Diagnostic Accuracy Of Endoscopic Ultrasound-guided Fine-needle Aspiration Research Articles

Accuracy of grading pancreatic neuroendocrine tumors on endoscopic ultrasound-guided fine needle aspiration: a multi-institutional study

Presenter: Ammar Javed MD | Johns Hopkins University School of Medicine Background: World Health Organization (WHO) grading system is prognostic in pancreatic neuroendocrine tumors (PanNETs). The concordance between WHO grade on cytological analysis (c-grade) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and histopathological analysis (h-grade) of surgical specimen is reported to be between 60 and 80%. Factors associated with concordance and trends of utilization of EUS-FNA for grading of PanNETs remain poorly understood. Methods: A multicenter retrospective study was performed on patients undergoing resection for PanNETs at four high-volume centers. Patients with functional or syndrome associated tumors, and those who received neoadjuvant therapy were excluded. Factors associated with concordance between c-grade and h-grade and trends of utilization of EUS-FNA for PanNETs over the last two decades were assessed. Results: Of the 1,398 patients included in the study, 704 (50.4%) underwent EUS-FNA; 579 (80.25) were diagnostic of PanNETs and WHO grade was reported for 296 (51.1%) patients. The concordance between c-grade and h-grade was 74.7% with moderate interrater agreement (Kc = 0.42, p<0.001). Significantly higher rates of concordance were observed in patients with smaller tumors ( < 2 vs. ≥2 cm, 70.1% vs. 29.9%, p = 0.030). The highest concordance was 100.0%and was observed in patients with small tumors without perineural invasion undergoing assessment between 2015-2019; perfect interrater agreement (Kc = 1.00, p<0.001). Over the last two decades an increase in the utilization of EUS-FNA from 31.5% to 61.4% was observed (p<0.001). Furthermore, EUS-FNA was more frequently diagnostic of PanNETs (p<0.001), and WHO grade was more frequently reported ( < 0.001). Despite increased utilization of EUS-FNA the rate of concordance did not change (p = 0.338). Conclusion: Higher rates of concordance between c-grade and h-grade are observed in patients with small PanNETs without perineural invasion. While an increase in the utilization and diagnostic accuracy of EUS-FNA has been observed, the concordance remains unchanged, suggesting a need for improved techniques and devices for accurate grading of PanNETs

Evaluation of Pancreatic Lesions With Endoscopic Ultrasound and Fine Needle Aspiration.

Background. Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are commonly used for assessing pancreatic lesions. This study aimed to evaluate the diagnostic yield and accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a single tertiary institution. Methods. Consecutive patients who underwent EUS-FNA of the pancreas at Queen Mary Hospital, Hong Kong, from January 2015 to March 2016 were retrospectively reviewed. Endoscopic findings and FNA results were analysed. For patients who subsequently underwent surgical resection of pancreatic lesion, EUS-FNA diagnoses were compared to histopathological findings of surgical specimens to determine its diagnostic accuracy. Results. One hundred twelve EUS-FNA were performed in 99 patients within the study time period and were included for analysis. Sixty-six (66.7%) pancreatic lesions were solid in nature and 33 (33.3%) were cystic. The overall diagnostic yield of EUS-FNA was 70.5% (n = 79). On multivariate analysis, more passes of needle were associated with a higher diagnostic yield (odds ratio = 2.000, P = .049). 57.1% (n = 64) of EUS-FNA results had an impact on management. Sixteen patients with diagnostic EUS-FNA subsequently underwent surgery for resection of the pancreatic lesion. Upon correlation to the histopathological findings of surgical specimens, there were 12 true-positive, 2 true-negative, 0 false-positive, and 2 false-negative cases. Sensitivity was 85.7%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 50%. The diagnostic accuracy of EUS-FNA was 87.5%. Conclusion. EUS-FNA is accurate and reliable for diagnosing pancreatic lesions.

