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Vilas-Boas F, Ribeiro T, Macedo G, Dhar J, Samanta J, Sina S, Manfrin E, Facciorusso A, Conti Bellocchi MC, De Pretis N, Frulloni L, Crinò SF. Endoscopic Ultrasound-Guided Through-the-Needle Biopsy: A Narrative Review of the Technique and Its Emerging Role in Pancreatic Cyst Diagnosis. Diagnostics (Basel) 2024; 14:1587. [PMID: 39125463 PMCID: PMC11311500 DOI: 10.3390/diagnostics14151587] [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: 07/03/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Pancreatic cystic lesions (PCLs) pose a diagnostic challenge due to their increasing incidence and the limitations of cross-sectional imaging and endoscopic-ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-guided through the needle biopsy (EUS-TTNB) has emerged as a promising tool for improving the accuracy of cyst type determination and neoplastic risk stratification. EUS-TTNB demonstrates superior diagnostic performance over EUS-FNA, providing critical preoperative information that can significantly influence patient management and reduce unnecessary surgeries. However, the procedure has risks, with an overall adverse event rate of approximately 9%. Preventive measures and further prospective studies are essential to optimize its safety and efficacy. This review highlights the potential of EUS-TTNB to enhance the diagnostic and management approaches for patients with PCLs. It examines the current state of EUS-TTNB, including available devices, indications, procedural techniques, specimen handling, diagnostic yield, clinical impact, and associated adverse events.
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Affiliation(s)
- Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina da Universidade do Porto, 4200-349 Porto, Portugal; (F.V.-B.); (T.R.); (G.M.)
| | - Tiago Ribeiro
- Gastroenterology Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina da Universidade do Porto, 4200-349 Porto, Portugal; (F.V.-B.); (T.R.); (G.M.)
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina da Universidade do Porto, 4200-349 Porto, Portugal; (F.V.-B.); (T.R.); (G.M.)
| | - Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; (J.D.); (J.S.)
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; (J.D.); (J.S.)
| | - Sokol Sina
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy; (S.S.); (E.M.)
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy; (S.S.); (E.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
| | - Nicolò De Pretis
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
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Chong J, Wee NK, Tan CH, Low HM, Chew WD, Vu CKF, Lee CH. Pancreatic cysts: can surveillance interval for small low-risk lesions be lengthened? Acta Radiol 2024; 65:406-413. [PMID: 38196245 DOI: 10.1177/02841851231222799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Surveillance of pancreatic cysts are necessary due to risk of malignant transformation. However, reported progression rates to advanced neoplasia are variable and the high frequency of surveillance scans may pose a considerable burden on healthcare resources. PURPOSE To validate the effectiveness of the Fukuoka Guidelines surveillance regime and determine if a longer surveillance interval can be established. MATERIAL AND METHODS All magnetic resonance imaging (MRI) studies of the pancreas performed at our institution between January 2014 and December 2016 with at least one pancreatic cystic lesion and follow-up MRI or computed tomography (CT) over at least two years were reviewed for size, worrisome feature (WF), and high-risk stigmata (HRS) at diagnosis and follow-up imaging (up to year 6). Reference standards for advanced neoplasia were based on endoscopic ultrasound, fine needle aspiration cytology, or the presence of ≥2 WF or ≥1 HRS on imaging. Comparison of MRI features of progression and outcomes of diagnostic endpoints between lesions <20 mm and ≥20 mm was performed. RESULTS A total of 270 patients were included (201 cysts <20 mm, 69 cysts ≥20 mm). Compared with cysts <20 mm, cysts ≥20 mm were more likely to be associated with WF or HRS (40.6% vs. 12.4%; P ≤0.00001), demonstrate increase in size of ≥5 mm in two years (20.3% vs. 10.9%; P = 0.049), and develop advanced neoplasia (24.6% vs. 0.5%; P <0.00001). CONCLUSION Pancreatic cysts <20 mm have a low risk of developing WF and HRS and surveillance interval may be lengthened.
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Affiliation(s)
- Jingli Chong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nicole Kessa Wee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Da Chew
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Charles Kien Fong Vu
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Conti Bellocchi MC, Manfrin E, Brillo A, Bernardoni L, Lisotti A, Fusaroli P, Parisi A, Sina S, Facciorusso A, Gabbrielli A, Crinò SF. Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy-A Unique Pictorial Essay with Clinical and Histopathological Correlations. Diagnostics (Basel) 2023; 13:3663. [PMID: 38132247 PMCID: PMC10743172 DOI: 10.3390/diagnostics13243663] [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: 11/06/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Due to their aspecific macroscopic appearance, uncommon pancreatic cystic lesions (PCLs) are often misdiagnosed as mucinous lesions and improperly resected. We aimed to evaluate the endoscopic ultrasound (EUS)-guided through-the-needle biopsy (TTNB) capacity of the preoperative diagnosis of uncommon PCLs. Overall, 136 patients with PCLs who underwent EUS-TTNB between 2016 and 2022 were retrospectively identified. Common histotypes (e.g., IPMN, serous cystadenoma, and mucinous cystadenoma) were excluded and 26 (19.1%) patients (15 female, mean age 52.9 ± 10.4) were analyzed. The EUS findings, adverse events (AEs), and TTNB outcomes in uncommon PCLs were evaluated. The cysts histotype was accurately diagnosed by TTNB in 24/26 (92.3%) cases (seven cystic neuroendocrine tumors, four squamoid cysts, three acinar cells cystadenomas, two lymphoepithelial cysts, two mucinous non-neoplastic cysts, two bronchogenic cysts, two cystic lymphangiomas, one solid-pseudopapillary neoplasm, and one schwannoma). In the remaining two cases, lymphangioma was eventually diagnosed after resection. Surgery was performed in 15/26 (57.7%) patients. The mean follow-up of non-surgical patients was 32.5 months. One severe acute case of pancreatitis (3.8%) that required surgery occurred after EUS-TTNB. Uncommon pancreatic/peripancreatic lesions represent the 19.1% of PCLs in our series, with mainly benign histotypes. TTNB demonstrated a high diagnostic performance with a low rate of AEs in this setting, representing a reliable tool with which to avoid useless surgery.
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Affiliation(s)
- Maria Cristina Conti Bellocchi
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy; (A.B.); (L.B.); (A.G.); (S.F.C.)
