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Min L, Qing Y, Chu Y, Liang C, Lv L, Liu D, Tan Y, Zhou Y. Role of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in the Diagnosis of Suspicious Malignant Esophageal Strictures. J Clin Med 2023; 12:jcm12062153. [PMID: 36983155 PMCID: PMC10057162 DOI: 10.3390/jcm12062153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: The accurate diagnosis of esophageal strictures is quite critical for optimizing medical intervention. However, the diagnosis of suspicious malignant esophageal strictures with intact mucosa appearance and negative biopsy results is challenging. This study aimed to evaluate the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis of suspicious esophageal strictures. (2) Methods: We retrospectively analyzed the cases with suspicious malignant esophageal strictures that underwent EUS-FNA, with or without rapid on-site evaluation (ROSE), in our hospital from April 2017 to September 2022. Their clinical manifestations, imaging examinations, gastroscopic examinations, EUS-FNA results, and therapeutic strategies were retrospectively recorded and analyzed. (3) Results: A total of 23 patients (15 male and 8 female) were enrolled in this study. Based on EUS-FNA results, 18 patients were diagnosed with malignancies, including 16 cases of primary esophageal cancer (13 squamous carcinomas and 3 adenocarcinomas), 1 case of mediastinal cancer, and 1 case of metastatic esophageal cancer; 1 case of tuberculosis was also confirmed by EUS-FNA. Among 4 cases of ambiguous diagnosis with EUS-FNA, 1 was diagnosed with an esophageal glomus tumor after surgical removal, and 2 patients survived for several years without medical intervention, which hinted at the possibility of benign esophageal strictures. No major complications, including bleeding or perforation, were observed. (4) Conclusions: EUS-FNA may serve as a safe and effective diagnostic tool in suspicious malignant esophageal strictures with accurate specimen acquisition, especially for biopsy-negative cases.
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Affiliation(s)
- Liang Min
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Yumin Qing
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Yi Chu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
- Correspondence: (D.L.); (Y.T.); (Y.Z.)
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
- Correspondence: (D.L.); (Y.T.); (Y.Z.)
| | - Yuqian Zhou
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
- Research Center of Digestive Disease, Central South University, Changsha 410011, China
- Correspondence: (D.L.); (Y.T.); (Y.Z.)
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van Hemel BM, Lamprou AA, Weersma R, Plukker JTM, Suurmeijer AJH, van Dullemen HM. Procedure-related, false-positive cytology results during EUS-guided FNA in patients with esophageal cancer. Gastrointest Endosc 2010; 71:1130-3. [PMID: 20598243 DOI: 10.1016/j.gie.2010.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 01/22/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND EUS is a standard staging procedure in esophageal cancer. For adequate staging, FNA of suspicious lymph nodes is recommended. Based on optimal staging, sophisticated treatment can be applied more properly. The working channel of the endoscope can potentially be contaminated by cancer cells derived from the luminal surface of esophageal cancer during EUS-guided FNA, which may result in false-positive cytology results of EUS-guided FNA of celiac lymph nodes. OBJECTIVE To determine whether passing an endoscope through intraluminal esophageal cancer can lead to contamination of the working channel with tumor cells. DESIGN An ex vivo assessment of contamination of endoscope working channels. SETTING University hospital. PATIENTS This study involved 13 patients with esophageal cancer. INTERVENTION Working channels of endoscopes that had been used in patients with intraluminal esophageal cancer were studied immediately after EUS. A routine ex vivo FNA was performed through the endoscope on 8 patients. The same procedure was performed through the endoscope on 5 other patients after the working channel had been cleaned by extensive flushing. MAIN OUTCOME MEASUREMENTS Semiquantitative scoring of cytology smears. RESULTS Six of 8 specimens contained carcinoma cells. No contamination by carcinoma cells or normal cells was observed when the working channel was flushed with tap water prior to the sham FNA procedure. LIMITATIONS This was an ex vivo study of a limited group of patients. CONCLUSION The working channel of the endoscope can be contaminated during the EUS-guided FNA procedure. Cancer cell contamination can be avoided by flushing the endoscope.