Adequacy and Incidence of Primary Pancreatic Cancer on Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) Cytology Samples: A Retrospective Review in Veteran Population at Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMCVAMC)

Abstract Introduction Pancreatic cancer is the one of leading causes of cancer-related deaths, accounts for 7% of cancer related deaths, and generally is diagnosed at an advanced stage. The 5-year survival rate is about 62%. There are no current screening recommendations for pancreatic cancer, so primary diagnosis is of the utmost importance. EUS modality for FNA has revolutionized the ability for the early diagnosis and staging of cancers of the gastrointestinal tract as being safe, cost-effective, minimally invasive technology to assess the pancreas. To date, there is no study in English literature assessing the adequacy for diagnosis and ancillary studies on EUS-FNA of pancreatic mass lesions in veterans. The veteran patient population is a unique cohort with different risk factors and demographics. Methods As a part of quality assurance project, a search was conducted to identify all EUS of pancreatic lesions performed at our hospital from February 2, 2011, to March 3, 2019. We evaluated adequacy on the cell blocks and diagnostic accuracy of EUS-FNA among all pancreatic mass lesions. Results Out of the total 130 EUS-FNA pancreas cases, the diagnosis was established in 127 cases (97.6%). Three cases were insufficient and total 26 cases were diagnosed as atypia, suggesting repeat FNA for definitive diagnosis. A definitive diagnosis was made in 101 cases (77.7%). Four cases were suspicious for malignancy. Malignancy/severe dysplasia was diagnosed in total 45 cases, most being primary pancreatic adenocarcinoma (41) and four with other diagnoses. Conclusion EUS-FNA is highly successful for procuring adequate material on the cytology samples for pancreatic lesions. EUS-FNAs for pancreatic lesions have high sensitivity and specificity for diagnosing and directing early, appropriate clinical management in veterans. The percentage of primary pancreatic adenocarcinomas out of total tumors in this veteran population is high (91.1%).

Lesion size determines diagnostic yield of EUS-FNA with onsite cytopathologic evaluation for upper gastrointestinal subepithelial lesions.

The aim of this study was to determine the diagnostic yield and factors influencing the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for upper gastrointestinal (GI) subepithelial lesions (SELs) with rapid onsite cytopathologic evaluation. This is a single-center, retrospective study. Among 22 patients who underwent EUS-FNA, a cytopathological diagnosis was reached in 16 (72.7%) patients. The EUS-FNA results were as follows: seven GISTs (31.8%), six leiomyomas (27.2%), four non-diagnostics (18%), two duplication cysts (9%), two spindle cell tumor (9%), and one ectopic pancreas (4.5%). The long-axis size was > 20 mm in 12 patients (average size: 31.3 ±9.3 mm) and < 20 mm (average size: 16.6 ±2.5 mm) in 10 patients. Diagnostic accuracy of EUS-FNA from lesions < 20 mm was 50% (5/10 lesions), and of lesions > 20 mm was 91.6% (11/12 lesions) (Fisher's exact test; p=0.028). Six patients underwent surgical resection. Surgical pathology results of five lesions (four GIST, one leiomyoma) were consistent with cytopathology results (83.3%). The diagnostic yield of EUS-FNA of the upper GI SELs with an onsite cytopathologic interpretation was 72.7%. Lesion size < 2 cm significantly reduces the diagnostic yield of EUS-FNA for the upper GI SELs.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis of Adrenal Metastasis in a High-Risk Population