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy;
| | - Alessandro Brillo
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy; (A.B.); (L.B.); (A.G.); (S.F.C.)
| | - Laura Bernardoni
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy; (A.B.); (L.B.); (A.G.); (S.F.C.)
| | - Andrea Lisotti
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, 40026 Imola, Italy; (A.L.)
| | - Pietro Fusaroli
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, Hospital of Imola, University of Bologna, 40026 Imola, Italy; (A.L.)
| | - Alice Parisi
- Department of Pathology and Diagnostics, University Hospital of Verona, 37126 Verona, Italy; (A.P.); (S.S.)
| | - Sokol Sina
- Department of Pathology and Diagnostics, University Hospital of Verona, 37126 Verona, Italy; (A.P.); (S.S.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Armando Gabbrielli
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy; (A.B.); (L.B.); (A.G.); (S.F.C.)
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy; (A.B.); (L.B.); (A.G.); (S.F.C.)
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Zhang G, Chen W, Wang Z, Wang F, Liu R, Feng J. Automated diagnosis of pancreatic mucinous and serous cystic neoplasms with modality-fusion deep neural network using multi-modality MRIs. Front Oncol 2023; 13:1181270. [PMID: 37795452 PMCID: PMC10546304 DOI: 10.3389/fonc.2023.1181270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
Background Pancreatic cystic neoplasms are increasingly diagnosed with the development of medical imaging technology and people's self-care awareness. However, two of their sub-types, serous cystic neoplasms (SCN) and mucinous cystic neoplasms (MCN), are often misclassified from each other. Because SCN is primarily benign and MCN has a high rate of malignant transformation. Distinguishing SCN and MCN is challenging and essential. Purpose MRIs have many different modalities, complete with SCN and MCN diagnosis information. With the help of an artificial intelligence-based algorithm, we aimed to propose a multi-modal hybrid deep learning network that can efficiently diagnose SCN and MCN using multi-modality MRIs. Methods A cross-modal feature fusion structure was innovatively designed, combining features of seven modalities to realize the classification of SCN and MCN. 69 Patients with multi-modalities of MRIs were included, and experiments showed performances of every modality. Results The proposed method with the optimized settings outperformed all other techniques and human radiologists with high accuracy of 75.07% and an AUC of 82.77%. Besides, the proposed disentanglement method outperformed other fusion methods, and delayed contrast-enhanced T1-weighted MRIs proved most valuable in diagnosing SCN and MCN. Conclusions Through the use of a contemporary artificial intelligence algorithm, physicians can attain high performance in the complex challenge of diagnosing SCN and MCN, surpassing human radiologists to a significant degree.
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Affiliation(s)
- Gong Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Weixiang Chen
- Department of Automation, Tsinghua University, Beijing, China
| | - Zizheng Wang
- Senior Department of Hepatology, Fifth Medical Center of the PLA General Hospital, Beijing, China
| | - Fei Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Jianjiang Feng
- Department of Automation, Tsinghua University, Beijing, China
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Facciorusso A, Kovacevic B, Yang D, Vilas-Boas F, Martínez-Moreno B, Stigliano S, Rizzatti G, Sacco M, Arevalo-Mora M, Villarreal-Sanchez L, Conti Bellocchi MC, Bernardoni L, Gabbrielli A, Barresi L, Gkolfakis P, Robles-Medranda C, De Angelis C, Larghi A, Di Matteo FM, Aparicio JR, Macedo G, Draganov PV, Vilmann P, Pecchia L, Repici A, Crinò SF. Predictors of adverse events after endoscopic ultrasound-guided through-the-needle biopsy of pancreatic cysts: a recursive partitioning analysis. Endoscopy 2022; 54:1158-1168. [PMID: 35451041 DOI: 10.1055/a-1831-5385] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS : Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNB-related AEs and to generate a prognostic model using recursive partitioning analysis (RPA). PATIENTS AND METHODS : Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. RESULTS : Mean cysts size was 36.7 mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45 %), serous cystadenoma (18.8 %), and mucinous cystadenoma (12.8 %). Fifty-eight (11.5 %) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p = 0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p = 0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p < 0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28 % AEs rate), low-risk (1.4 % AE rate, including patients < 64 years with other-than-IPMN diagnosis sampled with ≤ 2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1 % AEs rate, including the remaining patients). CONCLUSION : TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy.,Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Bojan Kovacevic
- Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Dennis Yang
- Center of Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Filipe Vilas-Boas
- Department of Gastroenterology, Centro Hospitalar e Universitário de São João-Porto, Porto, Portugal
| | - Belén Martínez-Moreno
- Unidad de Endoscopia. ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
| | - Serena Stigliano
- Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Sacco
- Gastroenterology Division, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Maria Cristina Conti Bellocchi
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Laura Bernardoni
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Armando Gabbrielli
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Claudio De Angelis
- Gastroenterology Division, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - José R Aparicio
- Unidad de Endoscopia. ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar e Universitário de São João-Porto, Porto, Portugal
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Peter Vilmann
- Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | | | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
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Karstensen JG, Vilmann P. Historical perspective on needle development: From the past to the future. Best Pract Res Clin Gastroenterol 2022; 60-61:101814. [PMID: 36577533 DOI: 10.1016/j.bpg.2022.101814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
With the introduction of EUS, endoscopy was no longer limited to luminal indications. However, the method was unable to distinguish malignant from benign lesions. Consequently, needles designed for tissue acquisition under EUS-guidance was designed. Initially, the needles were designed for fine needle aspiration (FNA); nevertheless, with increased requirement for the precured tissue in terms of quality and quantity, newly design needles aimed at obtaining tissue cores for histological assessment were developed. Recent studies demonstrate superiority of these fine needle biopsy needles (FNB) compared to FNA needles.
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Affiliation(s)
- John Gásdal Karstensen
- Pancreatitis Centre East, Gastro Unit, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Peter Vilmann
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Gastro Unit, Division of Endoscopy, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.
