Diagnostic Value Of Endoscopic Ultrasonography Research Articles

Diagnostic value of endoscopic ultrasonography for submucosal tumors of upper gastrointestinal tract

To evaluate the diagnostic value of endoscopic ultrasonography (EUS) for submucosal tumors (SMTs) of upper gastrointestinal tract. A retrospective analysis was made based on clinical data of 206 upper gastrointestinal SMTs patients from January 2009 to July 2013 in The First Affiliated Hospital of Soochow University. Preoperative EUS findings were compared with postoperative pathological diagnosis, and the sensitivity, specificity and accuracy of EUS diagnosis in property and layer origin of SMTs were calculated. The sensitivity, specificity and accuracy of EUS diagnosis in SMTs property were 60.2%, 67.1% and 61.2%. The sensitivity, specificity and accuracy of EUS diagnosis in layer origin of SMTs were 98.0%, 98.2% and 98.1%. EUS has limited value in the diagnosis of property of SMT, and has high accuracy of identifying the origin layer, which is helpful to choose therapeutic schedule of SMT under endoscopy.

Diagnostic value of endoscopic ultrasonography combined with detection of immunoglobulin and T-cell receptor gene rearrangements in primary gastrointestinal lymphoma

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) combined with detection of immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements in primary gastrointestinal lymphoma (PGIL). Methods From 12nd January, 2012 to 23rd May, 2014, the clinical data of 24 patients with suspicious PGIL under endoscopy (regular biopsy negative and without treatment) and underwent further EUS examination was retrospectively analyzed. All patients received EUS-guided biopsy or EUS-guided fine needle aspiration (FNA) and the tissue specimens were detected for Ig and TCR gene rearrangements. Considering biopsy result, surgical pathological diagnosis and follow-up result as gold standard, the clinical significance of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EUS combined with Ig/TCR gene rearrangements in PGIL were explored. Results Among 24 patients, 19 patients were finally diagnosed as PGIL, which were all non-Hodgkin's lymphoma (NHL); monoclonal gene rearrangement was found in 13 cases of the 19 cases. The left five cases were not lymphoma lesions (three cases of gastritis, one case of leather stomach and one case of malignant melanoma) with no monoclonal gene rearrangement. In cases diagnosed as PGIL, 14 were B cell NHL, which included eight cases of muscosa-associated lymphoid tissue (MALT) lymphoma and six cases of diffuse large B cell lymphoma. Of which, immunoglobulin heavy chain (IgH)/immunoglobulin kappa (IgK) gene rearrangement was found in 11 cases. A total of five cases were T cell NHL including one case of anaplastic large cell lymphoma, one case of NK/T cell lymphoma and three cases of enteropathy-associated T-cell lymphomas. TCR gene rearrangement was found in two cases. Because theoretically, there was no gene rearrangement in natural killer (NK)/T cell lymphoma, so NK/T cell lymphoma was excluded from statistical analysis. The sensitivity, specificity, PPV, NPV and accuracy of EUS combined with Ig/TCR gene rearrangements detection in PGIL were 72.2%, 100.0%, 100.0%, 50.0% and 78.3%, respectively. Conclusion The detection of monoclonal gene rearrangement in tissues from EUS-guided biopsy or EUS-guided FNA had better diagnostic value in PGIL, which improved the objectivity and accuracy of lymphoma diagnosis. Key words: Gastrointestinal neoplasms; Lymphoma; Gene rearrangement; Endoscopy

Application of Endoscopic Ultrasonography in the Diagnosis and Treatment of Lower Gastrointestinal Disease

Application of Endoscopic Ultrasonography in the Diagnosis and Treatment of Lower Gastrointestinal Disease

The diagnostic value of endoscopic ultrasonography for gastrointestinal submucosal tumors