While the left adrenal gland is readily accessible via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), data regarding the utility of EUS-FNA in the diagnosis of adrenal lesions remain limited. We aimed to ( 1) describe the clinical context, adverse event rate, and diagnostic performance of EUS-FNA, and ( 2) compare the safety profile and diagnostic accuracy of EUS-FNA with percutaneous adrenal biopsy. Single-center, retrospective cohort study. Medical records of patients who underwent adrenal EUS-FNA from 2005-2016 were reviewed. Biopsy outcomes were evaluated using a predefined reference standard. Results were compared to patients who underwent percutaneous biopsy (n = 419; 1994-2014) at the same institution. A total of 121 patients underwent EUS-FNA of 122 adrenal lesions (left [n = 121]; right [n = 1]; mean lesion size, 1.8 cm). Cytology was positive for malignancy in 35 (29%), suspicious for malignancy in 1 (1%), atypical in 1 (1%), negative for malignancy in 81 (66%), and nondiagnostic in 4 (3%). No adverse events were reported. EUS-FNA diagnosed metastasis with a sensitivity of 100%, specificity of 97.4%, positive predictive value of 91.7%, and negative predictive value of 100%. When compared to percutaneous biopsy, lesion size (1.8 cm vs. 3.7 cm; P<.001) and biopsy site (99% vs. 62% left adrenal; P<.001) were significantly different. EUS-FNA adverse event rate was lower than percutaneous biopsy (0% vs. 4%; P = .024), but nondiagnostic rates were similar (3.3% vs. 4.8%; P = .48). EUS-FNA is a sensitive technique to sample adrenal lesions in patients at high risk for adrenal metastasis with fewer adverse events compared to percutaneous biopsy. CI = confidence interval CT = computed tomography EUS-FNA = endoscopic ultrasound-guided fine-needle aspiration NPV = negative predictive value PPV = positive predictive value TUS = transabdominal ultra-sound.

Endoscopic therapy for the stenotic pancreaticojejunal anastomoses

A prototype forward-viewing echoendoscope has been developed for therapeutic endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The hard tip of the forward-viewing echoendoscope, which is shorter than that of the convex type echoendoscope, can be maneuvered flexibly. Using the forward-viewing echoendoscope, the gastrointestinal wall can be vertically punctured along the same axis as the scope, and this process is done more easily than with an oblique-viewing echoendoscope. The diagnostic accuracy of EUS-FNA with the forward-viewing echoendoscope is 97.4%, which is not significantly different to that of the oblique-viewing echoendoscope. The forward-viewing echoendoscope may be useful in situations where the location and procedure are difficult with the oblique-viewing scope, The forward-viewing echoendoscope is able to puncture the gastrointestinal wall vertically with minimal effort, therefore allowing therapeutic EUS procedures such as pseudocyst and abscess drainage, biliary drainage, and pancreatic duct drainage to be performed easily. However, a significant difference between the forward-viewing and oblique-viewing echoendoscopes in pseudocyst drainage has been reported recently. In the future, the forward-viewing and oblique-viewing echoendoscopes will probably be selectively used depending on not only lesion site but also the procedure required in individual patients, thereby facilitating various processes including puncture, tissue collection, and diagnosis, as well as therapeutic procedures.

Impact of endoscopic ultrasound-guided fine-needle aspiration and multidisciplinary approach in the management of abdominal or mediastinal mass.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a useful tool for the diagnosis of suspected abdominal or mediastinal neoplastic lesions. To evaluate the impact of EUS-FNA and multidisciplinary approach on the diagnostic work-up and therapeutic management of patients with abdominal or mediastinal neoplastic lesions. One hundred and twenty patients (69 men, median age 65 years) with a suspected abdominal or mediastinal neoplastic mass at computed tomography or MRI underwent EUS-FNA. All EUS-FNA findings and clinical data were evaluated by a multidisciplinary team (oncologists, surgeons, and gastroenterologists). EUS-FNA findings were compared with the final diagnosis made by histological evaluation of the surgical specimen or clinical outcome at follow-up. A correct diagnosis was obtained by EUS-FNA in 96/120 patients (80%), indicating benignancy of the lesion in 21 (18%) cases and confirming malignancy in 75 (62%). On the basis of EUS-FNA findings, chemotherapy was tailored in 57/75 (76%) patients with malignancy whereas the surgical strategy was changed in 21/120 (18%) of patients. Overall, the diagnostic accuracy of EUS-FNA was 85%. A multidisciplinary team approach enabled a correct diagnosis in patients in whom EUS-FNA was nondiagnostic and to identify five cases with false-negative EUS-FNA findings. EUS-FNA has a relevant impact on the management of suspected abdominal or mediastinal neoplastic lesions. A multidisciplinary team approach enables to overcome the EUS-FNA methodological limitations. The combination of EUS-FNA and multidisciplinary team approach could help to diagnose and tailor therapeutic options in such patients.