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Oyedeji O, Rodgers S, Wrubel A, Shah R, Husain S. Pancreatic lymphoepithelial cyst with concurrent HIV infection: A case report and review of the literature. SAGE Open Med Case Rep 2022; 10:2050313X221131166. [PMID: 36274859 PMCID: PMC9580076 DOI: 10.1177/2050313x221131166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/19/2022] [Indexed: 11/15/2022] Open
Abstract
Pancreatic lymphoepithelial cysts are rare, benign, non-neoplastic unilocular or multilocular cystic lesions. These circumscribed pancreatic lesions are filled with keratinous material grossly and exhibit distinct microscopic features. Pancreatic lymphoepithelial cysts are like the more common lymphoepithelial cysts of the parotid glands, which have been associated with the diffuse infiltrative lymphocytosis syndrome often seen in patients with HIV infection. However, pancreatic lymphoepithelial cysts are rare and their association with HIV infection has not been established. The presence of secondary changes in non-neoplastic cysts such as goblet cell metaplasia that was present in our case is an important feature to be included in the differential diagnosis and not to be interpreted as a mucinous neoplasm, particularly on fine-needle aspiration specimen microscopic evaluation that would impact further management. Here we describe the diagnosis and treatment of lymphoepithelial cysts in a patient who was on highly active antiretroviral therapy for HIV infection and we provide a brief literature review. Defining the clinical characteristics of lymphoepithelial cysts in patients with HIV and determining accurate preoperative diagnostic procedures will be critical for establishing effective surgical and medical approaches to treating these cysts, which differ substantially from other more serious pancreatic cystic lesions.
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Affiliation(s)
- Oluwayomi Oyedeji
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, USA,Oluwayomi Oyedeji, Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
| | - Shannon Rodgers
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Allen Wrubel
- Department of Diagnostic Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Rupen Shah
- Division of Surgical Oncology, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Sanam Husain
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, USA
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Abstract
Andrew Canakis.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Linda S Lee
- Division of Gastroenterology Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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9
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Impact of Antibiotic Prophylaxis on Infection Rate after Endoscopic Ultrasound Through-the-Needle Biopsy of Pancreatic Cysts: A Propensity Score-Matched Study. Diagnostics (Basel) 2022; 12:diagnostics12010211. [PMID: 35054378 PMCID: PMC8774428 DOI: 10.3390/diagnostics12010211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Despite weak evidence, antibiotic prophylaxis prior to endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) of pancreatic cystic lesions (PCLs) is routinely used in clinical practice. We aim to compare a group of patients treated with antibiotics before EUS-TTNB of PCLs and a group who did not undergo antimicrobial prophylaxis. Methods: Out of 236 patients with pancreatic cystic lesions referred to two high-volume centers between 2016 and 2021, after propensity score matching, two groups were compared: 98 subjects who underwent EUS-TTNB under antibiotic prophylaxis and 49 subjects without prophylaxis. Results: There was no difference in terms of baseline parameters between groups. Final diagnosis was serous cystadenoma in 36.7% of patients in the group not treated with prophylaxis and in 37.7% of patients in the control group, whereas IPMN and mucinous cystadenoma were diagnosed in 3 (6.1%) and 16 (32.6%) versus 6 (6.1%) and 32 (32.6%) patients in the two groups, respectively (p = 0.23). Overall, the adverse event rate was 6.1% in the group not treated with antibiotic prophylaxis and 5.1% in the control group (p = 0.49). Only a single infectious adverse event occurred in each group (p = 0.48). The diagnostic yields were 89.7% and 90.8% in the two groups (p = 0.7), and the diagnostic accuracy rate was 81.6% in both groups (p = 1.0). Conclusions: Prophylactic antibiotics do not seem to influence the risk of infection, and their routine use should be discouraged.
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Facciorusso A, Ramai D, Gkolfakis P, Shapiro A, Arvanitakis M, Lisotti A, Triantafyllou K, Fusaroli P, Papanikolaou IS, Crinò SF. Through-the-needle biopsy of pancreatic cystic lesions: current evidence and implications for clinical practice. Expert Rev Med Devices 2021; 18:1165-1174. [PMID: 34842023 DOI: 10.1080/17434440.2021.2012450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is increasing evidence to support the efficacy of endoscopic ultrasound (EUS)-guided through-the-needle biopsy (TTNB) technique as a means of sampling pancreatic cystic lesions (PCLs). Results provide evidence demonstrating the benefits of this procedure over standard EUS fine-needle aspiration (FNA), thus supporting a push for its widespread implementation in clinical practice. Though this technique has demonstrated advantages, achieving these advantages in clinical practice is contingent upon careful considerations to ensure safety and efficacy. AREAS COVERED The purpose of this review is to assess the level of evidence supporting the use of through-the-needle biopsy, revise its main technical and procedural characteristics, and to develop suggested guidelines outlining the safe assimilation of this device in clinical practice. EXPERT OPINION EUS-TTNB enables more definitive and accurate diagnosis of PCLs by providing higher-quality histological samples. However, EUS-TTNB is not appropriate for all PCLs. Selection of suitable patients as well as morphology and risk factors of the cystic lesion is a crucial component of achieving the described benefits of this procedure while minimizing risks of adverse effects. Subjects with weak or absent indications for this procedure are susceptible to a range of complications and may even result in fatality.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy.,Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Cub Erasme Hospital, Université Libre de Bruxelles (Ulb), Brussels, Belgium
| | - Alexandra Shapiro
- Department of Medicine, St. George's University School of Medicine, True Blue, Grenada
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Cub Erasme Hospital, Université Libre de Bruxelles (Ulb), Brussels, Belgium
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Italy
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
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11
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Kongkam P, Orprayoon T, Yooprasert S, Sirisub N, Klaikaew N, Sanpawat A, Safa S, Ridtitid W, Kullavanijaya P, Rerknimitr R. Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) from peritoneal lesions: a prospective cohort pilot study. BMC Gastroenterol 2021; 21:400. [PMID: 34689752 PMCID: PMC8542287 DOI: 10.1186/s12876-021-01953-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diagnostic laparoscopy is often a necessary, albeit invasive, procedure to help resolve undiagnosed peritoneal diseases. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, however, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC). Aim This pilot study aims to prospectively determine the effectiveness of EUS-FNB regarding adequacy of tissue for IHC staining, diagnostic rate and the avoidance rate of diagnostic laparoscopy or percutaneous biopsy in patients with these lesions. Methods From March 2017 to June 2018, patients with peritoneal or omental lesions identified by CT or MRI at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were prospectively enrolled in the study. All Patients underwent EUS-FNB. For those with negative pathological results of EUS-FNB, percutaneous biopsy or diagnostic laparoscopy was planned. Analysis uses percentages only due to small sample sizes. Results A total of 30 EUS-FNB passes were completed, with a median of 3 passes (range 2–3 passes) per case. For EUS-FNB, the sensitivity, specificity, PPV, NPV and accuracy of EUS-FNB from peritoneal lesions were 63.6%, 100%, 100%, 20% and 66.7% respectively. Adequate tissue for IHC stain was found in 25/30 passes (80%). The tissues from EUS results were found malignant in 7/12 patients (58.3%). IHC could be done in 10/12 patients (83.3%). Among the five patients with negative EUS results, two underwent either liver biopsy of mass or abdominal paracentesis, showing gallbladder cancer and adenocarcinoma. Two patients refused laparoscopy due to advanced pancreatic cancer and worsening ovarian cancer. The fifth patient had post-surgical inflammation only with spontaneous resolution. The avoidance rate of laparoscopic diagnosis was 58.3%. No major adverse event was observed. Conclusions EUS-FNB from peritoneal lesions provided sufficient core tissue for diagnosis and IHC. Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01953-9.
