Clinical Endoscopy

Modified Endoscopic Ultrasound Needle to Obtain Histological Core Tissue Samples: A Retrospective Analysis: Munish Ashat, Kaartik Soota, Jagpal S. Klair, Sarika Gupta, Chris Jensen, Arvind R. Murali, Randhir Jesudoss, Rami El-Abiad, Henning Gerke; Clin Endosc 2020;53(4):471-479. Published online February 5, 2020; DOI: https://doi.org/10.5946/ce.2019.108

Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration is very effective for providing specimens for cytological evaluation. However, the ability to provide sufficient tissue for histological evaluation has been challenging due to the technical limitations of dedicated core biopsy needles. Recently, a modified EUS needle has been introduced to obtain tissue core samples for histological analysis. We aimed to determine (1) its ability to obtain specimens for histological assessment and (2) the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) using this needle.
Methods
We retrospectively analyzed consecutive cases of FNB using modified EUS needles for 342 lesions in 303 patients. The cytology and histological specimens were analyzed. Diagnostic accuracy was calculated.
Results
Adequate cytological and histological assessment was possible in 293/342 (86%) and 264/342 (77%) lesions, respectively. Diagnostic accuracy of the cytological specimen was 294/342 (86%) versus 254/342 (74%) for the histological specimen (p<0.01). Diagnostic accuracy of the combined cytological and histological assessment was 323/342 (94.4%), which was significantly higher than that of both histology alone (p<0.001) and cytology alone (p=0.001).
Conclusions
EUS-FNB with the modified EUS needle provided histologic tissue cores in the majority of cases and achieved excellent diagnostic accuracy with few needle passes.

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Randomized trial comparing the Franseen needle versus 2 types of sharpened-tip 3-prong needles in EUS-guided tissue acquisition from solid pancreatic lesions
Takuya Ishikawa, Hirotaka Suzuki, Yasuki Hori, Jun Yashika, Hiroki Suhara, Hajime Sumi, Masahiko Ando, Yachiyo Kuwatsuka, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiromi Kataoka,
Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Effect of wet-heparinized suction on the quality of mediastinal solid tumor specimens obtained by endoscopic ultrasound-guided fine-needle aspiration: a retrospective study from a single center
Bo Xu, Qian Lu, Rong Fang, Xiaojuan Dai, Haiyan Xu, Xiangwu Ding, Huawei Gui
BMC Gastroenterology.2023;[Epub] CrossRef
Randomized controlled trial comparing the Franseen needle with the Fork-tip needle for EUS-guided fine-needle biopsy
Munish Ashat, Jagpal S. Klair, Sydney L. Rooney, Sagar J. Vishal, Chris Jensen, Nadav Sahar, Arvind R. Murali, Rami El-Abiad, Henning Gerke
Gastrointestinal Endoscopy.2021; 93(1): 140. CrossRef

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Performance and Clinical Role of Endoscopic Ultrasound Fine Needle Aspiration for Diagnosing Gastrointestinal Intramural Lesions: Hea Jung Sung, Yu Kyung Cho, Eun Young Park, Sung Jin Moon, Chul Hyun Lim, Jin Su Kim, Jae Myung Park, In Seok Lee, Sang Woo Kim, Myung-Gyu Choi, Kyu Yong Choi; Clin Endosc 2013;46(6):627-632. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.627

Abstract PDF PubReader ePub

Background/Aims

We evaluated the performance, clinical role, and diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in gastrointestinal intramural lesions.

Methods

Procedural and pathologic data were reviewed from consecutive patients undergoing EUS-FNA for intramural lesions. Final diagnoses were determined by surgical histopathologic conformation and the diagnosis of malignancy, including clinical follow-up with repeat imaging.

Results

Forty-six patients (mean age, 47 years; 24 males) underwent EUS-FNA. Lesions were located in the stomach (n=31), esophagus (n=5), and duodenum (n=10). The median lesion size was 2 cm (range, 1 to 20.6). Final diagnoses were obtained in 22 patients (48%). EUS-FNA was diagnostic in 40 patients (87%). The diagnostic accuracy of cytology for differentiating between benign and malignant lesions was 82%; diagnostic error occurred in three patients (6%). The cytologic results influenced clinical judgment in 78% cases. The primary reasons for negative or no clinical impact were false-negative results, misdirected patient management, and inconclusive cytology.

Conclusions

EUS-FNA exhibited an 87% diagnostic yield for gastrointestinal intramural lesions; the accuracy of cytology for differentiating malignancy was 82%. The limitations of EUS-FNA were primarily because of nondiagnostic sampling (9%) and probable diagnostic error (6%); these factors may influence the clinical role of EUS-FNA.