How good is fine needle aspiration? What results should you expect?

Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.

Accuracy of endoscopic ultrasound‐guided fine needle aspiration cytology on the differentiation of malignant and benign pancreatic cystic lesions: A single‐center experience

The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in cytology and the biochemical analysis of cyst fluid, together with the size of the lesion in the differentiation between benign and malignant pancreatic cystic lesions. Data of patients who underwent EUS-FNA for pancreatic cystic lesions in our center from January 2006 to October 2010 were retrospectively analyzed. The diagnostic accuracy of EUS-FNA was determined. Of the 56 patients, 37 (66.1%) had evaluable cytology for diagnosis and sufficient cyst fluid was available for biochemical analysis in 58.9% (33/56) of the patients. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA for detecting malignancy were 63%, 100%, 100% and 85%, respectively. EUS-FNA was the most accurate diagnostic method for differentiating malignant and benign pancreatic cystic lesions (88%). Cyst fluid carcinoembryonic antigen (CEA) > 365 ng/mL had a sensitivity of 100% for the detection of malignant cystic lesions. Although the rate of insufficient cyst fluid aspiration is high, the combination of cytological evaluation and CEA analysis of cyst fluid obtained by EUS-FNA is accurate in differentiating malignant cystic lesions from benign ones. Safe techniques are essential to improve the yield of cyst fluid aspiration by EUS.

Endoscopic ultrasound-guided fine needle aspiration versus percutaneous ultrasound-guided fine needle aspiration in diagnosis of focal pancreatic masses

Objective:Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer.Patients and Methods:A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2).Results:EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%).Conclusion:EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.

Diagnostic Accuracy of EUS-FNA Without On-Site Cytopathology in a Community Hospital

Purpose: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a method for obtaining tissue diagnosis for masses found in the gastrointestinal (GI) tract. The use of on-site cytopathologist is usually used to assess specimen adequacy and diagnosis; but many centers do not have this service available in daily clinical practice. The goal of this study was to retrospectively evaluate the diagnostic yield of EUS-FNA in patients presenting with solid lesions of the GI tract in a practice setting with no on-site cytopathology. Methods: We retrospectively looked at all EUSs done at our institution with FNA done for masses from 1/1/09 to 12/31/12. Two endoscopists performed all the EUSs. There were no on-site cytopathologist for any of the procedures. We then correlated the pathology report with the EUS report. Adequate specimen collection rate, cytological diagnosis and number of needle passes were evaluated. Results: Over the three year period a total number of 438 total EUS were done. 118 EUS were done for solid masses (pancreas and stomach) of which 90 were biopsied (mean age 67.8; age range 43-93). 43% were male. Average number of passes was 3.5. There were adequate samples in 87 of the 90 (96.6%) specimens that were obtained. None of these patients developed complications from the procedure. Conclusion: Performing EUS-guided FNA for the cytological diagnosis of gastrointestinal masses without on-site cytopathology does not significantly increases the number of inadequate samples when compared to recent studies which showed 1% inadequate sample with the availability of on-site pathology.

Clinical effectiveness and cost-effectiveness of endobronchial and endoscopic ultrasound relative to surgical staging in potentially resectable lung cancer: results from the ASTER randomised controlled trial.