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Affiliation(s)
- Pradermchai Kongkam
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Theerapat Orprayoon
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Sirilak Yooprasert
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nakarin Sirisub
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Naruemon Klaikaew
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anapat Sanpawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Shahram Safa
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wiriyaporn Ridtitid
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pinit Kullavanijaya
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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12
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Pancreatic/peripancreatic neurogenic tumor; little known masses not to be missed. Pancreatology 2021; 21:1386-1394. [PMID: 34446337 DOI: 10.1016/j.pan.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retroperitoneal neurogenic tumors are extremely rare pathological entities; therefore, few clinical features and natural courses, especially originating from the pancreatic/peripancreatic regions, have been reported. This study aimed to investigate the clinicopathological features of pancreatic and peripancreatic neurogenic tumors and assess the diagnostic value of computed tomography (CT) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). METHODS Between 2006 and 2018, patients who were diagnosed with neurogenic tumors were included. In total, 90 histologically confirmed cases of neurogenic tumors located in the pancreatic/peripancreatic regions were selected for analysis. RESULTS The mean age was 49.2 ± 13.1 years. There were no differences in sex distribution of the tumors. Schwannomas (44.4%) and paragangliomas (41.1%) were the most common neurogenic tumors. The sensitivity of CT was 62.2% in 90 cases. EUS-FNB was performed in 30 cases and the sensitivity of it was 83.3%. The diagnosis of neurogenic tumors with EUS-FNB or CT was not significantly associated with tumor location and size. Surgical resection was performed in 78 cases. Of the 12 patients who did not undergo surgery, 10 cases were followed-up without any increase in tumor size. CONCLUSIONS Through the present study, we verified radiological, pathological, and clinical aspects of the pancreatic/peripancreatic neurogenic tumors which little known before, therefore, this study can serve as the basis for research to present an optimal diagnosis and treatment of neurogenic tumors. In addition, EUS-FNB is useful in the diagnosis of pancreatic/peripancreatic neurogenic tumors with relatively high sensitivity and can help establish therapeutic plans before the surgery.
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13
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Crinò SF, Manfrin E. Through-The-Needle Biopsy: Shifting From Cytology to Histology for Preoperative Assessment of Pancreatic Cystic Lesions. Arch Pathol Lab Med 2021; 145:1193b-1193. [PMID: 34570891 DOI: 10.5858/arpa.2021-0207-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Stefano Francesco Crinò
- Departments of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute
| | - Erminia Manfrin
- Diagnostics and Public Health, University Hospital of Verona, Verona, Italy
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14
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Zhang Z, Pu J, Zhang H. Development and Validation of a Simple-to-Use Nomogram to Predict Early Death in Metastatic Pancreatic Adenocarcinoma. Front Oncol 2021; 11:729175. [PMID: 34568061 PMCID: PMC8458811 DOI: 10.3389/fonc.2021.729175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Pancreatic adenocarcinoma (PCa) is a highly aggressive malignancy with high risk of early death (survival time ≤3 months). The present study aimed to identify associated risk factors and develop a simple-to-use nomogram to predict early death in metastatic PCa patients. Methods Patients diagnosed with metastatic PCa between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were collected for model construction and internal validation. An independent data set was obtained from China for external validation. Independent risk variables contributed to early death were identified by logistic regression models, which were then used to construct a nomogram. Internal and external validation was performed to evaluate the nomogram using calibration curves and the receiver operating characteristic curves. Results A total of 19,464 patients in the SEER cohort and 67 patients in the Chinese cohort were included. Patients from the SEER database were randomly divided into the training cohort (n = 13,040) and internal validation cohort (n = 6,424). Patients in the Chinese cohort were selected for the external validation cohort. Overall, 10,484 patients experienced early death in the SEER cohort and 35 in the Chinese cohort. A reliable nomogram was constructed on the basis of 11 significant risk factors. Internal validation and external validation of the nomogram showed high accuracy in predicting early death. Decision curve analysis demonstrated that this predictive nomogram had excellent and potential clinical applicability. Conclusion The nomogram provided a simple-to-use tool to distinguish early death in patients with metastatic PCa, assisting clinicians in implementing individualized treatment regimens.
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Affiliation(s)
- Zhong Zhang
- Department of Oncology, The Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Juan Pu
- Department of Oncology, Lianshui People's Hospital, Huaian, China
| | - Haijun Zhang
- Department of Oncology, The Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
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15
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Sbeit W, Kadah A, Shahin A, Khoury T. The Yield of String Sign in Differentiating Mucinous from Non-Mucinous Pancreatic Cysts: A Retrospective Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:716. [PMID: 34356997 PMCID: PMC8305072 DOI: 10.3390/medicina57070716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: The diagnosis of pancreatic cysts is mostly based on a combination of morphological appearance and fluid analysis of amylase and carcinoembryonic antigen (CEA). We aimed to assess the capability of the string sign in differentiating mucinous from non-mucinous pancreatic cysts. Materials and Methods: All patients who were referred for endoscopic ultrasound (EUS) for pancreatic cysts assessment from 2015 to 2020 were retrospectively analyzed. Results: Our cohort consisted of 112 patients. Of them, 92 patients (82.1%) had mucinous cystic neoplasms (group A) and 20 patients (17.9%) had non-mucinous cystic neoplasms (group B). The average age in groups A and B was 71.3 and 60.4 years, respectively. String sign was positive in 47 patients (51.1%) and negative in 21 patients (22.8%) in group A, while in group B, string sign was negative in 19 patients (95%). String sign showed significant correlation with the diagnosis of mucinous cystic neoplasms (OR 64.2, 95% CI 8.1-508.6, p = 0.0001). Cytology confirmed mucinous cystic neoplasms that included 32 patients; the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of string sign for mucinous cystic neoplasms were high, reaching 93.8%, 85.7%, 96.8%, and 75%, respectively, with an excellent accuracy rate of 92.3%. Conclusions: The string sign is highly accurate for predicting pancreatic mucinous cystic neoplasms, and should be used as an important aid for improving diagnostic accuracy.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel; (W.S.); (A.K.); (A.S.)
