EUS-FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an important modality to obtain tissue diagnosis from mediastinal, pancreatic, and intra-abdominal lesions in close proximity to the pulmonary and gastrointestinal tract. It is considered to be a relatively safe, rapid, and minimally invasive technique with low complication rates. To determine the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and outcome of EUS-FNA, with histological correlation where applicable. Data of all 1059 consecutive patients who underwent EUS-FNA from 1 January 2005 to 31 December 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore was reviewed in this retrospective study. The major sites that were targeted for EUS-FNA were pancreatic (423), mediastinal (376), and other abdominal lesions (260). The average number of passes per patient was 2.22. Rapid on-site evaluation (ROSE) was adequate in 969 patients (91.4%). Concordance between ROSE and final cytology was 99.5%. Follow-up was available in 810 patients (76.4%). The overall diagnostic yield was 94.3%. Ancillary studies, including immunohistochemical stains and flow cytometry, helped to increase the diagnostic yield from 78.1% to 94.3%. The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy for EUS-FNA were 94.8%, 98.6%, 99.9%, 65.5%, and 95.1%, respectively. Seven of 1059 patients (0.6%) developed complications. EUS-FNA is a very sensitive and specific diagnostic tool with a minimal complication rate. Ancillary studies helped to increase the sensitivity, as well as the diagnostic yield.

Saqib M ，Maruf M ，Bashir S ，Mehmood S ，Akhter N ，Yusuf MA ，Loya A ... -  《-》

Onsite cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions.

Endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA) is considered to be a minimally invasive and safe technique, with low complication rates, for obtaining tissue samples from pancreatic lesions, and mediastinal and intra-abdominal nodes. We retrospectively reviewed the diagnostic accuracy of this method at a tertiary care hospital in Pakistan. The medical records of 393 consecutive patients referred to the gastroenterology service from August 2008 to September 2013 were reviewed in this retrospective study. The mean age of the patients at presentation was 51.2 years (range 6-89; 56.7% males). Major indications for referral were to establish a diagnosis in patients with a pancreatic mass or lymphadenopathy of unknown origin detected on CT scan or PET-CT (n = 235), to exclude lymph node metastasis in those with a known primary tumor (n = 114), and to rule out relapse of lymphoma after treatment or during follow up (n = 44). Of 393 patients, 181 had mediastinal lymphadenopathy, 115 had pancreatic lesions; 79 had intra-abdominal lymphadenopathy and 18 patients had miscellaneous lesions (gastric mass, splenic, retroperitoneal, esophageal, or adrenal lesions). A mean of 2.2 passes per patient were made; 85% of patients had ≤ 3 passes. The initial rapid onsite evaluation (ROSE) was positive in 363 of 393 (92.3%) patients, but on final cytopathological interpretation, 369 of 393 (93.9%) patients had an adequate specimen for diagnosis. Sufficient material for cytopathology was obtained in 369 patients (93.9%), whereas 24 patients (6.1%) had inadequate aspirate on EUS-FNA as assessed by final cytopathological interpretation. The concordance between final cytopathological diagnoses and ROSE was 98.2%. Follow-up data were available for 296 (75.3%) patients, whereas 97 patients were lost to follow up. Of these 296 patients, 283 of 296 patients were true positive, 9 of 296 were true negative, and 4 of 296 patients were false negative. The overall calculated sensitivity, specificity, positive predictive value, and negative predictive value were 98.6, 100, 100, and 69.2%, respectively. The major diagnoses that we obtained were granulomata (n = 114), adenocarcinoma (n = 104), reactive nodes (n = 35), metastatic carcinoma (n = 35), Hodgkin's lymphoma (HL; n = 19) and non-Hodgkin's lymphoma (NHL; n = 11), neuroendocrine tumors (n = 11), spindle cell lesions (n = 7), benign lesions (n = 9), cystic neoplasms (n = 6), solid pseudopapillary neoplasm (n = 3), and miscellaneous (n = 15). Only 3 of 393 patients (0.7%) suffered a complication as a result of EUS-FNA, and all three were successfully managed conservatively. EUS-FNA, combined with ROSE, is a safe and highly effective technique in experienced hands with excellent diagnostic accuracy and low complication rates.