To assess the clinical effectiveness and cost-effectiveness of endosonography (followed by surgical staging if endosonography was negative), compared with standard surgical staging alone, in patients with non-small cell lung cancer (NSCLC) who are otherwise candidates for surgery with curative intent. A prospective, international, open-label, randomised controlled study, with a trial-based economic analysis. Four centres: Ghent University Hospital, Belgium; Leuven University Hospitals, Belgium; Leiden University Medical Centre, the Netherlands; and Papworth Hospital, UK. known/suspected NSCLC, with suspected mediastinal lymph node involvement; otherwise eligible for surgery with curative intent; clinically fit for endosonography and surgery; and no evidence of metastatic disease. previous lung cancer treatment; concurrent malignancy; uncorrected coagulopathy; and not suitable for surgical staging. Study patients were randomised to either surgical staging alone (n = 118) or endosonography followed by surgical staging if endosonography was negative (n = 123). Endosonography diagnostic strategy used endoscopic ultrasound-guided fine-needle aspiration combined with endobronchial ultrasound-guided transbronchial needle aspiration, followed by surgical staging if these tests were negative. Patients with no evidence of mediastinal metastases or tumour invasion were referred for surgery with curative intent. If evidence of malignancy was found, patients were referred for chemoradiotherapy. The main clinical outcomes were sensitivity (positive diagnostic test/nodal involvement during any diagnostic test or thoracotomy) and negative predictive value (NPV) of each diagnostic strategy for the detection of N2/N3 metastases, unnecessary thoracotomy and complication rates. The primary economic outcome was cost-utility of the endosonography strategy compared with surgical staging alone, up to 6 months after randomisation, from a UK NHS perspective. Clinical and resource-use data were available for all 241 patients, and complete utilities were available for 144. Sensitivity for detecting N2/N3 metastases was 79% [41/52; 95% confidence interval (CI) 66% to 88%] for the surgical arm compared with 94% (62/66; 95% CI 85% to 98%) for the endosonography strategy (p = 0.02). Corresponding NPVs were 86% (66/77; 95% CI 76% to 92%) and 93% (57/61; 95% CI 84% to 97%; p = 0.26). There were 21/118 (18%) unnecessary thoracotomies in the surgical arm compared with 9/123 (7%) in the endosonography arm (p = 0.02). Complications occurred in 7/118 (6%) in the surgical arm and 6/123 (5%) in the endosonography arm (p = 0.78): one pneumothorax related to endosonography and 12 complications related to surgical staging. Patients in the endosonography arm had greater EQ-5D (European Quality of Life-5 Dimensions) utility at the end of staging (0.117; 95% CI 0.042 to 0.192; p = 0.003). There were no other significant differences in utility. The main difference in resource use was the number of thoracotomies: 66% patients in the surgical arm compared with 53% in the endosonography arm. Resource use was similar between the groups in all other items. The 6-month cost of the endosonography strategy was £9713 (95% CI £7209 to £13,307) per patient versus £10,459 (£7732 to £13,890) for the surgical arm, mean difference £746 (95% CI -£756 to £2494). The mean difference in quality-adjusted life-year was 0.015 (95% CI -0.023 to 0.052) in favour of endosonography, so this strategy was cheaper and more effective. Endosonography (followed by surgical staging if negative) had higher sensitivity and NPVs, resulted in fewer unnecessary thoracotomies and better quality of life during staging, and was slightly more effective and less expensive than surgical staging alone. Future work could investigate the need for confirmatory mediastinoscopy following negative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), the diagnostic accuracy of EUS-FNA or EBUS-TBNA separately and the delivery of both EUS-FNA or EBUS-TBNA by suitably trained chest physicians. Current Controlled Trials ISRCTN 97311620. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 18. See the HTA programme website for further project information.

Can endoscopic ultrasound-guided fine needle aspiration offer clinical benefit for tumors of the ampulla of vater? -an initial study.

Objective:No previous studies have described endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) only for intra-ampullary lesions of the papilla of Vater. We aimed to examine whether EUS-FNA can be used to diagnose such lesions.Methods:This study included a subset of 10 consecutive patients in whom EUS-FNA targeted the ampulla of Vater. All the patients underwent biopsy and/or brushing cytology under endoscopic retrograde cholangiopancreatography (ERCP) prior to EUS-FNA. The final diagnosis was based on pathological examinations of specimens obtained by surgical resection or clinical follow-up more than 1 year in case of evidence of benign lesions.Results:Tissues from the ampulla of Vater could be obtained by EUS-FNA for all 10 patients. The final diagnosis was papillitis (n = 7) and intra-ampullary carcinoma (n = 3). Carcinoma of the ampulla of Vater showed neither exposure on the duodenal mucosal surface nor invasion to the pancreas. The diagnostic accuracy of surface biopsy with duodenoscopy, and intra-ampullary biopsy and/or brush cytology with ERCP and/or intra-ampullary biopsy after endoscopic sphincterotomy (EST) in distinguishing between benign and malignancy was 70%. The diagnostic accuracy of EUS-FNA was 100%. No complications associated with EUS-FNA were encountered in this study.Conclusion:EUS-FNA for ampulla of Vater may be safely and accurately performed, and should be considered as a diagnostic modality before EST.