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel; (W.S.); (A.K.); (A.S.)
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel; (W.S.); (A.K.); (A.S.)
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel; (W.S.); (A.K.); (A.S.)
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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16
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Diagnostic and Interventional Role of Endoscopic Ultrasonography for the Management of Pancreatic Neuroendocrine Neoplasms. J Clin Med 2021; 10:jcm10122638. [PMID: 34203922 PMCID: PMC8232656 DOI: 10.3390/jcm10122638] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Pancreatic neuroendocrine neoplasms (PanNENs) are relatively rare, but their incidence has increased significantly in the last decades. Precise diagnosis and prognostic stratification are crucial for proper patient management. Endoscopic ultrasound (EUS) is the modality of choice for diagnosis of solid pancreatic tumors, showing a higher tumor detection rate than other imaging modalities, especially for small size lesions. EUS also serves as a guide for preoperative sampling and other interventions. EUS-tissue acquisition is a safe and highly accurate technique for cyto/histological diagnosis of PanNENs with a well-demonstrated correlation between Ki-67 proliferation index values and tumor grading on EUS and surgical specimens according to the WHO 2017 classification. Furthermore, the possibility of a preoperative EUS-guided fine needle tattooing or fiducial markers placement may help the surgeon to locate small and deep tumors, thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery. Finally, locoregional ablative treatments using either ethanol injection or radiofrequency ablation have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected patients unfit for surgery with functioning or non-functioning PanNENs. This article review highlights the current role of EUS in PanNENs management, focusing on the present and future applications of EUS-guided interventions.
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17
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Ang TL, Wang LM. The evolving role of EUS-guided tissue acquisition. J Dig Dis 2021; 22:204-213. [PMID: 33611846 DOI: 10.1111/1751-2980.12976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022]
Abstract
The introduction of endoscopic ultrasound-guided fine-needle aspiration into clinical practice was a pivotal moment for diagnostic gastrointestinal endoscopy. It facilitates the ease of tissue acquisition from previously inaccessible sites. The performance characteristics of cytological diagnosis are excellent. However, there remain areas of inadequacies. These include procedural inefficiencies such as the need for rapid on-site cytological evaluation or macroscopic on-site evaluation, the crucial role of histology for diagnosis in specific conditions, the issue of sampling errors and the need for repeat procedures, and the shift towards personalized medicine, which requires histology, immunohistochemical studies, and molecular analysis. The original Trucut biopsy needle had been cumbersome to use, but the recent introduction of newer-generation biopsy needles has transformed the landscape, such that there is now a greater focus on tissue acquisition for histological assessment. Concomitant technological advances of endoscopic ultrasound processors enabled higher-resolution imaging, and facilitated image enhancement using contrast harmonic endoscopic ultrasound and endoscopic ultrasound elastography. These techniques can be used as an adjunct to guide tissue acquisition in challenging situations. There is ongoing research on the use of artificial intelligence to complement diagnostic endoscopic ultrasound and the early data are promising. Artificial intelligence may be especially important to guide clinical decision-making if biopsy results are nondiagnostic.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital; Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lai Mun Wang
- Department of Laboratory Medicine, Section of Pathology, Changi General Hospital; Pathology Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
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Binda C, Dabizzi E, Sinagra E, Fornelli A, Saragoni L, Cennamo V, Anderloni A, Fabbri C. Micro-Biopsy Forceps in the Assessment of Peritoneal Carcinomatosis: A Possible New Indication? Clin Endosc 2021; 54:613-617. [PMID: 33765374 PMCID: PMC8357587 DOI: 10.5946/ce.2020.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is defined as a metastatic involvement of the peritoneum by several other primary sites and it is characterized by a marked worsening of prognosis, with limited treatment opportunities. Subsequently, PC should be ruled out before any invasive treatment is administered. A new through-the-needle micro-biopsy forceps (MF) was recently introduced that permits micro-histology cores. In this case series, we evaluated the feasibility of MF in the assessment of PC to complete patient diagnostic work-ups. Five consecutive patients referred for endoscopic ultrasound staging were sampled using MF. Sampling was feasible in all patients with a technical success of 100%. No adverse events were reported in any cases. This technique was feasible and safe with a technical success rate of 100%. It permitted sampling of peritoneal irregularity, obtained high-quality tissue fragments in all cases, and enabled an additional assessment, i.e., immunohistochemical staining.
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Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì - Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Emanuele Dabizzi
- Gastroenterology and Interventional Endoscopy Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Emanuele Sinagra
- Servizio di Endoscopia Digestiva, Fondazione Istituto G. Giglio di Cefalù, Cefalù (PA), Italy.,Section of Nutrition, Istituto Euromediterraneo di Scienze e Tecnologia (IEMEST), Palermo, Italy
| | - Adele Fornelli
- Pathology Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, AUSL Romagna, Forlì, Italy
| | - Vincenzo Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì - Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
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Cassiani J, Crinò SF, Manfrin E, Rivelli M, Gabbrielli A, Guglielmi A, Pedrazzani C. Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst. Clin Endosc 2021; 54:767-770. [PMID: 33596637 PMCID: PMC8505176 DOI: 10.5946/ce.2020.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/17/2020] [Indexed: 01/01/2023] Open
Abstract
A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectional imaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenal gland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture the cyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histological analysis of the retrieved fragments revealed a fibrous wall lined by "respiratory-type" epithelium with ciliated columnar cells, consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed based on the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis is commonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectional imaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperative histological diagnosis, thus supporting the decision-making process.
