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Sugimoto M, Takagi T, Suzuki R, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Hashimoto Y, Hikichi T, Ohira H. Lymphadenopathy Tissue Sampling by EUS-Guided Fine-Needle Biopsy Contributes to Meeting the Conditions for Genomic Profiling. J Clin Gastroenterol 2024:00004836-990000000-00325. [PMID: 39042483 DOI: 10.1097/mcg.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/12/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND AIMS EUS-guided fine-needle biopsy (EUS-FNB) performed with a Franseen needle or Fork-tip needle enables greater tissue acquisition. However, it is unknown whether EUS-FNB could contribute to lymphadenopathy genomic profiling. The aim of this study was to determine the efficacy of EUS-FNB using a Franseen or Fork-tip needle for tissue acquisition and genomic profiling in patients with lymphadenopathy. PATIENTS AND METHODS Patients with abdominal lymphadenopathy who underwent EUS-guided fine needle aspiration (FNA)/EUS-FNB were included in this study. The amount of acquired tissue and its suitability for genomic profiling were compared between FNA and FNB. Specimen quality was evaluated by a widely used pathologic adequacy scoring system (0: insufficient; 1 to 2: cytologic; 3: limited histologic; 4 to 5: sufficient histologic). The criteria of FoundationOne CDx (F1CDx) and NCC Oncopanel (NOP) were used to assess the suitability for genomic profiling. RESULTS In total, 72 patients underwent EUS-FNA, and the other 20 patients underwent EUS-FNB. The pathologic adequacy score and suitability for genomic profiling based on the criteria were significantly higher for FNB than for FNA [histologic adequacy score: 5 (4 to 5) versus 3 (0 to 5), P<0.01; F1CDx: 16.7% vs. 0%, P=0.01; NOP: 66.7% vs. 7.5%, P<0.01]. In multivariate analysis, EUS-FNB was identified as the only factor that influenced the suitability for genomic profiling based on the above-mentioned criteria (odds ratio 19.5, 95% CI: 3.74-102, P<0.01). CONCLUSIONS EUS-FNB performed using Franseen or Fork-tip needles may result in greater lymphadenopathy tissue acquisition and thus enhanced suitability for genomic profiling compared with EUS-FNA.
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Affiliation(s)
| | | | - Rei Suzuki
- Department of Gastroenterology, School of Medicine
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine
| | | | - Yuki Sato
- Department of Gastroenterology, School of Medicine
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital
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Okuno M, Iwata K, Mukai T, Kito Y, Tanaka T, Watanabe N, Kasahara S, Iwasa Y, Sugiyama A, Nishigaki Y, Shibata Y, Kitagawa J, Iwashita T, Tomita E, Shimizu M. Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration. Clin Endosc 2024; 57:364-374. [PMID: 37743067 PMCID: PMC11133993 DOI: 10.5946/ce.2023.095] [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: 03/25/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML). METHODS Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles. RESULTS Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1-6] vs. 4 [1-6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group. CONCLUSIONS Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.
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Affiliation(s)
- Mitsuru Okuno
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Keisuke Iwata
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takuji Tanaka
- Department of Diagnostic Pathology, Gifu Municipal Hospital, Gifu, Japan
| | - Naoki Watanabe
- Department of Diagnostic Pathology, Gifu Municipal Hospital, Gifu, Japan
| | - Senji Kasahara
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | - Yuhei Iwasa
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Akihiko Sugiyama
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Youichi Nishigaki
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Yuhei Shibata
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | | | - Takuji Iwashita
- First Department of Internal Medicine, Gifu Univeristy Hospital, Gifu, Japan
| | - Eiichi Tomita
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu Univeristy Hospital, Gifu, Japan
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Bellisario F, Attili F, Campana F, Borrelli de Andreis F, Bellesi S, Maiolo E, Alma E, Malafronte R, Macis G, Larocca LM, Annunziata S, D’Alò F, Hohaus S. Endoscopic Ultrasound-Guided Fine Needle Biopsy in the Diagnostic Work-Up of Deep-Seated Lymphadenopathies and Spleen Lesions: A Monocentric Experience. Diagnostics (Basel) 2023; 13:2839. [PMID: 37685377 PMCID: PMC10487140 DOI: 10.3390/diagnostics13172839] [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: 06/13/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023] Open
Abstract
EUS-FNB has been introduced in clinical practice as a less invasive diagnostic approach with respect to surgery. We performed a single-center retrospective study on the diagnostic efficacy of EUS-guided FNB, including 171 patients with lymph nodes, splenic, and extranodal lesions that underwent EUS for FNB at our institution. Excluding 12 patients who did not undergo FNB and 25 patients with a previous diagnosis of a solid tumor, we included 134 patients with clinical/radiological suspect of a lymphoproliferative disease, including 20 patients with a previous history of lymphoma. Out of the 134 biopsies, material of diagnostic quality was obtained in 111 procedures (84.3%). Histological examination of the EUS-FNB samples produced an actionable diagnosis in 100 cases (74.6%). Among the patients without an actionable diagnosis, a second, different diagnostic procedure produced a further eight diagnoses of lymphoma. Therefore, the sensitivity of EUS-FNB for diagnosing lymphomas was calculated to be 86.4% (51/59). Assignment of lymphomas to WHO classification subtypes was possible in 47/51 (92%) of the cases. In conclusion, EUS-FNB is an effective procedure for the histological characterization of lesions that are suspected to be lymphoproliferative disease, allowing for an actionable diagnosis in 75% of cases.