How can we get the best results with endoscopic ultrasound-guided fine needle aspiration?

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has evolved to become an indispensable tool for tissue acquisition. While the overall diagnostic accuracy of EUS-FNA is greater than 90% for lung cancer staging, it is lower for pancreatic mass lesions. Several factors such as location of the tumor, disease characteristics and procedural techniques determine the outcomes of EUS-FNA. In this review we evaluate the various technical factors that are keys to attaining optimal procedural outcomes.

Endoscopic ultrasound-guided fine-needle aspiration biopsy in the evaluation of bile duct strictures and gallbladder masses

Recently, there are very few research on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of bile duct and gallbladder masses. The objective of this study was to assess the overall diagnostic accuracy of EUS-FNA in the evaluation of patients with bile duct strictures and gallbladder masses with a meta-analysis. The MEDLINE, EMBASE, Cancerlit and Cochrane Library, and other database, from January 1995 to July 2010, were searched for studies evaluating EUS-FNA accuracy. Meta-analysis methods were used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio, summary receiver operating characteristic curves, and the Q* index. A total of nine studies with 284 patients, who fulfilled all the inclusion criteria, were considered for the analysis. EUS-FNA had a pooled sensitivity of 0.84 (95% confidence interval: 0.78-0.88) and a pooled specificity of 1.00 (95% confidence interval: 0.94-1.00). Overall area under the curve was 0.9254, The Q* index was 0.8598 and the calculated diagnostic odds ratio was 75.1. No complications occurred. EUS-FNA was an accurate and safe tool in the evaluation bile duct and gallbladder masses. High-quality prospective studies regarding EUS-FNA in the evaluation of patients with bile duct and gallbladder masses are still needed to be conducted.

Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study

BACKGROUND AND AIM: The diagnosis of gastrointestinal stromal tumors (GISTs) has important prognostic and therapeutic implications. The specific diagnosis of GIST has to be based on immunocytochemistry. This study aimed to prospectively compare in a crossover manner the accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB) in the specific diagnosis of gastric GISTs. We hypothesized that EUS-TCB is superior to EUS-FNA in this respect. PATIENTS AND METHODS: Forty patients with gastric subepithelial tumors suspected on the basis of EUS of being a GIST underwent both EUS-FNA and EUS-TCB. The sequence in which the techniques were employed was randomly assigned to avoid bias. RESULTS: Forty tumors were sampled (mean number of passes: 2.1 ± 0.9 with EUS-TNB and 1.9 ± 0.8 with EUS-FNA; P = not significant, NS). Final diagnoses were: GIST (n = 27), carcinoma (n = 2), leiomyoma (n = 1), schwannoma (n = 1), and no diagnosis possible (n = 9). Device failure occurred in 6 patients with EUS-TCB. A cytohistological diagnosis of mesenchymal tumor (n = 29) and carcinoma (n = 2) was made in 70 % of cases by EUS-FNA and in 60 % of cases by EUS-TCB ( P = NS). Among the samples that were adequate, immunohistochemistry could be performed in 74 % of EUS-FNA samples and in 91 % of EUS-TCB samples ( P = 0.025). When inadequate samples were included, the overall diagnostic accuracy of EUS-FNA was 52 % and that of EUS-TCB was 55 % ( P = NS). There were no complications. CONCLUSIONS: EUS-TCB is not superior to EUS-FNA in GISTs because of the high rate of technical failure of trucut. However, when an adequate sample is obtained with EUS-TCB, immunohistochemical phenotyping is almost always possible. EUS-TCB can be safely performed in this set of patients.

