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Kang H, Kim SJ, Young Do M, Kim EJ, Kim YS, Jang SI, Bang S, Cho JH. Endoscopic Ultrasound-guided Fine Needle Aspiration and Biopsy for Cytohistological Diagnosis of Gallbladder Cancer: a multicenter retrospective study. Gastrointest Endosc 2024:S0016-5107(24)00183-4. [PMID: 38521476 DOI: 10.1016/j.gie.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/15/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasonography-guided fine-needle aspiration and biopsy (EUS-FNAB) is a standard diagnostic procedure for pancreatic masses but not gallbladder (GB) cancer. We aimed to investigate the efficacy and safety of EUS-FNAB for patients with suspected GB cancer (GBC). METHODS We analyzed data from patients who underwent EUS-FNAB for suspected GBC in three hospitals between 2010 and 2023. We calculated and compared the diagnostic performance and safety of EUS-FNAB according to characteristic factors. RESULTS Of 170 patients, 163 had GBC. EUS-FNAB samples were obtained from the GB in 125 patients and sites other than the GB in 45 patients. The overall sensitivity, specificity, and accuracy were 83.4%, 100%, and 84.1%, respectively. The sensitivity and accuracy for patients with GB samples were 80.8% and 81.6%, respectively, whereas those for patients without GB samples were 90.7% and 91.1%, respectively. The sensitivity and accuracy were higher with FNB needles than with FNA needles, and with ≤22-gauge needles than with 25-gauge needles. However, no significant differences were observed between the GB and lymph node (LN) samples. GB lesions <40 mm in size, wall-thickening type, fundal location, absence of extensive liver invasion, and distant metastasis were more frequent in patients without GB samples than in patients with GB samples. Four mild bleeding events were the only reported adverse events. CONCLUSIONS EUS-FNAB was safe and showed high diagnostic performance for patients with suspected GBC, regardless of the target site. When appropriate GB targeting is difficult, targeting the LNs would be a good strategy with comparable outcomes.
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Affiliation(s)
- Huapyong Kang
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea; Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
| | - So Jeong Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Min Young Do
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yeon Suk Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Chazal T, Didier M, Durrleman J, Combes A, Febvre M, Nunes H, Valeyre D. [Mediastinitis following endobronchial ultrasound-guided transbronchial needle aspiration]. Rev Mal Respir 2018; 35:745-748. [PMID: 30098879 DOI: 10.1016/j.rmr.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 03/20/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure designed to explore mediastinal lymphadenopathy. Its use and indications have increased recently and severe, though rare, complications have been reported. CASE REPORT EBUS-TBNA was performed in a 64-year-old patient presenting with mediastinal lymphadenopathy, probably due to sarcoidosis, but without histological proof. Within hours of the aspiration of subcarinal lymph nodes (station 7), the patient developed fever and dry cough associated with progressive dysphagia and dysphonia that persisted for four weeks. Mediastinitis was diagnosed after a CT-scan revealed a collection in the subcarinal space previously tapped using CT guidance. Intravenous antibiotics were started and both symptoms and the mediastinal collection resolved without need of a surgical procedure. The patient recovered fully. CONCLUSION EBUS-TBNA is associated with a risk of mediastinitis that may manifest as an isolated fever arising within hours of the procedure. The pathogens responsible are usually contaminants from the oropharynx such as Streptococcus sp, probably inoculated directly into the mediastinum during transbronchial needle aspiration. Rapid diagnosis and treatment are necessary in order to reduce morbidity and mortality associated with mediastinitis.