Mehmood S ，Jahan A ，Loya A ，Yusuf MA ... -  《-》

Diagnostic value of endoscopic ultrasound-guided fine needle aspiration with rapid on-site evaluation performed by endoscopists in solid pancreatic lesions: A prospective, randomized controlled trial.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the most established diagnostic method for pancreatic tissue. Rapid on-site evaluation by a trained endoscopist (self-ROSE) can improve the diagnostic accuracy. This research is aimed to analyze the application value of self-ROSE for EUS-FNA in solid pancreatic lesions. A total of 194 consecutive patients with solid pancreatic lesions in Nanjing Drum Tower Hospital were randomized in a 1:1 ratio to EUS-FNA with or without self-ROSE in this single-center randomized controlled trial. Before initiating self-ROSE, the endoscopist underwent training for pancreatic cytologic sample adequacy assessment and cytopathological diagnosis of EUS-FNA in pathology department for 1 month. Some parts of the slides of EUS-FNA were air dried, stained on-site with BASO Liu's reagent, and on-site evaluated in self-ROSE group. Between the two groups, the diagnostic performance of EUS-FNA was analyzed, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, with a comparison of the number of needle passes and the complication rates. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 94.8%, 94.4%, 100%, 100%, and 58.3% in the self-ROSE group, respectively, and 70.1%, 65.1%, 100%, 100%, and 32.6% in the non-self-ROSE group. The diagnostic accuracy (P < 0.001) and sensitivity (P < 0.001) were both significantly increased during EUS-FNA in the self-ROSE group compared to the non-self-ROSE group. The rate of cytologic sample adequacy was 100% in self-ROSE group and 80.4% in non-self-ROSE group. The number of passes were 3.38 ± 1.00 in self-ROSE group and 3.22 ± 0.89 in non-self-ROSE group (P = 0.228). No complications were found in both. There was acceptable consistency between endoscopist and pathologist in the cytopathological diagnosis (kappa = 0.666, P < 0.05) and in the sample adequacy rate (kappa = 1.000, P < 0.001). Our results demonstrated that self-ROSE is valuable for EUS-FNA in the diagnosis of solid pancreatic lesions and is an important choice to routinely increase the accuracy of EUS-FNA in centers without ROSE assessment.

Zhang S ，Ni M ，Wang P ，Zheng J ，Sun Q ，Xu G ，Peng C ，Shen S ，Zhang W ，Huang S ，Wang L ，Zou X ，Lv Y ... -  《-》

Endoscopic ultrasound-guided tissue acquisition with or without rapid on-site evaluation for solid pancreatic lesions: five years of experience from a single center.

Liu Y ，Xiong D ，Zhao Y ，Meng Z ，Wu X ，Jiang Q ，Wang Q ，Wu D ，Zhang S ，Feng Y ，Yang A ... -  《-》

Analysis of Fine-Needle Biopsy vs Fine-Needle Aspiration in Diagnosis of Pancreatic and Abdominal Masses: A Prospective, Multicenter, Randomized Controlled Trial.

Endoscopic ultrasound (EUS)-guided fine needles with side fenestrations are used to collect aspirates for cytology analysis and biopsy samples for histologic analysis. We conducted a large, multicenter study to compare the accuracy of diagnosis via specimens collected with fine-needle biopsy (FNB) versus fine-needle aspiration (FNA) for patients with pancreatic and nonpancreatic masses. We performed a prospective single-blind study at 5 tertiary care centers in China. The study comprised 408 patients undergoing EUS for a solid mass (>1 cm) in the pancreas, abdomen, mediastinum, or pelvic cavity, from December 2014 through January 2016. Patients were randomly assigned to groups (1:1) for assessment by FNA (n = 190) or FNB (n = 187). After lesions were identified by EUS, samples were collected in a total of 4 passes by each needle. All procedures were performed by experienced endosonographers; cytologists and pathologists were blinded to the sample collection method. Patients were followed for at least 48 weeks, and final diagnoses were obtained after surgery, imaging analysis, or resolution of lesion. The primary aim was to compare diagnostic yields of EUS-FNA with EUS-FNB for all solid masses, then separately as pancreatic and nonpancreatic masses. The secondary endpoint was the quality of histologic specimen. Findings from FNB analysis were accurate for 91.44% of all cases, compared with 80.00% for all FNA cases, based on final patient diagnoses (P = .0015). In patients with pancreatic masses (n = 249), findings from histologic analysis of FNBs were accurate for 92.68% of the cases, compared with 81.75% for FNAs (P = .0099). In cytology analysis of pancreatic masses, samples collected by FNB accurately identified 88.62% of all pancreatic lesions, whereas samples collected by FNA accurately identified 79.37% (P = .00468). Analyses of samples of nonpancreatic masses collected by FNA versus FNB produced similar diagnostic yields. In a prospective study of patients with pancreatic masses, we found EUS-guided FNB samples to produce more accurate diagnoses than samples collected by EUS-guided FNA samples. No difference in diagnostic yield was seen between EUS-FNA and EUS-FNB for nonpancreatic masses. Clinical Trials.gov no: NCT02327065.

Cheng B ，Zhang Y ，Chen Q ，Sun B ，Deng Z ，Shan H ，Dou L ，Wang J ，Li Y ，Yang X ，Jiang T ，Xu G ，Wang G ... -  《-》