Role of Endoscopic Ultrasound-guided Fine-needle Aspiration in Lung and Mediastinal Lesions

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was initially introduced for diagnosing gastrointestinal and pancreatic lesions, and later on for lung and mediastinal lesions. It can provide tissue diagnosis of lung cancer where bronchoscopy is non-diagnostic. It is a minimally invasive method for lymph node (N) and metastasis (M) staging of non-small cell lung cancer, and is helpful for tissue proof of mediastinal mass with unknown origin. Few data on this topic have been reported from Eastern countries. We report our experience of using EUS-FNA for tissue proof of lung and mediastinal lesions. This was a retrospective analysis of prospectively collected data of 20 cases, with 21 EUS-FNAs of lung and mediastinal lesions (1 EUS-FNA performed on left adrenal gland) for tissue diagnosis and staging. With patients' informed written consent and fasting for 8 hours, EUS-FNA was performed with a linear echoendoscope using a 22- or 5-gauge needle and a syringe with 10-20 mL negative pressure. The cytology smear was fixed with 98% alcohol, while cell-block and tissue were sent for histology. There was no onsite cytopathologist. EUS-guided Tru-Cut biopsy was performed in 1 case. Malignancy was proven by FNA biopsy results, mediastinoscopy when performed, or by clinical course and follow-up. Of the 20 cases, 19 were male and 1 was female; mean age was 63.9 ± 12.6 years. Median tumor size was 2.6 cm (range, 1.8-5.0 cm), and median number of punctures was 3 (range, 2-7). Eighteen EUS-FNA punctures were performed at the mediastinum, and 2 directly on lung mass. The size of the left adrenal metastasis for extramediastinal EUS-FNA was 1.2 cm. Of the 16 EUS-FNA-positive cases, 12 were for tissue diagnosis, 3 were for both tissue diagnosis and staging (N2 and M1 staging), and 1 was for N2 staging. EUS-FNA provided a tissue diagnosis in 14 cases where bronchoscopy was negative. In 16 positive EUS-FNAs, all except 1 had adequate tissue for FNA biopsy. The sensitivity, specificity, and diagnostic accuracy of EUS-FNA were 84.2%, 100%, and 85%, respectively. EUS-FNA can diagnose lung cancer by confirmation of mediastinal lymph node metastasis, by direct puncture of lung tumor close to the esophagus. It is useful for lymph node (N) stations 5, 7, 8 and metastasis (M) staging in non-small cell lung cancer, and for the diagnosis of mediastinal mass of unknown etiology.

Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study

The diagnosis of gastrointestinal stromal tumors (GISTs) has important prognostic and therapeutic implications. The specific diagnosis of GIST has to be based on immunocytochemistry. This study aimed to prospectively compare in a crossover manner the accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB) in the specific diagnosis of gastric GISTs. We hypothesized that EUS-TCB is superior to EUS-FNA in this respect. Forty patients with gastric subepithelial tumors suspected on the basis of EUS of being a GIST underwent both EUS-FNA and EUS-TCB. The sequence in which the techniques were employed was randomly assigned to avoid bias. Forty tumors were sampled (mean number of passes: 2.1 +/- 0.9 with EUS-TNB and 1.9 +/- 0.8 with EUS-FNA; P = not significant, NS). Final diagnoses were: GIST (n = 27), carcinoma (n = 2), leiomyoma (n = 1), schwannoma (n = 1), and no diagnosis possible (n = 9). Device failure occurred in 6 patients with EUS-TCB. A cytohistological diagnosis of mesenchymal tumor (n = 29) and carcinoma (n = 2) was made in 70 % of cases by EUS-FNA and in 60 % of cases by EUS-TCB ( P = NS). Among the samples that were adequate, immunohistochemistry could be performed in 74 % of EUS-FNA samples and in 91 % of EUS-TCB samples ( P = 0.025). When inadequate samples were included, the overall diagnostic accuracy of EUS-FNA was 52 % and that of EUS-TCB was 55 % ( P = NS). There were no complications. EUS-TCB is not superior to EUS-FNA in GISTs because of the high rate of technical failure of trucut. However, when an adequate sample is obtained with EUS-TCB, immunohistochemical phenotyping is almost always possible. EUS-TCB can be safely performed in this set of patients.

