Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in a Paediatric Population: A Single-Centre Experience.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a modern and minimally invasive technique to acquire diagnostic material from within the gastrointestinal tract, as well as from adjacent organs and structures, which can help in the diagnosis and staging of a variety of gastrointestinal malignancies, as well as for non-malignant conditions. Though well described in adults, there is limited literature on the diagnostic utility of EUS-FNA in paediatric patients. The objective of this study was to evaluate the diagnostic accuracy and clinical utility of EUS-FNA in paediatric patients performed at our centre over the last 17 years.
After obtaining Institutional Review Board approval, 63 cases of paediatric EUS-FNA performed at SKMCH&RC from 2005 to 2022 were retrieved. A 22-gauge EUS-FNA needle was used for obtaining samples with the use of suction (when required). The sample was then smeared onto glass slides, with half being stained with RAPI stain while the rest with the Papanicolaou stain. Demographic details, indication for the procedure, results of rapid on-site adequacy status (ROSE), site of lesion, and cytological diagnosis were reviewed and analysed.
Of the 63 patients, 55 (87.3%) had an adequate sample (confirmed on ROSE). Forty-two (66.7%) were male and the mean age was 12.4 years. The most frequent indication of EUS-FNA was a sampling of enlarged lymph nodes (74.6%). The most common sites of nodal aspiration were sub-carinal (33.3%) and celiac lymph nodes (14.3%). EUS-FNA of a pancreatic lesion accounted for an additional 17.5% of cases. Involvement by Hodgkin's lymphoma was the most common diagnosis (25.4%) followed by granulomatous inflammation (19.1%). Cases of solid pseudo-papillary tumour (4.8%) and recurrent Wilm's tumour (3.2%) were also diagnosed. No patient suffered complications, and none required hospital admission, post-procedure. The sensitivity, specificity, PPV, and NPV of EUS-FNA were 98.1, 83.3, 96.4, and 90.9%, respectively.
EUS-FNA is a safe, well-tolerated, minimally invasive outpatient setting procedure with high sensitivity and significant utility in the diagnosis and staging of disease.
Bashir S
，Loya A
，Hussain M
，Sheikh UN
，Maqbool H
，Yusuf MA
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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
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Role of endoscopic ultrasound-guided-fine needle aspiration biopsy in the diagnosis of lymphoma of the pancreas: A clinicopathological study of nine cases.
Endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) is an established first-line procedure in the management of solid and cystic pancreatic masses. Lymphoma is an uncommon diagnosis in EUS-FNA of the pancreas, and it is more common for such a diagnosis to be because of secondary involvement of the pancreas by a lymphoproliferative disorder than for this to represent isolated primary pancreatic lymphoma (PPL). We present the clinical, EUS and cytological features of these lesions.
After obtaining approval from our Institutional Review Board (IRB), nine cases of lymphoma diagnosed on EUS-FNA at a tertiary care cancer centre over a period of 8 years from 2008 to 2016 were retrieved from our endoscopy and pathology archives. Rapid onsite evaluation (ROSE) was carried out by a trained cytopathologist in all these cases. Cell blocks were available in seven cases, and immunophenotyping was performed on cell blocks using the immunoperoxidase method. Flow cytometry was performed in two cases.
The most frequent site of involvement was the head of the pancreas (n=5, 55.6%). Four out of nine cases were diagnosed as PPL (44.4%). Five cases were diagnosed as lymphoma secondarily involving the pancreas (55.6%). The most frequent diagnosis was diffuse large B-cell lymphoma (n=6, 66.7%), followed by Hodgkin's lymphoma (n=2, 22.2%) and peripheral T-cell lymphoma (n=1, 11.1%).
EUS-FNA in experienced hands is a valuable diagnostic modality, in conjunction with ROSE, immunohistochemistry and flow cytometry, in the diagnosis and sub-typing of both primary and secondary pancreatic lymphoma.
Sadaf S
，Loya A
，Akhtar N
，Yusuf MA
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