Ultrasound-Enhanced Fine-Needle Biopsy Improves Yield in Human Epithelial and Lymphoid Tissue

OBJECTIVE

Needle biopsy is a common technique used to obtain cell and tissue samples for diagnostics. Currently, two biopsy methods are widely used: (i) fine-needle aspiration biopsy (FNAB) and (ii) core needle biopsy (CNB). However, these methods have limitations. Recently, we developed ultrasound-enhanced fine-needle aspiration biopsy (USeFNAB), which employs a needle that flexurally oscillates at an ultrasonic frequency of ∼32 kHz. The needle motion contributes to increased tissue collection while preserving cells and tissue constructs for pathological assessment. Previously, USeFNAB has been investigated only in ex vivo animal tissue. The present study was aimed at determining the feasibility of using USeFNAB in human epithelial and lymphoid tissue.

METHODS

Needle biopsy samples were acquired using FNAB, CNB and USeFNAB on ex vivo human tonsils (N = 10). The tissue yield and quality were quantified by weight measurement and blinded pathologists' assessments. The biopsy methods were then compared.

RESULTS

The results revealed sample mass increases of, on average, 2.3- and 5.4-fold with USeFNAB compared with the state-of-the-art FNAB and CNB, respectively. The quality of tissue fragments collected by USeFNAB was equivalent to that collected by the state-of-the-art methods in terms of morphology and immunohistochemical stainings made from cell blocks as judged by pathologists.

CONCLUSION

Our study indicates that USeFNAB is a promising method that could improve tissue yield to ensure sufficient material for ancillary histochemical and molecular studies for diagnostic pathology, thereby potentially increasing diagnostic accuracy.

The diagnostic performance of novel torque technique for endoscopic ultrasound-guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial

BACKGROUND AND AIM

Although several techniques for improved outcomes in endoscopic ultrasound (EUS)-guided tissue acquisition have been reported, the reported diagnostic yield for pancreatic masses is not satisfactory. The effects of novel technique (torque method) on twisting the scope in the clockwise or counterclockwise direction during EUS-fine needle biopsy (EUS-FNB) are unknown. We compared the diagnostic yield of EUS-FNB for pancreatic masses using the torque and standard techniques.

METHODS

From April 20, 2017, to March 16, 2018, 124 consecutive patients with solid pancreatic mass who underwent EUS-FNB using either the torque or standard technique were randomly assigned. Three passes were made with each technique, comprising 10 uniform to-and-fro movements on each pass with a 10-mL syringe suction. The primary outcome was procurement rates of histologic cores, and the secondary outcomes were the diagnostic performance and technical failure.

RESULTS

There were significant differences between the groups regarding the procurement rate of the histologic core and optimal quality core (standard vs torque: 87.1% [54/62] vs 98.4% [61/62], P = 0.038 and 79.0% [49/62] vs 93.5% [58/62], P = 0.037). The sensitivity, specificity, positive predictive value, and negative predictive values of EUS-FNB were 85.45%, 100%, 100%, and 46.67%, respectively, for the standard technique and 96.49%, 100%, 100%, and 71.43%, respectively, for the torque technique. The diagnostic accuracies of the standard and torque techniques were 87.10% and 96.77%, respectively.

CONCLUSIONS

The torque technique for EUS-FNB offered acceptable technical feasibility and superior diagnostic performance, including optimal histologic core procurement, compared with the standard technique.

Best practices in endoscopic ultrasound-guided fine-needle aspiration

Over the past 2 decades, endoscopic ultrasound-guided fine-needle aspiration has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. The technique is useful for biopsy of mucosal and submucosal lesions in which prior endoscopic biopsies have been nondiagnostic; to sample peri-intestinal structures such as lymph nodes; and to sample masses in the pancreas, liver, adrenal glands, gallbladder, and bile duct. Also, with the advent of neoadjuvant therapies for diseases such as pancreatic cancer, most patients require a tissue diagnosis before initiating treatment. This review provides a perspective on technical issues that are key for best practices in endoscopic ultrasound-guided fine-needle aspiration.

Presence of intratumoral anechoic foci predicts an increased number of endoscopic ultrasound-guided fine-needle aspiration passes required for the diagnosis of pancreatic adenocarcinoma

BACKGROUND AND AIM

For reduction in cost, time and risk of complications, the number of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) passes should be minimized. Previous studies have shown that tumor differentiation and site of aspiration will affect the number of passes in patients with pancreatic cancer. There have been no reports that EUS features of pancreatic malignancies per se will influence the number of passes. Our aim was to prospectively assess various factors that would affect the number of passes in patients with pancreatic cancer.

