1
|
Badaoui A, De Wergifosse M, Rondelet B, Deprez PH, Stanciu-Pop C, Bairy L, Eucher P, Delos M, Ocak S, Gillain C, Duplaquet F, Pirard L. Improved Accuracy and Sensitivity in Diagnosis and Staging of Lung Cancer with Systematic and Combined Endobronchial and Endoscopic Ultrasound (EBUS-EUS): Experience from a Tertiary Center. Cancers (Basel) 2024; 16:728. [PMID: 38398119 PMCID: PMC10886864 DOI: 10.3390/cancers16040728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided tissue acquisition (EUS-TA) are accurate procedures for the diagnosis and staging of mediastinal lymph nodes (MLNs) in lung cancer. However, the respective contribution of separate and combined procedures in diagnosis and staging has not been fully studied. The aim of this study was to assess their respective performances. METHODS Patients with suspected malignant MLNs in lung cancer or recurrence identified by PET-CT who underwent combined EBUS-TBNA and EUS-TA were retrospectively reviewed. RESULTS A total of 141 patients underwent both procedures. Correct diagnosis was obtained in 82% with EBUS-TBNA, 91% with EUS-TA, and 94% with the combined procedure. The overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of EBUS-TBNA, EUS-TA, and the combined procedure for diagnosing malignancy were [75%, 100%, 100%, 58%], [87%, 100%, 100%, 75%], and [93%, 100%, 100%, 80%], respectively, with a significantly better sensitivity of the combined procedure (p < 0.0001). Staging (82/141 patients) was correctly assessed in 74% with EBUS-TBNA, 68% with EUS-TA, and 85% with the combined procedure. The overall sensitivity, specificity, PPV, and NPV of EBUS-TBNA, EUS-TA, and the combined procedure for lung cancer staging were [62%, 100%, 100%, 55%], [54%, 100%, 100%, 50%], and [79%, 100%, 100%, 68%], respectively, significantly better in terms of sensitivity for the combined procedure (p < 0.001). CONCLUSION The combined EBUS-EUS approach in lung cancer patients showed better accuracy and sensitivity in diagnosis and staging when compared with EBUS-TBNA and EUS-TA alone.
Collapse
Affiliation(s)
- Abdenor Badaoui
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (A.B.); (C.G.)
| | - Marion De Wergifosse
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
| | - Benoit Rondelet
- Department of Vascular and Thoracic Surgery, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (B.R.); (P.E.)
| | - Pierre H. Deprez
- Department of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 1200 Bruxelles, Belgium;
| | - Claudia Stanciu-Pop
- Department of Pathological Anatomy, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (C.S.-P.); (M.D.)
| | - Laurent Bairy
- Department of Anesthesiology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium;
| | - Philippe Eucher
- Department of Vascular and Thoracic Surgery, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (B.R.); (P.E.)
| | - Monique Delos
- Department of Pathological Anatomy, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (C.S.-P.); (M.D.)
| | - Sebahat Ocak
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
- Pole of Pneumology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, 1200 Bruxelles, Belgium
| | - Cédric Gillain
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (A.B.); (C.G.)
| | - Fabrice Duplaquet
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
| | - Lionel Pirard
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
| |
Collapse
|
2
|
Okasha HH, El-Meligui A, Pawlak KM, Żorniak M, Atalla H, Abou-Elmagd A, Abou-Elenen S, El-Husseiny R, Alzamzamy A. Practical approach to linear EUS examination of the mediastinum. Endosc Ultrasound 2021; 10:406-413. [PMID: 34854401 PMCID: PMC8785678 DOI: 10.4103/eus-d-21-00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
EUS has become a substantial diagnostic and therapeutic modality for many anatomical regions. The extent of endosonographic assessment is wide, and among others, allows for the evaluation of the mediastinal anatomy and related pathologies such as mediastinal lymphadenopathy and staging of central malignant lung lesions. Moreover, EUS assessment has proved more accurate in detecting small lesions missed by standard imaging examinations such as computed tomography or magnetic resonance. Endosonographically, various mediastinal anatomical landmarks and stations can be visualized by transesophageal scanning, thus providing arranged systematic examination of the mediastinum. In addition, the correct position during the examination is crucial for EUS-guided procedures such as tissue sampling and drainage of mediastinal abscesses. The evolution of EUS-guided diagnostic and interventional procedures has contributed to the increasing importance of understanding the mediastinal anatomy during the EUS examination.