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Affiliation(s)
- Jessica Cassiani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona Hospital Trust, University of Verona, Verona, Italy
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona Hospital Trust, University of Verona, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostic and Public Health, University of Verona Hospital Trust, University of Verona, Verona, Italy
| | - Matteo Rivelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona Hospital Trust, University of Verona, Verona, Italy
| | - Armando Gabbrielli
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona Hospital Trust, University of Verona, Verona, Italy
| | - Alfredo Guglielmi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona Hospital Trust, University of Verona, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona Hospital Trust, University of Verona, Verona, Italy
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20
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Rift CV, Scheie D, Toxværd A, Kovacevic B, Klausen P, Vilmann P, Hansen CP, Lund EL, Hasselby JP. Diagnostic accuracy of EUS-guided through-the-needle-biopsies and simultaneously obtained fine needle aspiration for cytology from pancreatic cysts: A systematic review and meta-analysis. Pathol Res Pract 2021; 220:153368. [PMID: 33652239 DOI: 10.1016/j.prp.2021.153368] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To address the diagnostic accuracy of endoscopic ultrasound guided through-the-needle-biopsies (TTNBs) and simultaneously obtained cytology samples from pancreatic cysts compared to the final histopathological diagnosis of the surgical specimen, and to give an overview of ancillary tests performed on TTNBs. METHODS A literature search was conducted in MEDLINE, Embase and Scopus. Studies were included in the meta-analysis, if they had data for TTNB, cytology and a surgical specimen of pancreatic cysts as reference standard. The assessment of the risk of bias and quality of the included studies was conducted using the modified QUADAS-2 tool. RESULTS Ten studies with 99 patients were included in the meta-analysis. Data regarding study design and clinicopathological features were extracted systematically. For TTNB, pooled sensitivity was 0.86 (95 % CI 0.62-0.96), specificity 0.95 (95 % CI 0.79-0.99) and area under the curve (AUC) 0.86 for the diagnosis of a mucinous cyst and pooled sensitivity was 0.78 (95 % CI 0.61-0.89), specificity 0.99 (95 % CI 0.90-0.99) and AUC 0.92 for the diagnosis of a high-risk cyst. For a specific diagnosis, pooled sensitivity was 0.69 (95 % CI 0.50-0.83), specificity 0.47 (95 % CI 0.28-0.68) and AUC 0.49. For cytology performed simultaneously, pooled sensitivity was 0.46 (95 % CI 0.35-0.57), specificity 0.90 (95 % CI 0.46-0.99) and AUC 0.64 for the diagnosis of mucinous cysts, and pooled sensitivity was 0.38 (95 % CI 0.23-0.55), specificity 0.99 (95 % CI 0.90-0.99) and AUC 0.84 for the diagnosis of a high-risk cyst. For a specific diagnosis, pooled sensitivity was 0.29 (95 % CI 0.21-0.39), specificity 0.45 (95 % CI 0.25-0.66) and AUC 0.30. Furthermore, immunohistochemical stains can be useful to establish the specific cyst subtype. CONCLUSIONS TTNBs have a higher sensitivity and specificity than cytology for the diagnosis of mucinous cyst and high- risk cysts of the pancreas.
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Affiliation(s)
- Charlotte Vestrup Rift
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
| | - David Scheie
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Anders Toxværd
- Department of Pathology, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, DK 2730, Herlev, Denmark
| | - Bojan Kovacevic
- Gastroenterology Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, DK 2730, Herlev, Denmark
| | - Pia Klausen
- Gastroenterology Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, DK 2730, Herlev, Denmark
| | - Peter Vilmann
- Gastroenterology Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, DK 2730, Herlev, Denmark
| | - Carsten Palnæs Hansen
- Department of Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Eva Løbner Lund
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
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21
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Kovacevic B, Klausen P, Rift CV, Toxværd A, Grossjohann H, Karstensen JG, Brink L, Hassan H, Kalaitzakis E, Storkholm J, Hansen CP, Hasselby JP, Vilmann P. Clinical impact of endoscopic ultrasound-guided through-the-needle microbiopsy in patients with pancreatic cysts. Endoscopy 2021; 53:44-52. [PMID: 32693411 DOI: 10.1055/a-1214-6043] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The limited data on the utility of endoscopic ultrasound (EUS)-guided through-the-needle biopsies (TTNBs) in patients with pancreatic cystic lesions (PCLs) originate mainly from retrospective studies. Our aim was to determine the clinical impact of TTNBs, their added diagnostic value, and the adverse event rate in a prospective setting. METHODS This was a prospective, single-center, open-label controlled study. Between February 2018 and August 2019, consecutive patients presenting with a PCL of 15 mm or more and referred for EUS were included. Primary outcome was a change in clinical management of PCLs following TTNB compared with cross-sectional imaging and cytology. Adverse events were defined according to the ASGE lexicon. RESULTS 101 patients were included. TTNBs led to a change in clinical management in 11.9 % of cases (n = 12). Of these, 10 had serous cysts and surveillance was discontinued, while one of the remaining two cases underwent surgery following diagnosis of a mucinous cystic neoplasm. The diagnostic yield of TTNBs for a specific cyst diagnosis was higher compared with FNA cytology (69.3 % vs. 20.8 %, respectively; P < 0.001). The adverse event rate was 9.9 % (n = 10; 95 % confidence interval 5.4 % - 17.3 %), with the most common event being acute pancreatitis (n = 9). Four of the observed adverse events were severe, including one fatal outcome. CONCLUSIONS TTNBs resulted in a change of clinical management in about one in every 10 patients; however, the associated adverse event risk was substantial. Further studies are warranted to elucidate in which subgroups of patients the clinical benefit outweighs the risks.