METHODS

Between May 2003 and December 2004, 41 patients with presumed pancreatic cancer were studied. EUS-guided FNA was performed with an Olympus GF-UC2000P echoendoscope and a 22-gauge needle. On-site assessment of the specimen by a cytopathologist was available during the procedure.

RESULTS

Adenocarcinomas were confirmed in 25 patients. Pancreatic adenocarcinomas with intratumoral anechoic foci required a higher number of diagnostic passes than those without anechoic change (3.40 vs 2.27, P < 0.05). An average of 4.00 FNA passes for diagnosing a well-differentiated adenocarcinoma was also significantly higher than the 2.40 diagnostic passes for a moderately differentiated adenocarcinoma and the 2.00 passes for a poorly differentiated one (P < 0.05).

CONCLUSIONS

The existence of intratumoral anechoic foci was not a rare finding under detailed EUS investigation of pancreatic cancer. Both the existence of intratumoral anechoic foci and the differentiation of the cancer are significant predictive factors for the number of diagnostic EUS-FNA passes.

Usefulness of endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of pancreatic cancer

BACKGROUND

Endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) has come into widespread use, mainly in Western countries, as an efficient and safe method for the cytologic or histologic diagnosis of pancreatic cancer. However, it still has received relatively little attention in Japan. To evaluate the clinical status of EUS-FNAB in Japan, we retrospectively analyzed the results with regard to the ability of EUS-FNAB to diagnose pancreatic cancer, as well as its safety.

METHODS

A total of 52 patients (37 male, 15 female; mean age, 62.5 years; range, 33-85 years) with focal pancreatic lesions underwent EUS-FNAB at our group of hospitals in one region of Japan. Final diagnosis was confirmed by histologic examination of surgical specimens or clinical follow-up.

RESULTS

The final diagnoses were malignant tumors in 32 patients and benign ones in 20. Insertion of the needle into the lesion was successful in 50 of the 52 patients (96.2%). Adequate specimens were obtained by EUS-FNAB from 47 of the 50 pancreatic lesions (94.0%). With five false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 89.4%, 82.1%, 100%, 100%, and 79.2%, respectively. No complications occurred.

CONCLUSIONS

EUS-FNAB is an efficient and safe method for the histologic diagnosis of pancreatic cancer. It should be considered as one of the indispensable modalities for the histological diagnosis of pancreatic cancer in Japan, as it is in Western countries.

Autoimmune chronic pancreatitis

In recent years a peculiar type of chronic pancreatitis with underlying autoimmunity has been described. Lymphoplasmacytic infiltration and fibrosis on histology and elevated IgG levels or detected autoantibodies on laboratory data support the concept of autoimmune chronic pancreatitis (AIP). Pancreatic imaging reveals a rare association of diffuse enlargement of the pancreas and irregular narrowing of the main pancreatic duct, which is unique and specific to AIP. Although AIP is not a common disease, it is increasingly being recognized as knowledge of this entity builds up. Clinically it is very important to be aware of this disease because AIP can clinically disguise as pancreaticobiliary malignancies, ordinary chronic, or acute pancreatitis. Above all, AIP is a very attractive disease to clinicians in terms of its dramatic response to oral steroid therapy in contrast to ordinary chronic pancreatitis. This review discusses the clinical, laboratory, histologic, and imaging findings that are seen in patients with AIP, especially focusing on the diagnosis.

Role of fine needle aspiration cytology and endoscopic biopsy in the preoperative assessment of pancreatic and peripancreatic malignancies