Collapse
Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed El-Meligui
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Katarzyna M Pawlak
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Michał Żorniak
- Department of Medicine II, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Hassan Atalla
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amr Abou-Elmagd
- Department of Internal Medicine, Armed Forces College of Medicine, Cairo, Egypt
| | - Sameh Abou-Elenen
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo, Egypt
| | - Ramy El-Husseiny
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo, Egypt
| |
Collapse
|
3
|
Tejedor-Tejada J, Chavarría C, Burgueño-Gómez B, Fanjul I, García-Alonso FJ, Torres MÁ, Madrigal B, Pérez-Miranda M, De la Serna-Higuera C. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and classification of lymphomas. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:404-410. [PMID: 33222483 DOI: 10.17235/reed.2020.7191/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and effective technique in the diagnosis of mediastinal and abdominal masses. However, the usefulness of EUS-FNA in the diagnosis and classification of lymphomas is controversial. The aim of this study was to determine the yield of EUS-FNA in the diagnosis and classification of lymphomas. METHODS a retrospective case series was performed in a tertiary referral center. All consecutive patients referred for EUS-FNA with a suspected diagnosis of lymphoma from March 2013 to June 2019 were included. RESULTS thirty-five patients (54.3 % women, median age 72 years) were included. The most frequent location of the node was the abdomen (67.9 %). Nodes were punctured using a 22-gauge (85.7 %) and 19-gauge needle (14.3 %) with a slow-pull technique. The number of passes performed were three or more in 82.9 % of patients. The samples were processed by the cellblock method. Adequate samples for immunohistochemical and molecular biological study were obtained in 33 (94.3 %) patients. EUS-FNA correctly diagnosed lymphoma in 30 out of 35 patients (85.7 %), and subclassification was determined in 23 patients (65.7 %). The most frequent diagnosis was non-Hodgkin lymphoma (85.7 %). There was one moderate adverse event (bleeding), which was resolved during the procedure. CONCLUSIONS EUS-FNA may be a valuable technique in the evaluation of suspected lymphomas with an adequate diagnostic yield and a very low rate of adverse events.
Collapse
Affiliation(s)
- Javier Tejedor-Tejada
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Carlos Chavarría
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Beatriz Burgueño-Gómez
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Ignacio Fanjul
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | | | | | | | - Manuel Pérez-Miranda
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | | |
Collapse
|
4
|
Mizuide M, Ryozawa S, Fujita A, Ogawa T, Katsuda H, Suzuki M, Noguchi T, Tanisaka Y. Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration: A Narrative Review. Diagnostics (Basel) 2020; 10:diagnostics10110964. [PMID: 33213103 PMCID: PMC7698484 DOI: 10.3390/diagnostics10110964] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Considerable progress has been made recently in the use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to diagnose intra-luminal gastrointestinal lesions and extra-luminal lesions near the gastrointestinal tract. Numerous reports have indicated that EUS-FNA has high diagnostic performance and safety, which has led to the routine use of EUS-FNA and an increasing number of cases. Thus, while EUS-FNA has a low rate of complications, endoscopists may encounter these complications as the number of cases increases. Infrequent reports have also described life-threatening complications. Therefore, endoscopists should possess a comprehensive understanding of the complications of EUS-FNA, which include hemorrhage, perforation, infection, and acute pancreatitis, as well as their management. This review examines the available evidence regarding the complications associated with EUS-FNA, and the findings will be useful for ensuring that endoscopists perform EUS-FNA safely and appropriately.