T1189 Endoscopic Ultrasound for Rectal Cancer Re-Staging After Neoadjuvant Therapy: Is It Really Useful?

AIM Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an established technique used to sample a variety of abnormalities. A drawback of EUS-FNA is the lack of histologic information necessary to characterize tissue architecture. EUS-guided Trucut biopsy (EUS-TCB) is designed to provide a tissue core with intact architecture when compared to EUS-FNA. Numerous studies have attempted to demonstrate the superiority of EUS-TCB over EUS-FNA but have been unable to individually demonstrate statistical significance. Our aim was to compare the diagnostic accuracy of EUS-FNA with that of EUS-TCB using a systematic review of existing studies. METHODWe performed a literature search of studies comparing the accuracy of EUS-FNA with EUS-TCB. Data comparing these two modalities, including diagnostic accuracy, the number of passes and their complication rates were extracted, pooled and analyzed. RESULTS Eight studies (n = 424, 5 prospective and 3 retrospective) were identified. The overall diagnostic accuracy for EUS-FNA was 80% (340/ 425) and for EUS-TCB was 80% (290/362). The most common reasons for EUS-TCB failure was an inadequate amount of tissue biopsied or failure to deploy the TCB needle, which typically occurred during a trans-duodenal approach. Six studies assessed the overall combined diagnostic accuracy of both modalities to be 97% (308/318). The average number of needle passes for EUS-FNA was 3.6 (range 1.3-6.5) and EUS-TCB was 2.4 (range 1.2-4.1). The complication rates for EUS-FNA and EUS-TCB were 1.4% and 2.1% respectively (NS). CONCLUSION This systematic analysis demonstrates no significant difference in the diagnostic accuracy of EUS-FNA compared to EUS-TCB. However, there is a significant increase in diagnostic accuracy when these two modalities are combined. As EUS-TCB has certain technical limitations, its clinical applicability may need to be individualized for each patient.

T1192 A Randomized Trial of Metabolite-Adjusted Versus Weight-Based Dosing of Azathioprine (AZA) in Crohn's Disease (CD) [Clinicaltrials. Gov Identifier Nct00113503

AIM Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an established technique used to sample a variety of abnormalities. A drawback of EUS-FNA is the lack of histologic information necessary to characterize tissue architecture. EUS-guided Trucut biopsy (EUS-TCB) is designed to provide a tissue core with intact architecture when compared to EUS-FNA. Numerous studies have attempted to demonstrate the superiority of EUS-TCB over EUS-FNA but have been unable to individually demonstrate statistical significance. Our aim was to compare the diagnostic accuracy of EUS-FNA with that of EUS-TCB using a systematic review of existing studies. METHODWe performed a literature search of studies comparing the accuracy of EUS-FNA with EUS-TCB. Data comparing these two modalities, including diagnostic accuracy, the number of passes and their complication rates were extracted, pooled and analyzed. RESULTS Eight studies (n = 424, 5 prospective and 3 retrospective) were identified. The overall diagnostic accuracy for EUS-FNA was 80% (340/ 425) and for EUS-TCB was 80% (290/362). The most common reasons for EUS-TCB failure was an inadequate amount of tissue biopsied or failure to deploy the TCB needle, which typically occurred during a trans-duodenal approach. Six studies assessed the overall combined diagnostic accuracy of both modalities to be 97% (308/318). The average number of needle passes for EUS-FNA was 3.6 (range 1.3-6.5) and EUS-TCB was 2.4 (range 1.2-4.1). The complication rates for EUS-FNA and EUS-TCB were 1.4% and 2.1% respectively (NS). CONCLUSION This systematic analysis demonstrates no significant difference in the diagnostic accuracy of EUS-FNA compared to EUS-TCB. However, there is a significant increase in diagnostic accuracy when these two modalities are combined. As EUS-TCB has certain technical limitations, its clinical applicability may need to be individualized for each patient.