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Affiliation(s)
- T Chazal
- Service de pneumologie, hôpital Avicenne, 93000 Bobigny, France.
| | - M Didier
- Service de pneumologie, hôpital Avicenne, 93000 Bobigny, France
| | - J Durrleman
- Service de pneumologie, hôpital Avicenne, 93000 Bobigny, France
| | - A Combes
- Service de réanimation médicale, hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - M Febvre
- Service de pneumologie, hôpital Tenon, 75020 Paris, France
| | - H Nunes
- Service de pneumologie, hôpital Avicenne, 93000 Bobigny, France
| | - D Valeyre
- Service de pneumologie, hôpital Avicenne, 93000 Bobigny, France
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Kim MS, Park CK, Shin HJ, Seo HW, Chang J, Ahn S, Kim TO, Lim JH, Oh IJ, Kwon YS, Kim YI, Lim SC, Kim YC. Review of Sarcoidosis in a Province of South Korea from 1996 to 2014. Tuberc Respir Dis (Seoul) 2017; 80:291-295. [PMID: 28747963 PMCID: PMC5526957 DOI: 10.4046/trd.2017.80.3.291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/02/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022] Open
Abstract
Background Since the introduction of endobronchial ultrasound (EBUS)–guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes, the incidence of histopathologically-confirmed sarcoidosis has increased. Methods The electronic medical records of Chonnam National University (CNU) Hospital and CNU Hwasun Hospital (CNUHH) were searched for confirmed cases of sarcoidosis diagnosed between 1996 and 2014. Cases were selected using a combination of clinical, radiological, and pathological evidence. Of 115 cases with the relevant disease codes, 16 cases were excluded, as they had not been confirmed pathologically or had no definitive clinical features of sarcoidosis. Results Among 99 cases of confirmed sarcoidosis, only nine patients were diagnosed with sarcoidosis before 2008; the rest were diagnosed from 2008 onward, after the introduction of EBUS-TBNA. EBUS-TBNA was used in 75.8% of patients, open surgical biopsy in 13.2%, and mediastinoscopic biopsy in 5.1%. At the time of diagnosis, 42.4% of sarcoidosis cases were at stage I, 55.6% at stage II, and 2% at stage III. Spontaneous remission of sarcoidosis was observed in 33.3% of cases, and stable disease in 37.4%; systemic steroid treatment was initiated in 23.2% of cases. Of the patients treated with systemic steroids, 69.6% showed improvement. The median duration of steroid treatment was 5 months. Conclusion Following the introduction of EBUS-TBNA, the number of newly diagnosed sarcoidosis patients has increased. Clinical features of sarcoidosis were similar to those previously reported. Spontaneous remission occurred in about one-third of patients, while one-fourth of patients required systemic steroid treatment.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Cheol-Kyu Park
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hong-Joon Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyeong-Won Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jinsun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Ahn
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Ok Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jung-Hwan Lim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yu-Il Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Chul Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Kim SY, Lee JW, Park YS, Lee CH, Lee SM, Yim JJ, Kim YW, Han SK, Yoo CG. Incidence of Fever Following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Tuberc Respir Dis (Seoul) 2016; 80:45-51. [PMID: 28119746 PMCID: PMC5256340 DOI: 10.4046/trd.2017.80.1.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic method for mediastinal and hilar lymphadenopathy. This study aimed to investigate the incidence of fever following EBUS-TBNA. METHODS A total of 684 patients who underwent EBUS-TBNA from May 2010 to July 2012 at Seoul National University Hospital were retrospectively reviewed. The patients were evaluated for fever by a physician every 6-8 hours during the first 24 hours following EBUS-TBNA. Fever was defined as an increase in axillary body temperature over 37.8℃. RESULTS Fever after EBUS-TBNA developed in 110 of 552 patients (20%). The median onset time and duration of fever was 7 hours (range, 0.5-32 hours) after EBUS-TBNA and 7 hours (range, 1-52 hours), respectively, and the median peak body temperature was 38.3℃ (range, 37.8-39.9℃). In most patients, fever subsided within 24 hours; however, six cases (1.1%) developed fever lasting longer than 24 hours. Infectious complications developed in three cases (0.54%) (pneumonia, 2; mediastinal abscess, 1), and all three patients had diabetes mellitus. The number or location of sampled lymph nodes and necrosis of lymph node were not associated with fever after EBUS-TBNA. Multiple logistic regression analysis did not reveal any risk factors for developing fever after EBUS-TBNA. CONCLUSION Fever is relatively common after EBUS-TBNA, but is transient in most patients. However, clinicians should be aware of the possibility of infectious complications among patients with diabetes mellitus.