Collapse
Affiliation(s)
| | - Shomei Ryozawa
- Correspondence: ; Tel.: +81-42-984-4111; Fax: +81-42-984-0432
| | | | | | | | | | | | | |
Collapse
|
5
|
Rapid on-site evaluation during endoscopic ultrasound-guided fine-needle aspiration of lymph nodes does not increase diagnostic yield: A randomized, multicenter trial. Am J Gastroenterol 2018; 113:677-685. [PMID: 29681624 DOI: 10.1038/s41395-018-0025-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Studies on the impact of rapid on-site evaluation (ROSE) during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of lymph nodes are retrospective and have shown conflicting results. We aimed to compare the diagnostic yield of EUS-FNA of lymph nodes with ROSE (ROSE+) and without ROSE (ROSE-). METHODS This was a multicenter, randomized controlled trial. Consecutive patients who were scheduled to undergo EUS-FNA of mediastinal or abdominal lymph nodes were randomized to ROSE+ or ROSE-. In the ROSE+ group, the number of passes was dictated by the on-site cytotechnician. In the ROSE- group, five passes were performed without interference from the cytotechnician. All samples were reviewed by a single-expert cytopathologist, blinded to group allocation. Primary endpoint was diagnostic yield with and without ROSE. RESULTS After inclusion of 90 patients, interim analysis showed futility of study continuation since diagnostic yield of ROSE+ and ROSE- were comparable. A total of 91 patients were randomized to ROSE+ (N = 45) or ROSE- (N = 46). Diagnostic yield of ROSE+ and ROSE- and diagnostic accuracy were comparable: 93.3% vs. 95.7% (P = 0.68) and 97.6% vs. 93.2% (P = 0.62), respectively. Two major complications (one per group) occurred (p = 0.99). ROSE- patients more often reported self-limiting post-procedural pain (p < 0.001). Median procedure time for ROSE+ (20 min) and ROSE- (23 min) was comparable (P = 0.06). Median time to review slides in the ROSE- group (12:47 min) was longer than with ROSE+ (7:52 min) (P < 0.001). Mean costs of ROSE- and ROSE+ were comparable: €938.29 (±172.70) vs. €945.98 (±223.38) (P = 0.91), respectively. CONCLUSIONS Diagnostic yield and accuracy of EUS-FNA of mediastinal and abdominal lymph nodes with and without ROSE are comparable. Time needed to review slides was shorter and post-procedural pain was less often reported in the ROSE+ group. Based on the primary outcome, the implementation of ROSE during EUS-FNA of mediastinal and abdominal lymph nodes cannot be advised. (Dutch Trial Register: NTR4876).
Collapse
|
6
|
EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014; 80:939-59.e7. [PMID: 25434654 DOI: 10.1016/j.gie.2014.07.066] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/17/2014] [Indexed: 02/08/2023]
|
7
|
Nguyen P, Bhatt M, Bashirzadeh F, Hundloe J, Ware R, Fielding D, Ravi Kumar AS. Comparison of objective criteria and expert visual interpretation to classify benign and malignant hilar and mediastinal nodes on 18-F FDG PET/CT. Respirology 2014; 20:129-37. [DOI: 10.1111/resp.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/04/2014] [Accepted: 07/24/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Phan Nguyen
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Medicine; Faculty of Health Sciences; University of Queensland; St Lucia Queensland Australia
| | - Manoj Bhatt
- School of Medicine; Faculty of Health Sciences; University of Queensland; St Lucia Queensland Australia
- Department of Nuclear Medicine and Specialised PET Services Queensland; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Medicine; Faculty of Health Sciences; University of Queensland; St Lucia Queensland Australia
| | - Justin Hundloe
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Medicine; Faculty of Health Sciences; University of Queensland; St Lucia Queensland Australia
| | - Robert Ware
- Queensland Children's Medical Research Institute; Herston Queensland Australia
| | - David Fielding
- Department of Thoracic Medicine; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
- School of Medicine; Faculty of Health Sciences; University of Queensland; St Lucia Queensland Australia
| | - Aravind S. Ravi Kumar
- School of Medicine; Faculty of Health Sciences; University of Queensland; St Lucia Queensland Australia
- Department of Nuclear Medicine and Specialised PET Services Queensland; The Royal Brisbane and Women's Hospital; Herston Queensland Australia
| |
Collapse
|
8
|
von Bartheld MB, van Breda A, Annema JT. Complication rate of endosonography (endobronchial and endoscopic ultrasound): a systematic review. ACTA ACUST UNITED AC 2014; 87:343-51. [PMID: 24434575 DOI: 10.1159/000357066] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/24/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Endosonography [endoscopic ultrasound (EUS)-guided fine needle aspiration and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration] is increasingly used for lung cancer staging and the assessment of sarcoidosis. Serious adverse events (SAE) have been reported in case reports, but the true incidence of complications is yet unknown. OBJECTIVES To assess the rate of SAE related to endosonography and to investigate associated risk factors. MATERIALS AND METHODS PubMed, EMBASE and Cochrane libraries were searched for eligible references up to April 2012 and these included studies reporting on linear EUS or EBUS for the analysis of mediastinal/hilar nodal or central intrapulmonary lesions. Case series describing complications were excluded. Reported complications were classified into SAE or minor adverse events (AE). RESULTS 190 studies met the inclusion criteria. Information on follow-up was missing in half of the studies. In 16,181 patients, 23 SAE (0.14%) and 35 AE (0.22%) were reported. No mortality was observed. SAE were more frequent in patients investigated with EUS (0.30%) than in those investigated with EBUS (0.05%). Infectious SAE were most prevalent (0.07%) and predominantly occurred in patients with cystic lesions and sarcoidosis. In lung cancer patients, complications were rare. DISCUSSION Endosonography for intrathoracic nodal assessment seems safe for lung cancer patients and mortality has not been reported. For cystic lesions and sarcoidosis, there may be a small, but nonnegligible risk of infectious complications. The true incidence of SAE might be higher as accurate documentation of complications is missing in most studies.