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Affiliation(s)
- Bojan Kovacevic
- Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
| | - Pia Klausen
- Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
| | | | - Anders Toxværd
- Department of Pathology, Herlev Hospital, Herlev, Denmark
| | - Hanne Grossjohann
- Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark
| | - John Gásdal Karstensen
- Gastroenterology Unit, Pancreatitis Centre East, Hvidovre Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Brink
- Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
| | - Hazem Hassan
- Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
| | | | - Jan Storkholm
- Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Peter Vilmann
- Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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22
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Tacelli M, Celsa C, Magro B, Barchiesi M, Barresi L, Capurso G, Arcidiacono PG, Cammà C, Crinò SF. Diagnostic performance of endoscopic ultrasound through-the-needle microforceps biopsy of pancreatic cystic lesions: Systematic review with meta-analysis. Dig Endosc 2020; 32:1018-1030. [PMID: 31912580 DOI: 10.1111/den.13626] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/24/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Endoscopic ultrasound through-the-needle biopsy (EUS-TTNB) is a useful tool for differential diagnosis among pancreatic cystic lesions (PCLs). Cystic fluid cytology (CFC) is recommended by guidelines, but its diagnostic accuracy is about 50%. The aim of this meta-analysis is to assess the clinical impact of EUS-TTNB in terms of technical success (TS), histological accuracy (HA) and diagnostic yield (DY). METHODS Original studies in English language on EUS-TTNB were searched in MEDLINE and EMBASE until October 2019. Diagnostic accuracy of EUS-TTNB for identification of mucinous PCLs was calculated using individual diagnostic data of patients who underwent CFC and surgery. RESULTS Nine studies, including 454 patients who underwent EUS-TTNB, met the inclusion criteria for the meta-analysis. TS and HA of EUS-TTNB were, respectively, 98.5% (95% Confidence Interval [CI] 97.3%-99.6%) and 86.7% (95%CI 80.1-93.4). DY was 69.5% (95%CI 59.2-79.7) for EUS-TTNB and 28.7% (95%CI 15.7-41.6) for CFC. Heterogeneity persisted significantly high in most of subgroup analyses. In the multivariate meta-regression, cyst size was independently associated with higher DY. Sensitivity and specificity for mucinous PCLs were 88.6 and 94.7% for EUS-TTNB, and 40 and 100% for CFC. Adverse events rate was 8.6% (95%CI 4.0-13.1). CONCLUSIONS This meta-analysis shows that EUS-TTNB is a feasible technique that allows a high rate of adequate specimens to be obtained for histology; in about two-thirds of patients a specific histotype diagnosis could be assessed. The number of adverse events is slightly higher respect to standard EUS-FNA, but complications are very rarely severe.
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Affiliation(s)
- Matteo Tacelli
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Ciro Celsa
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Bianca Magro
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Marco Barchiesi
- Department of Internal Medicine, ASST FBF-Sacco, Milan, Italy
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy
| | - Gabriele Capurso
- Pancreato-biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Calogero Cammà
- Section of Gastroenterology and Hepatology, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
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23
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Crinò SF, Le Grazie M, Manfrin E, Conti Bellocchi MC, Bernardoni L, Granato A, Locatelli F, Parisi A, Di Stefano S, Frulloni L, Larghi A, Gabbrielli A. Randomized trial comparing fork-tip and side-fenestrated needles for EUS-guided fine-needle biopsy of solid pancreatic lesions. Gastrointest Endosc 2020; 92:648-658.e2. [PMID: 32433914 DOI: 10.1016/j.gie.2020.05.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to compare the performance of EUS-guided fine-needle biopsy using fork-tip or side-fenestrated needles in patients with solid pancreatic lesions. METHODS A randomized controlled study was conducted in a single academic center on patients who underwent sampling with fork-tip or side-fenestrated 22-gauge or 25-gauge needles. Three passes were performed, each independently evaluated by a blinded pathologist and by endosonographers for macroscopic on-site evaluation (MOSE). The primary outcome was histologic yield; secondary aims were safety, diagnostic yield, sample quality, number of needle passes required to establish a diagnosis, and reliability of MOSE. RESULTS One hundred ninety-two patients were enrolled. Both 22-gauge and 25-gauge fork-tip needles retrieved significantly higher rates of histologic samples than side-fenestrated needles (P < .013). Safety and diagnostic accuracy were comparable in the 2 arms, whereas sample quality (tissue integrity and blood contamination) was significantly better in the fork-tip group (P < .0001). The median number of diagnostic passes was lower using fork-tip needles (P = .054). The agreement between MOSE and pathologic evaluation was almost perfect in the fork-tip group and fair in the side-fenestrated group. CONCLUSIONS Both needles showed equivalent safety and diagnostic accuracy. However, fork-tip needles provided a higher rate of extremely good-quality histologic samples and required fewer needle passes to reach a diagnosis. MOSE is a highly reliable tool when fork-tip needles are used compared with side-fenestrated needles. (Clinical trial registration number: NCT03622229.).
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Affiliation(s)
- Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Marco Le Grazie
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Erminia Manfrin
- Unit of Pathology, Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Anna Granato
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Alice Parisi
- Unit of Pathology, Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Serena Di Stefano
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy
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24
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Rift CV, Kovacevic B, Toxværd A, Klausen P, Hansen CP, Vilmann P, Hasselby JP. EUS-guided through-the-needle biopsy sampling of pancreatic cystic lesions: a pathologist's guide for the endoscopist. Gastrointest Endosc 2020; 92:252-258. [PMID: 32334016 DOI: 10.1016/j.gie.2020.04.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/15/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Charlotte Vestrup Rift
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bojan Kovacevic
- Gastro Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Anders Toxværd
- Department of Pathology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Pia Klausen
- Gastro Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Carsten Palnæs Hansen
- Department of Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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25
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Current Status of Needles in the Optimization of Endoscopic Ultrasound-Guided Procedures. Diagnostics (Basel) 2020; 10:diagnostics10070463. [PMID: 32650628 PMCID: PMC7400280 DOI: 10.3390/diagnostics10070463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Endoscopic ultrasound (EUS) is among the most important tools for the evaluation of gastrointestinal tumors and affected areas around the gastrointestinal tract. It enables the acquisition of material from abnormal lesions via the gastrointestinal wall for tissue confirmation via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-FNA has played a vital role in oncological care and has become the standard method for tissue sampling. The choice of needle type is an important factor determining tissue acquisition and has been evaluated by many researchers. New needles are introduced into the market almost every year, and opinions vary regarding proper needle selection. While there are diverse opinions but no definitive recommendations about the use of one particular device, fine-needle biopsy needles may provide detailed information on a tissue’s architecture based on greater sample yields. This permits additional analyses, including genetic sequencing and phenotyping, thereby enabling the provision of more personalized treatment plans. Furthermore, other EUS-guided procedures have been developed, including interventional EUS and through-the-needle devices. Given the continued attempts to improve the diagnostic ability and therapeutic techniques, we review in detail the available types of puncture needles to provide guidance on the selection of the appropriate needle types.
