 02/05/2011] [Accepted: 02/22/2011] [Indexed: 12/15/2022] Open
Abstract
Endoscopic ultrasound-guided fine needle aspiration-biopsy is a safe and effective technique in diagnosing and staging of pancreatic ductal adenocarcinoma. However its predictive negative value does not exceed 50% to 60%. Unfortunately, the majority of pancreatic cancer patients have a metastatic and/or a locally advanced disease (i.e., not eligible for curative resection) which explains the limited access to pancreatic tissue specimens. Endoscopic ultrasound-guided fine needle aspiration-biopsy is the most widely used approach for cytological and histological material sampling in these situations used in up to two thirds of patients with pancreatic cancer. Based on this unique material, we and others developed strategies to improve the differential diagnosis between carcinoma and inflammatory pancreatic lesions by analysis of KRAS oncogene mutation, microRNA expression and methylation, as well as mRNA expression using both qRT-PCR and Low Density Array Taqman analysis. Indeed, differentiating pancreatic cancer from pseudotumoral chronic pancreatitis remains very difficult in current clinical practice, and endoscopic ultrasound-guided fine needle aspiration-biopsy analysis proved to be very helpful. In this review, we will compile the clinical and molecular advantages of using endoscopic ultrasound-guided fine needle aspiration-biopsy in managing pancreatic cancer.
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Affiliation(s)
- Barbara Bournet
- Department of Gastroenterology, University Hospital Center Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France; E-Mail:
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
| | - Adeline Pointreau
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
| | - Yannick Delpu
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
| | - Janick Selves
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
| | - Jerome Torrisani
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
| | - Louis Buscail
- Department of Gastroenterology, University Hospital Center Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France; E-Mail:
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: (+33) 5 61 32 30 55; Fax: (+33) 5 61 32 35 99
| | - Pierre Cordelier
- INSERM U1037, University Hospital Center Rangueil, Toulouse, France; E-Mails: (A.P.); (Y.D.); (J.S.); (J.T.); (P.C.)
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Hijioka S, Mekky MA, Bhatia V, Sawaki A, Mizuno N, Hara K, Hosoda W, Shimizu Y, Tamada K, Niwa Y, Yamao K. Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc 2010; 72:622-7. [PMID: 20630515 DOI: 10.1016/j.gie.2010.05.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Accepted: 05/10/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) is a useful modality for sampling various targets, but its applicability to gallbladder (GB) mass lesions is limited. OBJECTIVE To determine the usefulness of EUS-FNA for diagnosing GB mass lesions. DESIGN Single-center, retrospective, case-series study. SETTING Tertiary-care referral center. PATIENTS This study involved 15 consecutive patients who underwent EUS-FNA of GB mass lesions. We punctured GB masses in patients with suspected xanthogranulomatous cholecystitis to distinguish them from malignancy, and in patients with unresectable GB carcinoma for pathological confirmation. The final diagnosis was based on surgical histopathological results or follow-up outcome. INTERVENTIONS EUS-FNA. MAIN OUTCOME MEASUREMENTS Evaluation of EUS-FNA sampling adequacy rate and diagnostic yield. RESULTS Xanthogranulomatous cholecystitis was suspected in 6 of the 15 patients. EUS-FNA revealed foam cells (n = 3), inflammatory cells (n = 1, proven by cholecystectomy), and GB carcinoma (n = 1), and the amount of the aspirate was insufficient in one case (xanthogranulomatous cholecystitis was later proven by extended hepatectomy). The mean follow-up period of the patients with xanthogranulomatous cholecystitis was 1177 days. Adenocarcinoma was confirmed by EUS-FNA in 8 of the 9 patients with suspected unresectable GB carcinoma, and the FNA was inconclusive in one. All 10 patients with GB carcinoma underwent chemotherapy. The overall sampling adequacy was 86.6%. The accuracy of EUS-FNA for detecting malignancy and for the final diagnosis was 93.3% (95% CI, 62.4%-99.9%) and 80% (95% CI, 54%-93.7%), respectively. LIMITATIONS A small patient cohort and a retrospective design with potential selection bias. CONCLUSIONS Malignant GB mass lesions can be safely and accurately differentiated by EUS-FNA. Thus, patients with xanthogranulomatous cholecystitis can avoid undue extensive surgery.