Collapse
Affiliation(s)
- M B von Bartheld
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | |
Collapse
|
9
|
Transesophageal Ultrasonography for Lung Cancer Staging: Learning Curves of Pulmonologists. J Thorac Oncol 2013; 8:1402-8. [DOI: 10.1097/jto.0b013e3182a46bf1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
10
|
Schmidt RL, Factor RE, Witt BL, Layfield LJ. Quality Appraisal of Diagnostic Accuracy Studies in Fine-Needle Aspiration Cytology: A Survey of Risk of Bias and Comparability. Arch Pathol Lab Med 2013; 137:566-575. [DOI: 10.5858/arpa.2012-0199-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Context.—The quality of diagnostic accuracy studies is determined by 2 key factors: risk of bias and comparability. Bias can distort accuracy estimates and poor reporting impairs comparability. While diagnostic accuracy studies for fine-needle aspiration cytology (FNAC) are frequently published, the methodologic issues associated with this body of literature have never been reviewed.Objective.—To assess the quality of design and reporting of diagnostic test accuracy studies in FNAC.Data Sources.—Diagnostic accuracy studies were identified by a Medline (US National Library of Medicine) search. Sixty-four FNAC diagnostic test accuracy studies were randomly selected for structured review with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) survey. Studies were divided between 2 time periods: 2000-2001 and 2009-2011.Conclusions.—Diagnostic test accuracy studies of FNAC suffer from numerous deficiencies in study design, which negatively affect the reliability of accuracy estimates.
Collapse
Affiliation(s)
- Robert L. Schmidt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Rachel E. Factor
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Benjamin L. Witt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Lester J. Layfield
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| |
Collapse
|
11
|
Accuracy and Quality Assessment of EUS-FNA: A Single-Center Large Cohort of Biopsies. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012. [PMID: 23197929 PMCID: PMC3503321 DOI: 10.1155/2012/139563] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction. Thorough quality control (QC) study with systemic monitoring and evaluation is crucial to optimizing the effectiveness of EUS-FNA. Methods. Retrospective analysis was composed of investigating consecutive patient files that underwent EUS-FNA. QC specifically focused on diagnostic accuracy, impacts on preexisting diagnoses, and case management. Results. 268 patient files were evaluated. EUS-FNA cytology helped establish accurate diagnoses in 92.54% (248/268) of patients. Sensitivity, specificity, PPV, NPV, and accuracy were 83%, 100%, 100%, 91.6%, and 94%, respectively. The most common biopsy site was the pancreas (68%). The most accurate location for EUS-FNA was the esophagus, 13/13 (100%), followed by the pancreas (89.6%). EUS-FNA was least informative for abdominal lymph nodes (70.5%). After FNA and followup, eight false negatives for tumors were found (3%), while 7.5% of samples still lacked a definitive diagnosis. Discussion. QC suggests that the diagnostic accuracy of EUS-FNA might be improved further by (1) taking more FNA passes from suspected lesions, (2) optimizing needle selection (3) having an experienced echo-endoscopist available during the learning curve, and (4) having a cytologist present during the procedure. QC also identified remediable reporting errors. In conclusion, QC study is valuable in identifying weaknesses and thereby augmenting the effectiveness of EUS-FNA.
Collapse
|
12
|
Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
Collapse
|
13
|
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.