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Affiliation(s)
- Seo Yun Kim
- Division of Pulmonology, Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Jin Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Jafri M, Sachdev AH, Khanna L, Gress FG. The Role of Real Time Endoscopic Ultrasound Guided Elastography for Targeting EUS-FNA of Suspicious Pancreatic Masses: A Review of the Literature and A Single Center Experience. JOP 2016; 17:516-524. [PMID: 28912670 PMCID: PMC5595420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Endoscopic ultrasound guided elastography is an imaging modality that can be used to evaluate tissue stiffness and to assess solid pancreatic lesions. It can also assist in optimizing the diagnostic yield of endoscopic ultrasound guided fine needle aspiration biopsies. AIMS To review the literature on solid pancreatic lesions, the use of EUS guided fine needle aspiration and endoscopic ultrasound guided elastography and to present a single center experience using elastography to direct fine needle aspiration biopsies of solid pancreatic lesions. METHODS We present a review of the literature and a single center experience describing the use of EUS guided elastography in directing fine needle aspiration biopsies of solid pancreatic lesions. RESULTS Thirteen male veterans with an average age of 62.3 (SD±11.8) years were enrolled in the study. The mean pancreatic mass size on EUS was 5.1×5.2 (SD±4.4×4.5) cm. A total of 13 lesions were identified during elastography. The lesions were most commonly found in the body (n=5), followed by multifocal lesions (n=4), pancreatic head (n=3) and tail (n=1). The seven concerning pancreatic lesions were stratified based on color pattern identified on EUS and EUS-elastography. Three lesions were homogenously blue, and four lesions were heterogeneously blue. The remaining six lesions which were less concerning were predominantly green. Of the three lesions, that were homogenously blue, two were diagnosed as adenocarcinoma (n=2) and chronic pancreatitis (n=1) respectively. Of the four heterogeneously blue lesions two were adenocarcinomas, while the other two represented a large B-cell lymphoma and chronic pancreatitis. Patients whose lesions were characterized as homogenous or heterogeneous green were benign and remained disease free after a median of two years of regular follow up. LIMITATIONS Relatively small number of patients studied. CONCLUSIONS In our single center experience we found that the use of real time endoscopic ultrasound guided elastography for targeting fine needle aspiration of suspicious pancreatic lesions may be beneficial as an adjunct modality to complement conventional EUS. Larger prospective studies need to be conducted to evaluate the utility of this modality in targeting pancreatic lesions.
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Affiliation(s)
- Mikram Jafri
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Amit H Sachdev
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Lauren Khanna
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Frank G Gress
- Columbia University College of Physicians and Surgeons, New York, USA
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Jang SM, Kim MJ, Cho JS, Lee G, Kim A, Kim JM, Park CH, Park JM, Song BG, Eom JS. New-onset malignant pleural effusion after abscess formation of a subcarinal lymph node associated with endobronchial ultrasound-guided transbronchial needle aspiration. Tuberc Respir Dis (Seoul) 2014; 77:188-92. [PMID: 25368666 PMCID: PMC4217036 DOI: 10.4046/trd.2014.77.4.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/04/2014] [Accepted: 07/14/2014] [Indexed: 12/04/2022] Open
Abstract
We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.
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Affiliation(s)
- Sun Mi Jang
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Ji Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea
| | - Ahrong Kim
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Mi Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Chul Hong Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jong Man Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Byeong Gu Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jung Seop Eom
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Luz LP, Al-Haddad MA, Sey MSL, DeWitt JM. Applications of endoscopic ultrasound in pancreatic cancer. World J Gastroenterol 2014; 20:7808-7818. [PMID: 24976719 PMCID: PMC4069310 DOI: 10.3748/wjg.v20.i24.7808] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/15/2014] [Accepted: 02/17/2014] [Indexed: 02/06/2023] Open
Abstract
Since the introduction of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA), EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma (PDAC). The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC. Initially, its use for detection, diagnosis and staging will be described. EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC, this high accuracy, however, is decreased in specific situations particularly in the presence of chronic pancreatitis. Novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed. EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC. Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control, EUS-guided fiducial and brachytherapy seed placement, fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage. The future role of EUS and EUS in management of PDAC is still emerging.
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