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Affiliation(s)
- Bettien M van Hemel
- Departments of Pathology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Zhang S, Abreo F, Lowery-Nordberg M, Veillon DM, Cotelingam JD. The role of fluorescence in situ hybridization and polymerase chain reaction in the diagnosis and classification of lymphoproliferative disorders on fine-needle aspiration. Cancer Cytopathol 2010; 118:105-12. [PMID: 20340097 DOI: 10.1002/cncy.20070] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) has been used in the evaluation of lymphadenopathy for a long time and is highly reliable in the identification of metastatic malignancies. However, the role of FNA in the assessment of new lymphoproliferative disorders continues to be a subject of debate. The objective of the current study was to evaluate the role of molecular cytogenetic studies in FNA diagnoses of lymphoproliferative disorders. METHODS A retrospective, computer-based search for lymph node FNAs from 2006 to 2007 was performed. Cases with either fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR) studies were subjected to further analysis. RESULTS In total, 243 lymph node FNAs were performed during the period, including 104 that were positive/suspicious for metastatic malignancies, 16 that were positive/suspicious for lymphomas, 15 that demonstrated atypical lymphoid proliferation, 73 that were reactive, 14 that were deemed granulomas, and 21 that were determined to be nondiagnostic. Molecular analysis included combined FISH/PCR in 4 cases, FISH only in 7 cases, and PCR only in 4 cases. By using multiplex PCR, 6 cases with atypical/negative flow cytometry results were diagnosed as 4 B-cell lymphomas, 1 T-cell lymphoma, and 1 reactive lymph node; and 4 cases that had atypical T cells determined by flow cytometry were diagnosed as reactive. One CD10-negative follicular lymphoma and 2 cases with suspicious flow cytometry results were positive for t(14;18)(q32;q21) by FISH. Forty-five cases had follow-up histology with 3 false-negative findings and no false-positive results. CONCLUSIONS In this study, multiplex PCR studies for immunoglobulin heavy-chain or T-cell receptor gene rearrangements were useful for demonstrating clonality, and FISH studies were able to detect translocations or gene rearrangements that allowed for the subclassification of B-cell non-Hodgkin lymphomas.
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Affiliation(s)
- Songlin Zhang
- Department of Pathology, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71130, USA.
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Polkowski M. Endosonographic staging of upper intestinal malignancy. Best Pract Res Clin Gastroenterol 2009; 23:649-61. [PMID: 19744630 DOI: 10.1016/j.bpg.2009.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 05/26/2009] [Indexed: 02/07/2023]
Abstract
Numerous studies conducted over the last 25 years provide evidence on the high diagnostic accuracy and important role of endoscopic ultrasonography (EUS) in staging oesophageal and gastric carcinoma. This extensive research was recently subjected to metaanalyses, condensing our knowledge on EUS performance and facilitating its comparison with competing methods. It is, however, important to realise that the management of oesophageal and gastric carcinoma is evolving and so are staging algorithms, setting new challenges for EUS and re-defining its position. Restaging after neoadjuvant treatment and precise assessment of early carcinoma before endoscopic treatment are areas of growing interest, but the role of EUS in these settings is rather limited. Rapidly developing cross-sectional imaging has the potential to challenge the position of EUS as the most accurate method in loco-regional staging. On the other hand, EUS guided fine-needle aspiration offers the unique opportunity to obtain cytological confirmation of lymph node metastases, with future potential for molecular staging.
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Affiliation(s)
- M Polkowski
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland.
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Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer. Gastrointest Endosc 2009; 69:1210-7. [PMID: 19012886 DOI: 10.1016/j.gie.2008.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 08/07/2008] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although EUS-guided FNA (EUS-FNA) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) are both used in the staging of esophageal cancer, the utility of routinely performing both tests is unclear. OBJECTIVES The primary aim of the study was to determine the benefit of routine FDG-PET for esophageal cancer nodal staging in patients undergoing EUS-FNA. The secondary objective was to determine EUS criteria that selectively identify patients in whom PET yields additional information. DESIGN Retrospective chart review. SETTING Tertiary-care academic medical center. PATIENTS AND INTERVENTIONS All patients who underwent both EUS and PET for initial staging of esophageal cancer between April 2003 and August 2007. MAIN OUTCOME MEASUREMENTS EUS and PET detection of malignant lymph nodes and distant metastases. RESULTS Of 242 patients who underwent esophageal EUS for a malignant indication, 148 also underwent PET within 30 days. EUS detected locoregional-node disease by EUS criteria or cytology in 92 patients, and PET was positive in a minority of these patients (n = 41 [45%]). For celiac-node staging, PET was positive in 2 of 17 patients (12%) with celiac-node involvement detected by EUS. EUS was also significantly more sensitive than PET in the detection of nodal disease confirmed by cytology or histology (86% vs 44%). PET did not alter nodal staging in any patient with complete EUS-FNA. PET identified distant metastases only in those patients with incomplete EUS or nodal disease detected by EUS. LIMITATIONS Single institution, retrospective analysis. CONCLUSIONS The addition of PET to a complete EUS examination did not alter regional-node or celiac-node staging. PET performance in overall staging is strongly associated with EUS assessment of lymph nodes.
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