Skip Navigation
Skip to contents

Clin Endosc : Clinical Endoscopy

OPEN ACCESS

Articles

Page Path
HOME > Clin Endosc > Volume 52(4); 2019 > Article
Commentary Endoscopic Ultrasound-Guided Liver Biopsies: Is the Future Here Yet?
Ihab I. El Hajj1,2,3, Mohammad Al-Haddad1,orcid
Clinical Endoscopy 2019;52(4):297-298.
DOI: https://doi.org/10.5946/ce.2019.126
Published online: July 23, 2019

1Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

2Division of Gastroenterology, St. George Hospital University Medical Center, University of Balamand, Beirut, Lebanon

3Division of Gastroenterology, Clemenceau Medical Center Affiliated with Johns Hopkins International, Beirut, Lebanon

Correspondence: Mohammad Al-Haddad Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 550 N. University Blvd, Suite 4100, Indianapolis, IN 46202, USA Tel: +1-317-944-7896, Fax: +1-317-948-8144, E-mail: moalhadd@iu.edu
• Received: June 26, 2019   • Accepted: June 27, 2019

Copyright © 2019 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 4,348 Views
  • 82 Download
prev next
See the article "Comparison of Endoscopic Ultrasound Biopsy Needles for Endoscopic Ultrasound-Guided Liver Biopsy" on page 347.
See "Comparison of Endoscopic Ultrasound Biopsy Needles for Endoscopic Ultrasound-Guided Liver Biopsy" by Armen Eskandari, Patrick Koo, Heejung Bang, et al., on page [Related article:] 347-352.
See "Endoscopic Ultrasound-Guided Liver Biopsy Using a Core Needle for Hepatic Solid Mass" by Hyung Ku Chon, Hee Chan Yang, Keum Ha Choi, et al., on page [Related article:] 340-346.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been proven as an effective modality for sampling of gastrointestinal and liver lesions [1,2]. The sampling needle type represents one of the several factors that affect the EUS tissue acquisition (EUS-TA) outcomes [3,4]. In the last few years, the progressive replacement of EUS-FNA with EUS guided-fine needle biopsy (EUS-FNB) was noted due to the introduction of several specially designed needles that provide core tissue samples that allow for histological assessment. The EchoTip ProCore (Cook Medical, Winston-Salem, NC, USA) needle has a reverse bevel design and the EZ shot 3 plus needle (Olympus America Inc., Lombard, IL, USA) has a flexible coil sheath that allows for precise and smooth penetration into the target lesion. The SharkCore (Medtronic, Minneapolis, MN, USA) needle has a fork-tip design with 2 leading sharp tips and the Acquire needle (Boston Scientific Co., Natick, MA, USA) has a Franseen tip design with 3 symmetrical cutting surfaces [5]. When compared with conventional ultrasound and computed tomography scan, EUS showed superiority in the detection and sampling of liver lesions. In a recent review of 9 published studies (6 prospective, 2 retrospective, and 1 observational), the diagnostic accuracy of tissue sampling of liver lesions via EUS-FNA and/or FNB ranged from 80% to 100% [6].
In this issue, Eskandari et al. [7] compared the performance of 6 needles with different gauges (Shark Core 19 and 22 G, Acquire 19 and 22 G, EZ Shot 3 Plus 19 G, and EchoTip Pro-Core 20 G) for EUS-guided liver biopsy on a freshly harvested bovine liver. All the 19 and 20 G needles yielded similar mean numbers of complete portal tracts (CPTs) and were significantly superior to the Shark Core 22 G needle. The outcomes with the large bore needles were significantly superior to that with the 22 G SharkCore needle. No statistically significant difference in the total specimen length was found among the three 19 G needles and the 20 G needle tested. The performance of the two 22 G needles was similar (number of CPTs, mean fragment length, and mean specimen length).