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26
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Crinò SF, Gabbrielli A, Manfrin E. Response. Gastrointest Endosc 2020; 92:236-237. [PMID: 32586561 DOI: 10.1016/j.gie.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
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27
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Eiterman A, Lahooti A, Krishna SG. Endosonographic diagnosis of advanced neoplasia in intraductal papillary mucinous neoplasms. World J Gastroenterol 2020; 26:3201-3212. [PMID: 32684735 PMCID: PMC7336327 DOI: 10.3748/wjg.v26.i23.3201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/25/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer has a high mortality rate with minimal proven interventions. Intraductal Papillary Mucinous Neoplasms (IPMNs) are known precursor lesions for pancreatic cancer. Identification of pancreatic cysts has improved from advances in abdominal imaging. Despite multiple revisions of the international consensus recommendations and various guidelines by other major societies, successful risk stratification of the malignant potential of mucinous pancreatic cysts remains challenging. Specifically, detection and accurate classification of advanced neoplasia (high-grade dysplasia and/or adenocarcinoma) in IPMNs is suboptimal with current diagnostic strategies. Development of interventional techniques utilizing endoscopic ultrasound include - through-the-needle microforceps biopsy, next-generation or whole genome molecular analysis of cyst fluid, and needle-based confocal laser endomicroscopy. These techniques suffer from a series of limitations in technical success, diagnostic yield, and clinical feasibility, but a combination approach may offer a solution that optimizes their cyst evaluation and risk stratification. Assessment and comparison of these techniques is restricted by lack of adequate surgical specimens for testing of diagnostic accuracy, resulting in a possible sample bias. Additional large-scale multicenter studies are needed to accumulate evidence for the utility and feasibility of their translation into clinical practice. Great strides have been made in pancreatic cyst evaluation, but further research is required to improve diagnostic accuracy and clinical management of IPMNs.
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Affiliation(s)
- Andrew Eiterman
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Ali Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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28
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Abstract
Important advancements in endoscopic ultrasound-guided tissue sampling techniques and development of new needle designs have improved the diagnostic yield of pancreatic lesions. This innovation in endoscopic ultrasound has also opened the door for early diagnosis and precision therapy in the management of cancer patients. Endoscopic ultrasound fine needle biopsy is an invaluable tool and newer biopsy designs will probably play a pivotal role in the management of pancreatic lesions in the next future. Aim of the current review was to provide an overview on the available techniques and devices for the endoscopic ultrasound-guided sampling of pancreatic solid and cystic lesions.
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29
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Kovacevic B, Kalaitzakis E, Klausen P, Brink L, Hassan H, Karstensen JG, Vilmann P. EUS-guided through-the-needle microbiopsy of pancreatic cysts: Technical aspects (with video). Endosc Ultrasound 2020; 9:220-224. [PMID: 32611847 PMCID: PMC7529000 DOI: 10.4103/eus.eus_12_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cystic lesions are frequently encountered and diagnostically challenging as some of the cysts may have malignant potential (mucinous) while others are completely benign (serous). EUS-guided through-the-needle biopsy (EUS-TTNB) of the cyst wall has recently been introduced as an alternative to cyst fluid cytology. Several studies have shown that microbiopsies outperform cytology in terms of distinction between mucinous and nonmucinous lesions, but also in determining the specific cyst diagnosis. However, little is known about the technical aspects of tissue sampling with TTNB. Herein, we summarize our experience with the procedure in a tertiary referral center and discuss indications, technical aspects, and safety of the procedure. Most adverse events (AEs) associated with the procedure are mild, but there is emerging evidence that the rate of postprocedural pancreatitis is higher compared to standard fine-needle aspiration. The added diagnostic yield should therefore be placed in perspective with an increased risk of AEs. Prospective studies are warranted to fully identify which patient groups could benefit from EUS-TTNB.
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Affiliation(s)
- Bojan Kovacevic
- Gastroenterology Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Evangelos Kalaitzakis
- Gastroenterology Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Pia Klausen
- Gastroenterology Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Lene Brink
- Gastroenterology Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - Hazem Hassan
- Gastroenterology Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
| | - John G Karstensen
- Gastroenterology Unit, Pancreatitis Centre East, Hvidovre Hospital, Department of Clinical Medicine, Copenhagen University, Hvidovre, Denmark
| | - Peter Vilmann
- Gastroenterology Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, Herlev, Denmark
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30
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Haghighi M, Sethi A, Tavassoly I, Gonda TA, Poneros JM, McBride RB. Diagnosis of Pancreatic Cystic Lesions by Virtual Slicing: Comparison of Diagnostic Potential of Needle-Based Confocal Laser Endomicroscopy versus Endoscopic Ultrasound-Guided Fine-Needle Aspiration. J Pathol Inform 2019; 10:34. [PMID: 31799020 PMCID: PMC6883479 DOI: 10.4103/jpi.jpi_32_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pancreatic cystic lesions are often challenging entities for diagnosis and management. EUS-FNA diagnostic accuracy is limited by paucicellularity of cytology specimens and sampling errors. Needle-based confocal laser endomicroscopy (nCLE) provides real-time imaging of the microscopic structure of the cystic lesion and could result in a more accurate diagnosis. AIMS AND OBJECTIVES To determine the diagnostic utility of in vivo nCLE and EUS-FNA in the diagnosis and histologic characterization of pancreatic cystic lesions (PCL). MATERIALS AND METHODS All patients diagnosed with PCL who had undergone nCLE and FNA over a 10-year period within a major urban teaching hospital were included in this study. All gastroenterology reports of the nCLE images and corresponding pathologist findings from the EUS-FNA were collected and compared with, a final diagnosis prospectively collected from clinicopathological and imaging data. RESULTS A total of n=32 patients were included in this study, which consisted of n=13 serous cystadenoma (SCA), n=7 intraductal papillary mucinous neoplasms (IPMN), n=2 mucinous cystic neoplasms (MCN), n=3 well-differentiated neuroendocrine tumors, n=2 cysts, n=2 benign pancreatic lesions, n=1 adenocarcinoma, n=1 gastrointestinal stromal tumor (GIST) and n=1 lymphangioma. The overall diagnostic rate was higher in nCLE (87.5%) vs. EUS-FNA (71.9%) While the diagnostic accuracy of nCLE and EUS-FNA were comparable in characterization of benign vs. malignant lesions, the nCLE diagnosis demonstrated higher accuracy rate in identifying mucinous cystic neoplasms compared to EUS-FNA. CONCLUSION nCLE is a useful companion diagnostic tool for pancreatic cystic lesions and could assist the cytopathologist to better triage the sample for required ancillary testing and treatment planning. The combination of nCLE and EUS-FNA may be especially helpful in reducing the proportion of cases categorized as non-diagnostic.
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Affiliation(s)
- Mehrvash Haghighi
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA
| | - Iman Tavassoly
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tamas A. Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA
| | - John M. Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York City, New York, USA
| | - Russell B. McBride
- Department of Pathology, The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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