Sixty-seven of 207 patients with pancreatic and peripancreatic malignancies underwent preoperative fine needle aspiration cytology (FNA), and 24 patients underwent intraluminal endoscopic biopsies. All patients had confirmation of the diagnosis of malignancy either at operation, autopsy, or by clinical follow-up. FNA of liver metastases was positive for malignancy in 12 of 12 patients. FNA of the pancreas was performed on 44 patients with pancreatic adenocarcinoma and 11 patients with other pancreatic or peripancreatic malignancies. The diagnosis of cancer was established by FNA in 32 of 44 (72.4%) patients with pancreatic adenocarcinoma and 1 of 11 patients (9.1%) with other pancreatic or peripancreatic malignancies. In the patients with pancreatic adenocarcinoma, 17 of 18 patients (94.4%) who had no operative intervention, 12 of 18 (66.7%) patients who had palliative bypass procedures, and 3 of 8 (37.5%) patients resected had positive FNA. Eighteen of 24 patients (75%) who underwent intraluminal endoscopic biopsies, and 11 of 15 (73.3%) with ampullary carcinoma were positive. We believe that FNA is of limited value in the diagnosis of small resectable tumors of the pancreas as it identified cancer in only 3 of 8 patients in whom it was employed. False negative FNA may delay the diagnosis and treatment of pancreatic malignancies. Patients in whom there is a high index of suspicion of pancreatic or peripancreatic malignancy based on clinical presentation, CT scan, or ERCP assessment do not require preoperative, histologic proof of malignancy prior to pancreaticoduodenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Fine-needle aspiration biopsy of pancreatic ductal adenocarcinoma: loss of diagnostic accuracy with small tumors

Eighty-three patients underwent CT-directed fine-needle aspiration biopsies (FNAB) for pancreatic ductal adenocarcinoma. Five factors that might have influenced the diagnostic sensitivity of FNAB were analyzed: clinical history, the number of passes for each FNAB, and three radiologic criteria including tumor size, tumor location, and the presence or absence of suspected tumor necrosis by CT scan. Sixty-three patients had a diagnosis of pancreatic carcinoma confirmed by FNAB (overall sensitivity = 76%). Tumor size was the only factor that correlated with the diagnostic sensitivity of FNAB. [table: see text] Of 12 patients whose FNAB was negative but suspicious for malignancy, 10 had a repeat FNAB and 4 were positive for carcinoma. We conclude that the diagnostic sensitivity of FNAB decreases significantly with decreasing tumor size and that a repeat FNAB for suspicious biopsies should be done to increase the diagnostic yield.

Diagnostic value of cytology for biliary stricture

Over the past 20 years, bile aspiration at endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography has been developed for cytological diagnosis of biliary tract stricture. This safe and specific test has allowed a diagnosis to be reached before or without operation in about one-third of malignancies of the pancreas or biliary tree. The recent development of biliary brush cytology has produced better results. An endobiliary biopsy forceps is now available that may allow safe sampling of lesions causing extrinsic compression of the biliary tract. An endobiliary aspiration cytology needle has been produced that may permit non-ulcerating lesions to be diagnosed. A safe alternative to endobiliary methods is percutaneous fine-needle aspiration cytology; this yields a diagnosis in about half of patients presenting with obstructive jaundice and an imaged mass lesion.

Intraoperative fine needle aspiration cytology of pancreatic lesions

The aim of the present study was to demonstrate the practicality of intraoperative fine needle aspiration (FNA) cytology of pancreatic lesions in 43 patients. The indication for performing this procedure was to determine the nature of pancreatic masses. Conclusive cytologic diagnoses were reached in 41 patients who represent the present study. On the basis of histologic findings in 30 cases (73.2%) and on clinical findings in 11 cases (26.8%), a final diagnosis of malignant pancreatic disease (MPD) was established in 31 and of benign pancreatic disease (BPD) in 10 patients. Among the 31 cases with MPD, the cytologic diagnosis was correct in 30 patients and falsely negative in one patient. Among 10 patients with BPD, all the cytologic finding were reported as benign. The sensitivity and specificity and positive and negative predictive values for cytologic findings were 96.8%, 100%, 100%, and 90.9%, respectively. The diagnostic accuracy of FNA cytology was 97.6%. No complications followed the procedure. We conclude that intraoperative FNA cytology of pancreatic lesions is a simple, safe, highly sensitive, and specific tool in differentiating benign from malignant pancreatic lesions. This procedure should be carried out in any patient with pancreatic mass incidentally found at laparotomy or in a patient undergoing surgery because of suspected nonmetastasizing MPD in whom repeated imaging guided FNA failed to demonstrate malignancy.

Percutaneous biopsy of pancreatic lesions

Percutaneous biopsy provides an effective means of tissue diagnosis in pancreatic lesions. Accuracy rates are ranging between 72 and 100%, with a sensitivity for carcinomas between 69 and 90% and a constantly high specificity of 100% in most series of the literature. The rate of major complications is low, with an incidence of about 0.05%.