Objective To investigate the diagnostic value of endoscopic ultrasonography( EUS)for gastrointestinal submucosal tumors. Methods EUS was performed on 378 patients with submucosal tumor detected by endoscopy. The shape,number,origin,and property were recorded under endoscopic ultrasonogra-phy. The diagnostic consistent rate was calculated with pathology as the golden standard. Results Among 378 patients,there were 131 cases of gastrointestinal leiomyoma,mostly low echo( n=87 ),homogeneous echo (n=119),and originated from muscular layer of mucosa(n=92). There were 111 cases of gastrointestinal stromal tumor,mainly low echo(n=51),medium low echo(n=51),homogeneous echo(n=78),originated from muscularis propria(n=85). There were also 50 cases of carcinoid tumor,mainly low echo(n=36), originated from submucosa(n=27). Forty-five cases of lipoma were detected,also originated from submuco-sa,mainly hyperecho(n=40),homogeneous echo(n=41). Heterotopic pancreas(n=19),schwannoma (n=4),and granular cell tumor(n=4)were relatively rare. Overall diagnostic consistent rate of EUS in submucosal tumor was 78. 6%( 297/378 ),diagnostic consistent rate of the shape of the tumor was 91. 8%(347/378),diagnostic consistent rate of the number was 95. 5%(361/378),and the consistent rate of origin was 96. 8%(366/378). Conclusion All kinds of submucosal tumor have certain features under endoscopic ultrasonography. Endoscopic ultrasonography can display echo,size,origin of gastrointestinal submucosal tumors,as well as their relations with the wall layer in gastrointestinal tract. It plays an important role in the diagnosis,differential diagnosis and treatment options,but there are still some limitations. Key words: Endoscopic ultrasonography ; Gastrointestinal submucosal tumor ;

Diagnostic value of endoscopic ultrasonography for preoperative localization of parathyroid adenomas

The most common cause of primary hyperparathyroidism (PHPT) is a single, sporadic parathyroid adenoma. Ultrasonography (US) and (99m)Technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy are the imaging methods most widely used to localize parathyroid adenomas. The purpose of the present study was to determine the diagnostic value and accuracy of endoscopic ultrasonography (EUS) for localizing parathyroid adenoma compared with those of US and (99m)Tc-MIBI scintigraphy. Forty-seven patients with a PHPT diagnosis and who were recommended for surgery were enrolled in this study. An endoscopist who was blinded to the previous US and (99m)Tc-MIBI scintigraphy results performed the EUS in each patient. Thirty-nine female and eight male patients with PHPT were evaluated. The presence of adenoma was confirmed by subsequent postsurgical pathology results. One case was excluded because the histopathological evaluation was compatible with a lymph node, although the lesion was detected using three different imaging modalities preoperatively. The locations of the parathyroid adenomas were correctly documented by US in 39 patients (84.7 %) by (99m)Tc-MIBI scintigraphy in 35 (76.0 %), and by EUS in 44 (95.6 %) of 46 patients. EUS located all 31 adenomas detected previously with US and (99m)Tc-MIBI scintigraphy. EUS also successfully located three adenomas that could not be identified by US and (99m)Tc-MIBI scintigraphy. The positive predictive value and diagnostic accuracy of EUS, US, and (99m)Tc-MIBI were 97.7, 97.7, and 95.6 %; 88.6, 97.5, and 86.9 %; and 77.7, 97.2, 76.0 %, respectively. EUS was preferred as the second step imaging tool for detecting parathyroid adenomas that could not be localized by US and (99m)Tc-MIBI scintigraphy.

Diagnostic value of endoscopic ultrasonography in detection of gastrointestinal protuberant lesions and reasons for misdiagnosis

Diagnostic value of endoscopic ultrasonography in detection of gastrointestinal protuberant lesions and reasons for misdiagnosis

Diagnostic value of endoscopic ultrasonography guided biopsy in large gastric folds

Diagnostic value of endoscopic ultrasonography guided biopsy in large gastric folds

Endoscopic ultrasonographic findings predict the risk of carcinoma in branch duct intraductal papillary mucinous neoplasms of the pancreas