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Affiliation(s)
- Flaminia Bellisario
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Fabia Attili
- Endoscopia Digestiva, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.B.d.A.)
| | - Fabrizia Campana
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Federica Borrelli de Andreis
- Endoscopia Digestiva, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.A.); (F.B.d.A.)
| | - Silvia Bellesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Rosalia Malafronte
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Macis
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Luigi Maria Larocca
- Patologia Oncoematologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Salvatore Annunziata
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
| | - Francesco D’Alò
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.B.); (S.B.); (E.M.); (E.A.); (R.M.); (G.M.); (S.A.); (S.H.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Carrara S, Rahal D, Khalaf K, Rizkala T, Koleth G, Bonifacio C, Andreozzi M, Mangiavillano B, Auriemma F, Bossi P, Balzarotti M, Facciorusso A, Staiano T, Maldi E, Spadaccini M, Colombo M, Fugazza A, Maselli R, Hassan C, Repici A. Diagnostic accuracy and safety of EUS-guided end-cutting fine-needle biopsy needles for tissue sampling of abdominal and mediastinal lymphadenopathies: a prospective multicenter series. Gastrointest Endosc 2023; 98:191-198. [PMID: 36990125 DOI: 10.1016/j.gie.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND AIMS The role of the newer EUS fine-needle biopsy needles in lymphadenopathies (LAs) is still under evaluation. We aimed to evaluate the diagnostic accuracy and adverse event rate of EUS-guided fine-needle biopsy sampling (EUS-FNB) in diagnosing LAs. METHODS From June 2015 to June 2022, all patients referred to 4 institutions for EUS-FNB of mediastinal and abdominal LAs were enrolled. Twenty-two-gauge Franseen tip or 25-gauge fork-tip needles were used. The criterion standard for positive results was surgery or imaging and clinical evolution over a follow-up of at least 1 year. RESULTS One hundred consecutive patients were enrolled, consisting of those with a new diagnosis of LA (40%), presence of LA with a previous history of neoplasia (51%), or suspected lymphoproliferative disease (9%). EUS-FNB was technically feasible in all LA patients with 2 to 3 passes (mean, 2.62 ± .93). The overall sensitivity, positive predictive value, specificity, negative predictive value, and accuracy for EUS-FNB were 96.20%, 100%, 100%, 87.50%, and 97.00%, respectively. Histologic analysis was feasible in 89% of cases. Cytologic evaluation was performed in 67% of specimens. A statistical difference between the accuracy of the 22-gauge or 25-gauge needle (P = .63) was not found. A subanalysis on lymphoproliferative disease revealed a sensitivity and accuracy of 89.29% and 90.0%, respectively. No adverse events were recorded. CONCLUSIONS EUS-FNB with new end-cutting needles is a valuable and safe method to diagnose LAs. The high quality of histologic cores and the good amount of tissue allowed a complete immunohistochemical analysis of metastatic LAs and precise subtyping of the lymphomas. (Clinical trial registration number: NCT02855151.).