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Affiliation(s)
- Susumu Hijioka
- Department of Gastroenterology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
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Two Cases of Retroperitoneal Liposarcoma Diagnosed Using Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA). DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2009; 2009:673194. [PMID: 19859574 PMCID: PMC2765729 DOI: 10.1155/2009/673194] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 08/05/2009] [Indexed: 11/17/2022]
Abstract
This report describes our experience with two cases that were ultimately diagnosed as retroperitoneal liposarcoma using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Case 1 is that of a 54-year-old woman with chief complaints of nausea and abdominal distention. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large (15 cm diameter) tumor, which was significantly compressing the stomach and apparently occupied the entire left abdominal cavity. Although advanced primary gastrointestinal stromal tumor (GIST) or retroperitoneal tumor was inferred as the differential diagnosis, a definitive diagnosis was difficult using imaging alone. After EUS-FNA was done, the tumor was diagnosed histopathologically as high-grade liposarcoma. Case 2 is that of a 73-year-old man. Abdominal ultrasonography and CT showed a 6 cm diameter tumor within the pelvic cavity. The tumor had high MRI signal-intensity on both T1 and T2 images. Endorectal EUS showed a hyperechoic mass. The images suggested lipoma or liposarcoma containing lipoma-like components. Myxoid liposarcoma was revealed by subsequent EUS-FNA. Performing EUS-FNA was clinically useful for determining the subsequent therapeutic strategy in these cases where a tumor of unknown origin existed in the retroperitoneum.
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Gupta K, Mallery S. Small-caliber endobronchial ultrasonic videoscope: successful transesophageal and transgastric FNA after failed passage of a standard ultrasonic endoscope. Gastrointest Endosc 2007; 66:574-7. [PMID: 17725948 DOI: 10.1016/j.gie.2007.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 02/05/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS-guided tissue acquisition is a valuable technique. Obstructing lesions of the oropharynx or esophagus may preclude passage of a standard echoendoscope. In the past this has prevented EUS-guided tissue sampling. The recently introduced small-caliber ultrasonic bronchovideoscope (developed for endobronchial ultrasound) may allow EUS-guided FNA in this setting. OBJECTIVE Our purpose was to assess the possible use of the ultrasonic bronchovideoscope to perform upper GI EUS in patients where passage of standard EUS scope was unsuccessful. DESIGN A descriptive case series. SETTING A tertiary referral center. RESULTS Two patients were evaluated after failure of passage of a standard echoendoscope (1 with congenital narrowing of the esophageal inlet, 1 with postoperative deformity). In both cases, sonographic visualization of the lesion of concern was achieved and FNA was performed successfully. CONCLUSIONS The ultrasonic bronchovideoscope may be a valuable tool to perform FNA of mediastinal and GI lesions in situations when a standard ultrasonic endoscope cannot be passed because of luminal narrowing.
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Affiliation(s)
- Kapil Gupta
- Division of Gastroenterology, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, Minnesota 55415, USA
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Logrono R, Bhanot P, Chaya C, Cao L, Waxman I, Bhutani MS. Imaging, morphologic, and immunohistochemical correlation in gastrointestinal stromal tumors. Cancer 2006; 108:257-66. [PMID: 16795074 DOI: 10.1002/cncr.21918] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) recently have been distinguished morphologically, immunohistochemically, and genetically from other gastrointestinal-tract spindle cell neoplasms. The objective of this study was to correlate clinical and imaging findings with morphology and immunohistochemistry to diagnose GISTs and to differentiate them from other spindle cell lesions in the gastrointestinal tract. METHODS The authors reviewed 9 patients who had tumors that were diagnosed as GIST by image-guided and endosonographic-guided fine-needle aspiration (FNA) with or without core biopsy (7 stomach tumors and 2 intraabdominal tumors). The male:female ratio was 3:6, and the patients ranged in age from 38 years to 80 years. Onsite evaluation, preliminary cytologic evaluation, and immunohistochemistry were provided for 6 patients. Immunostains were performed, depending on sample size, on aspirates and/or core biopsies. RESULTS On imaging studies, most tumors were smooth and homogenous, consistent with GIST. Tumors ranged in size from 1.8 cm to 22 cm. The largest neoplasm showed solid/cystic and necrotic components. Aspirates consisted of spindle cell, neoplastic proliferation arranged in fascicles that exhibited focal, nuclear palisading; indistinct, cytoplasmic borders; and no significant atypia or mitosis. Focal epithelioid changes or cytologic atypia and mitoses were observed in 2 tumors. Immunostains revealed tumor expression of CD117 and/or CD34 in 5 of 6 tumors, expression of actin in 3 of 6 tumors, and expression of desmin in 1 of 6 tumors. All tumors were diagnosed as GIST (or consistent with GIST for tumors that lacked immunochemical analysis). Five patients underwent surgical excision, and the GIST diagnosis was confirmed in 3 patients, whereas 1 tumor proved to be neurofibroma, and another tumor was leiomyoma. No surgical follow-up was available for the remaining 4 patients, who had imaging and morphologic findings consistent with GIST. CONCLUSIONS In the setting of consistent clinical and radiologic findings, the combined use of cytomorphology and immunohistochemistry on FNA and/or core biopsy in most instances provides a reliable pathologic diagnosis of GIST. The need of sufficient material for performing ancillary studies and the usual impossibility of excluding malignancy are limitations of FNA cytology of GIST.
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Affiliation(s)
- Roberto Logrono
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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