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Citations to this article as recorded by

Feasibility and clinical value of linear endoscopic ultrasonography imaging in the lower gastrointestinal subepithelial lesions
Li Tao, Yajun Chen, Qianqian Fang, Fan Xu, Qianwei Yu, Lijiu Zhang, Xiangpeng Hu
Scientific Reports.2024;[Epub] CrossRef
Endoscopic ultrasound‐guided fine needle aspiration cytology diagnosis of upper gastrointestinal tract mesenchymal tumors: Impact of rapid onsite evaluation and correlation with histopathologic follow‐up
Syed M. Gilani, Thiruvengadam Muniraj, Harry R. Aslanian, Guoping Cai
Diagnostic Cytopathology.2021; 49(2): 203. CrossRef
Diagnosis of Gastric Subepithelial Tumor: Focusing on Endoscopic Ultrasonography
Eun Young Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2015; 15(1): 9. CrossRef
Endoscopic Ultrasound-Guided Fine Needle Biopsy without Rapid On-Site Cytologic Examination: A Time to Change the Paradigm?
Yeon Suk Kim
Clinical Endoscopy.2014; 47(3): 207. CrossRef

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The Appropriateness of Colonoscopy Indication and the Diagnostic Yield of Colonoscopy: Choon Young Lee, M.D., Choong Hyeon Lee, M.D., Young Ho Kim, M.D., Jong Woo Lee, M.D., Shin Yeon Kim, M.D.*, Dong Il Park, M.D.* and In Kyung Sung, M.D.^†; Korean J Gastrointest Endosc 2009;38(6):332-338. Published online June 30, 2009

Abstract PDF: Background
/Aims: We wanted to evaluate if the guidelines for appropriately performing colonoscopy by the American Society for Gastrointestinal Endoscopy (ASGE) yield good diagnostic efficacy, and we wanted to assess the appropriateness of referrals.
Methods
A total of 2,412 consecutive patients (1,605 men and 807 women) who were undergoing colonoscopy from September 2006 to February 2007 were prospectively enrolled in the study. The diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of performed colonoscopies. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure.
Results
The large majority (64.2%) of patients had colonoscopy for an indication that was considered 'generally indicated', while the procedure was considered 'generally not indicated' for 22.4% of the patients. The diagnostic yield of colonoscopy was significantly higher for the appropriate colonoscopies (59.1%) than for the inappropriate colonoscopies (23.2%). On the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of the indication that was "generally indicated" (odds ratio=9.5) and with the referrals by a gastroenterologist (odds ratio=1.7).
Conclusions
The ASGE guidelines have shown a good diagnostic yield. Further steps are required to update and standardize the guidelines to increase the diagnostic yield. (Korean J Gastrointest Endosc 2009;38:332-338)

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원저 / 담도암 환자에서 담도경적 조직 검사 결과에 영향을 미치는 인자 ( Factors Affecting the Yield of Cholangioscopic Biopsy in the Patients with Bile Duct Cancer ): Korean J Gastrointest Endosc 2001;22(3):146-151. Published online November 30, 2000

Abstract PDF: Background
/Aims: This study analyzed the factors associated with the yield of percutaneous transhepatic cholangioscopic biopsies in patients with bile duct cancer. Methods: One hundred and sixteen patients who had received percutaneous transhepatic cholangioscopy and who had been confirmed as having bile duct cancer were enrolled in this study. Results: When the location of the tumor was divided into intrahepatic (IHD), hilar and common bile duct, the biopsy yield was significantly higher in IHD cancer (93.7%) than in cases of hilar cancer (69.6%) (p<0,05). After a bile duct cancer had been classified as a nodular (n=31), papillary (n=27) or infiltrative type (n=58) upon cholangioscopic findings, the biopsy yields from nodular (96.8%) or papillary types (96,3%) were significantly higher than from infiltrative types (58.6%; p<0.01). However, cholangioscopic classification of bile duct cancer was the only independent factor affecting biopsy yield by multiple logistic regression analysis (p=0,001). The sensitivity of the combination of cholangioscopic biopsy and tumor vessel in overall bile duct cancer, especially in the infiltrative type, was significantly increased when it was compared with that for cholangioscopic biopsies (p<0.01) or for tumor vessels alone (p<0,01). Conclusions: The cholangioscopic classification of bile duct tumors might provide important clues to predict biopsy yield. (Korean J Gastrointest Endosc 2001;22:146 - 151)

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