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Affiliation(s)
| | - Daoud Rahal
- Department of Pathology, Humanitas Research Center- IRCCS, Milan, Italy
| | - Kareem Khalaf
- Division of Gastroenterology and Digestive Endoscopy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Tommy Rizkala
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Glenn Koleth
- Division of Gastroenterology and Digestive Endoscopy
| | | | | | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy Humanitas University, Pieve Emanuele, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy Humanitas University, Pieve Emanuele, Italy
| | - Paola Bossi
- Department of Pathology, Humanitas Research Center- IRCCS, Milan, Italy
| | - Monica Balzarotti
- Department of Medical Oncology and Hematology, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Teresa Staiano
- Digestive Endoscopy Unit, Candiolo Cancer Institute-IRCCS, Turin, Italy
| | - Elena Maldi
- Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Roberta Maselli
- Division of Gastroenterology and Digestive Endoscopy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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5
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Facciorusso A, Crinò SF, Gkolfakis P, Ramai D, Lisotti A, Papanikolaou IS, Mangiavillano B, Tarantino I, Anderloni A, Fabbri C, Triantafyllou K, Fusaroli P. Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis. Gastroenterol Rep (Oxf) 2022; 10:goac062. [PMCID: PMC9632631 DOI: 10.1093/gastro/goac062] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Endoscopic ultrasound (EUS)-guided tissue acquisition represents the choice of methods for suspected lymph nodes (LNs) located next to the gastrointestinal tract. This study aimed to compare the pooled diagnostic performance of EUS-guided fine-needle biopsy (EUS-FNB) and fine-needle aspiration (EUS-FNA) for LNs sampling.
Methods
We searched PubMed/MedLine and Embase databases through August 2021. Primary outcome was diagnostic accuracy; secondary outcomes were sensitivity, specificity, sample adequacy, optimal histological core procurement, number of passes, and adverse events. We performed a pairwise meta-analysis using a random-effects model. The results are presented as odds ratio (OR) or mean difference along with 95% confidence interval (CI).
Results
We identified nine studies (1,276 patients) in this meta-analysis. Among these patients, 66.4% were male; the median age was 67 years. Diagnostic accuracy was not significantly different between the two approaches (OR, 1.31; 95% CI, 0.81–2.10; P = 0.270). The accuracy of EUS-FNB was significantly higher when being performed with newer end-cutting needles (OR, 1.87; 95% CI, 1.17–3.00; P = 0.009) and in abdominal LNs (OR, 2.48; 95% CI, 1.52–4.05; P < 0.001) than that of EUS-FNA. No difference in terms of sample adequacy was observed between the two approaches (OR, 1.40; 95% CI, 0.46–4.26; P = 0.550); however, histological core procurement and diagnostic sensitivity with EUS-FNB were significantly higher than those with EUS-FNA (OR, 6.15; 95% CI, 1.51–25.07; P = 0.010 and OR, 1.87; 95% CI, 1.27–2.74, P = 0.001). The number of needle passes needed was significantly lower in the EUS-FNB group than in the EUS-FNA group (mean difference, −0.54; 95% CI, −0.97 to −0.12; P = 0.010).
Conclusions
EUS-FNA and EUS-FNB perform similarly in LN sampling; however, FNB performed with end-cutting needles outperformed FNA in terms of diagnostic accuracy.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia , Foggia, Italy
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona , Verona, Italy
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona , Verona, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB) , Brussels, Belgium
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health , Salt Lake City, UT, USA
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna , Imola, 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
| | | | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT , Palermo, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center—IRCCS , Rozzano, Milano, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna , Forlì-Cesena, 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 , Imola, Italy
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6
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Facciorusso A, Crinò SF, Muscatiello N, Gkolfakis P, Samanta J, Londoño Castillo J, Cotsoglou C, Ramai D. Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study. Cancers (Basel) 2021; 13:cancers13174298. [PMID: 34503112 PMCID: PMC8428361 DOI: 10.3390/cancers13174298] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Lymph node (LN) sampling or staging is crucial to the management of malignancies. The use of endoscopic ultrasound for lymph node sampling can be performed with EUS fine-needle aspiration (FNA) or EUS fine-needle biopsy (FNB). However, it remains unclear whether EUS-FNA or EUS-FNB is superior for sampling of abdominal lymph nodes. In this study, we retrospectively compared a large volume of patients who underwent lymph node sampling using EUS-FNA or EUS-FNB. Most patients were diagnosed with metastatic colorectal disease. We found that EUS-FNB had a higher diagnostic accuracy and sensitivity compared to EUS-FNA. Both modalities had no adverse events. Thus, the results support the use of EUS-FNB for abdominal lymph node sampling. Abstract There is a paucity of evidence on the comparison between endoscopic ultrasound (EUS) fine-needle biopsy (FNB) and fine-needle aspiration (FNA) for lymph node (LNs) sampling. The aim of this study was to compare these two approaches in a multicenter series of patients with abdominal tumors. Out of 502 patients undergoing EUS sampling, two groups following propensity score matching were compared: 105 undergoing EUS-FNB and 105 undergoing EUS-FNA. The primary outcome was diagnostic accuracy. Secondary outcomes were diagnostic sensitivity, specificity, sample adequacy, optimal histological core procurement, number of passes, and adverse events. Median age was 64.6 years, and most patients were male in both groups. Final diagnosis was LN metastasis (mainly from colorectal cancer) in 70.4% of patients in the EUS-FNB group and 66.6% in the EUS-FNA group (p = 0.22). Diagnostic accuracy was significantly higher in the EUS-FNB group as compared to the EUS-FNA group (87.62% versus 75.24%, p = 0.02). EUS-FNB outperformed EUS-FNA also in terms of diagnostic sensitivity (84.71% vs. 70.11%; p = 0.01), whereas specificity was 100% in both groups (p = 0.6). Sample adequacy analysis showed a non-significant trend in favor of EUS-FNB (96.1% versus 89.5%, p = 0.06) whereas the histological core procurement rate was significantly higher with EUS-FNB (94.2% versus 51.4%; p < 0.001). No procedure-related adverse events were observed. These findings show that EUS-FNB is superior to EUS-FNA in tissue sampling of abdominal LNs.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy; (A.F.); (N.M.)
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy;
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy;
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy; (A.F.); (N.M.)
| | - Paraskevas Gkolfakis
- Hepatopancreatology and Digestive Oncology Unit, Department of Gastroenterology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | | | | | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT 84132, USA
- Correspondence:
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7
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Vigliar E, Acanfora G, Iaccarino A, Mascolo M, Russo D, Scalia G, Della Pepa R, Bellevicine C, Picardi M, Troncone G. A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System. Diagnostics (Basel) 2021; 11:diagnostics11081314. [PMID: 34441249 PMCID: PMC8393909 DOI: 10.3390/diagnostics11081314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022] Open
Abstract
Fine-needle cytology (FNC) is a useful diagnostic tool in the first line evaluation of lymphadenopathy of unknown aetiology. Nevertheless, considering the large number of conditions presenting as lymphadenopathy, lymph node cytology represents a challenging scenario. Recently, an expert panel published the proposal of the Sydney system for performing classification and reporting of lymph node cytopathology; the aim of the present study was to evaluate the applicability of this system. Thus, 300 lymph node FNCs performed over 1 year were reviewed and categorized according to the Sydney system classification. Overall, n = 20 cases (6.7%) were categorized as L1-inadequate/non-diagnostic; n = 104 (34.7%) as benign (L2); n = 25 (8.3%) as atypical (L3); n = 13 (4.3%) as suspicious (L4), and n = 138 (46%) as malignant (L5). FNC diagnoses were correlated with histopathologic and clinical follow-up to assess the diagnostic accuracy and the risk of malignancy (ROM) for each diagnostic category. Statistical analysis showed the following results: sensitivity 98.47%, specificity 95.33%, positive predictive value 96.27%, negative predictive value 98.08%, and accuracy 97.06%. The ROM was 50% for the category L1, 1.92% for L2, 58.3% for L3, and 100% for L4 and L5. In conclusion, FNC coupled with ancillary techniques ensures satisfactory diagnostic accuracy and the implementation of the Sydney system may improve the practice of cytopathologists.
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Affiliation(s)
- Elena Vigliar
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
| | - Gennaro Acanfora
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.A.); (M.M.); (D.R.)
| | - Antonino Iaccarino
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.A.); (M.M.); (D.R.)
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.A.); (M.M.); (D.R.)
| | - Giulia Scalia
- Laboratory of Clinical Research and Advanced Diagnostics, CEINGE Biotecnologie Avanzate, 80131 Naples, Italy;
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, 80131 Naples, Italy; (R.D.P.); (M.P.)
| | - Claudio Bellevicine
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, 80131 Naples, Italy; (R.D.P.); (M.P.)
| | - Giancarlo Troncone
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
- Correspondence:
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