In this same issue, Chon et al. [8] studied the safety, efficacy, and outcomes of EUS-FNB using a core needle (EchoTip Pro-Core HD ultrasonography-guided biopsy needle) in 58 hepatic solid masses (46 metastatic and 16 non-metastatic lesions). The metastatic lesions included 38 metastatic pancreatic cancer lesions, 4 metastatic ampullary cancer lesions, and 4 metastatic lung cancer lesions. The non-metastatic lesions included 9 cholangiocarcinomas and 3 hepatocellular carcinomas. The diagnostic accuracy was 89.7%. The sensitivity and specificity were 89.7% and 100%, respectively. The analysis of factors that could affect the diagnostic accuracy of EUS-FNB for hepatic solid masses revealed no significant associations. The factors assessed included the number of needle passes, needle gauge, needle approach route (transgastric or transduodenal), and mass size.
Both studies have several limitations. The first study was performed on an ex vivo liver model; thus, adverse events could not be evaluated, and a real-time tissue evaluation may be affected by anatomical and technical variations. The second study was retrospective, with a relatively small sample size and possibly underreported adverse events.
At our facility and on the basis of the increasing evidence supporting the use of FNB for sampling solid lesions and performing targeted biopsies, we have gradually adopted FNB as a replacement for FNA for the sampling of solid lesions. This approach has the advantages of fewer number of passes and shorter overall procedure time [4]. We strongly believe that future needle platforms will adopt an improved tip design for better access and enhanced core retention to optimize EUS-TA. The main question remains whether the available literature provides enough evidence to support the use of EUS-FNA and/or EUS-FNB for liver lesions as a replacement for percutaneous liver biopsy, which has been considered the gold standard for many years. Further studies are needed to address this concern.
  • 1. Wani S, Shah RJ. EUS-guided tissue acquisition: do we need to shoot for a “core” to score? Gastrointest Endosc 2016;84:1047–1049.ArticlePubMed
  • 2. El Hajj II, Al-Haddad M. Endoscopic ultrasound-guided tissue acquisition of pancreatic masses. Tech Gastrointest Endosc 2018;20:30–38.Article
  • 3. Al-Haddad M. Fine-needle biopsy sampling under EUS guidance: is one needle tip really better than the other? Gastrointest Endosc 2018;87:1163.ArticlePubMed
  • 4. El Hajj II, Al-Haddad M. EUS-FNA giving way to fine-needle biopsy: is it time to retire your old trusted needles? Gastrointest Endosc 2018;87:1439–1442.ArticlePubMed
  • 5. El Hajj II, Wu H, Reuss S, et al. Prospective assessment of the performance of a new fine needle biopsy device for EUS-guided sampling of solid lesions. Clin Endosc 2018;51:576–583.ArticlePubMedPMCPDF
  • 6. Ichim VA, Chira RI, Mircea PA. Diagnostic yield of endoscopic ultrasound-guided biopsy of focal liver lesions. Med Pharm Rep 2019;92:15–20.ArticlePubMedPMC
  • 7. Eskandari A, Koo P, Bang H, Gui D, Urayama S. Comparison of endoscopic ultrasound biopsy needles for endoscopic ultrasound-guided liver biopsy. Clin Endosc 2019;52:347–352.ArticlePubMedPMCPDF
  • 8. Chon HK, Yang HC, Choi KH, Kim TH. Endoscopic ultrasound-guided liver biopsy using a core needle for hepatic solid mass. Clin Endosc 2019;52:340–346.ArticlePubMedPMCPDF

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • Cite
        CITE
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Endoscopic Ultrasound-Guided Liver Biopsies: Is the Future Here Yet?
        Clin Endosc. 2019;52(4):297-298.   Published online July 23, 2019
        Close
      • XML DownloadXML Download
      Endoscopic Ultrasound-Guided Liver Biopsies: Is the Future Here Yet?
      Endoscopic Ultrasound-Guided Liver Biopsies: Is the Future Here Yet?

      Clin Endosc : Clinical Endoscopy Twitter Facebook
      Close layer
      TOP