Collapse
Affiliation(s)
- Mohamad A Eloubeidi
- Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama, Lebanon
| | | | | | | | | | | | | |
Collapse
|
14
|
van Zoonen M, van Oijen MGH, van Leeuwen MS, van Hillegersberg R, Siersema PD, Vleggaar FP. Low impact of staging EUS for determining surgical resectability in esophageal cancer. Surg Endosc 2012; 26:2828-34. [PMID: 22692460 DOI: 10.1007/s00464-012-2254-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 03/19/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although studies have shown that EUS has a high sensitivity and specificity for T and N staging, the value of EUS for staging tumors as resectable or nonresectable after CT of the chest and abdomen and US neck assessment, is largely unknown. This study was designed to assess the diagnostic value of EUS for determining resectability of esophageal cancer. METHODS A retrospective analysis of all consecutive patients with esophageal carcinoma who underwent staging EUS, CT, and US. Tumors were considered resectable when there was no evidence of metastases or ingrowth in adjacent structures. Sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of CT/US neck and CT/US neck + EUS for predicting surgical resectability were calculated. PPVs of CT/US alone and CT/US + EUS together were compared for assessing the diagnostic value of EUS. RESULTS In total, 211 patients (155 men; mean age of 64 ± 9.4 years) were included, of which 176 (83 %) underwent all three staging investigations. Based on preoperative staging, 173 (82 %) patients were considered resectable and 38 (18 %) nonresectable. Of all 173 initially resectable patients, 145 were operated on. Of these patients, five (3.4 %) tumors were found nonresectable during surgery. Postoperative sensitivity, specificity, PPV, and NPV of CT/US and CT/US + EUS for predicting surgical resectability were 88 versus 87 %, 20 versus 40 %, 97 versus 98 %, and 6 versus 10 %, respectively. CONCLUSIONS Although EUS adds to the specificity of preoperative esophageal cancer staging after CT chest and abdomen, and US of the neck have been performed, the overall added value of EUS is limited.
Collapse
Affiliation(s)
- M van Zoonen
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
15
|
Hirdes MMC, Vleggaar FP. Performance of EUS-FNA for mediastinal lymphadenopathy: impact on patient management and costs in low-volume EUS centers. Surg Endosc 2011; 25:3124-5. [PMID: 21455804 PMCID: PMC3160554 DOI: 10.1007/s00464-011-1648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. M. C. Hirdes
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F. P. Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
16
|
Nguyen P, Bashirzadeh F, Hundloe J, Salvado O, Dowson N, Ware R, Masters IB, Bhatt M, Kumar AR, Fielding D. Optical differentiation between malignant and benign lymphadenopathy by grey scale texture analysis of endobronchial ultrasound convex probe images. Chest 2011; 141:709-715. [PMID: 21885729 DOI: 10.1378/chest.11-1016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Morphologic and sonographic features of endobronchial ultrasound (EBUS) convex probe images are helpful in predicting metastatic lymph nodes. Grey scale texture analysis is a well-established methodology that has been applied to ultrasound images in other fields of medicine. The aim of this study was to determine if this methodology could differentiate between benign and malignant lymphadenopathy of EBUS images. METHODS Lymph nodes from digital images of EBUS procedures were manually mapped to obtain a region of interest and were analyzed in a prediction set. The regions of interest were analyzed for the following grey scale texture features in MATLAB (version 7.8.0.347 [R2009a]): mean pixel value, difference between maximal and minimal pixel value, SEM pixel value, entropy, correlation, energy, and homogeneity. Significant grey scale texture features were used to assess a validation set compared with fluoro-D-glucose (FDG)-PET-CT scan findings where available. RESULTS Fifty-two malignant nodes and 48 benign nodes were in the prediction set. Malignant nodes had a greater difference in the maximal and minimal pixel values, SEM pixel value, entropy, and correlation, and a lower energy (P < .0001 for all values). Fifty-one lymph nodes were in the validation set; 44 of 51 (86.3%) were classified correctly. Eighteen of these lymph nodes also had FDG-PET-CT scan assessment, which correctly classified 14 of 18 nodes (77.8%), compared with grey scale texture analysis, which correctly classified 16 of 18 nodes (88.9%). CONCLUSIONS Grey scale texture analysis of EBUS convex probe images can be used to differentiate malignant and benign lymphadenopathy. Preliminary results are comparable to FDG-PET-CT scan.
Collapse
Affiliation(s)
- Phan Nguyen
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; The University of Queensland, UQ Centre for Clinical Research, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia.
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Justin Hundloe
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Olivier Salvado
- The Australian eHealth Research Centre, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia
| | - Nicholas Dowson
- The Australian eHealth Research Centre, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia
| | - Robert Ware
- Queensland Children's Medical Research Institute, The Royal Children's Hospital, Herston, Australia
| | - Ian Brent Masters
- Department of Respiratory Medicine, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Manoj Bhatt
- Queensland PET Service, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Aravind Ravi Kumar
- Queensland PET Service, CSIRO Information and Communication Technologies Centre, The Royal Children's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - David Fielding
- Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St. Lucia, QLD, Australia
| |
Collapse
|
17
|
Mediastinal lymphadenopathy: assessing clinical utility of EUS-FNA. Surg Endosc 2011; 25:2756-7. [PMID: 21301879 DOI: 10.1007/s00464-011-1575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|