BackgroundThe preoperative diagnosis of branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas can be very difficult, since low-risk and high-risk lesions can be difficult to differentiate even after cytological analysis. The purpose of this study was to evaluate the preoperative diagnostic value of endoscopic ultrasonography (EUS) in differentiating low-risk and high-risk IPMNs. MethodsWe retrospectively identified 36 patients who underwent preoperative EUS for branch duct IPMNs. The pathological diagnosis after surgical resection was low-grade dysplasia (n = 26), moderate dysplasia (n = 1), high-grade dysplasia or carcinoma in situ (n = 5), and invasive carcinoma (n = 4). We divided the patients into two groups: low risk (low-grade dysplasia or moderate dysplasia) and high risk (high-grade dysplasia or carcinoma). We focused on the diameter of the cystic dilated branch duct, the main pancreatic duct, and the mural nodule as measured using the EUS findings. ResultsThe cystic dilated branch duct diameter (31.5 mm vs. 41.9 mm, P = 0.0225) was significantly correlated with low-risk and high-risk IPMNs, but the main pancreatic duct diameter (5.37 mm vs. 5.44 mm, P = 0.9418) was not significantly correlated with the low-risk and high-risk IPMNs. The mural nodule diameter of the papillary protrusions (4.3 mm vs. 16.4 mm, P < 0.0001) and the width diameter of the mural nodule (5.7 mm vs. 23.2 mm, P < 0.0001) were significantly correlated with low-risk and high-risk IPMNs. ConclusionsThe mural nodule of papillary protrusions diameter and width diameter observed using EUS was a reliable preoperative diagnostic finding capable of distinguishing low-risk and high-risk IPMNs.

Diagnostic value of endoscopic ultrasonography in the esophageal carcinoma preoperative TN staging

Aim: To study the diagnostic value of endoscopic ultrasonography in the esophageal carcinoma preoperative TN staging.

Sonographic features of duodenal lipomas in eight clinicopathologically diagnosed patients.

To investigate the sonographic features and diagnostic value of endoscopic ultrasonography (EUS) for duodenal lipomas (DLs). A total of eight consecutive patients with DL diagnosed pathologically were included in the study. One EUS expert reviewed the ultrasonic images for all lesions, including the original layer of the duodenal wall, the echo intensity and the echo homogeneity. The size of the lesions and the perifocal structures were also investigated. The diagnosis by EUS was compared with the histological results. Using routine endoscopy, only one case was correctly diagnosed as DL. Four cases were classified as submucosal tumors, and three cases were mistaken for stromal tumors. All tumors appeared as round or oval intensive hyperechoic lesions with distinct anterior borders that originated from the submucosal layer on EUS. Tumors ranged from 8 to 36 mm in size, with an average size of 16 mm. Homogeneous echogenicity was seen in all cases except one that had a tubular structure inside the tumor. Echo attenuation was observed only in the area behind the tumors in five cases, and it was observed both inside and behind the tumors in three cases in which the posterior border was obscure or invisible. Seven (87.5%) cases were correctly diagnosed as DL, and one (12.5%) was mistaken as Brunner's gland adenoma by EUS. Pathologically, all tumors originated from the submucosal layer and consisted of mature fat cells without heteromorphism. Among the fat cells, there was a small amount of thick-wall vessels infiltrating the lymphocytes, and abundant fibrous connective tissues. On EUS, DL is featured as an intensive homogeneous hyperechoic submucosal lesion with marked echo attenuation and without involvement of the mucosa.

Diagnostic value of endoscopic ultrasonography for large gastric folds

Objective To evaluate endoscopic ultrasonography （EUS） for diagnosis of large gastric folds. Methods EUS was performed in 66 patients with possible large gastric folds which could not be diag- nosed by conventional gastroscopy. The characteristics of EUS findings were analyzed, and the EUS results were compared with pathological findings to evaluate the sensitivity, specificity and accuracy of EUS. Re- suits The diagnostic sensitivity, specificity and accuracy of EUS for diffused infiltrated gastric cancer were 92. 3% （24/26）, 95.1% （39/41） and 95.5% （63/66）, respectively, and those for gastric lymphoma were 92. 3% （12/13）, 96. 1% （49/51） and 92. 4% （61/66）, respectively. The accuracy in differential diagno- sis of benign and malignant disease was 93.9% （62/66）. There were statistical differences between benign and malignant large gastric folds in characteristics of EUS findings, including width of gastric wall, enlarge- ment of muscularis propria and preservation of gastric layer （P 〈 0. 05 ）. Conclusion EUS is of high accu- racy for diagnosis of large gastric folds, especially for diffused infiltrated gastric cancer and gastric lympho- ma. Such features as width of gastric wall, the enlargement of muscularis propria and the preservation of gas- tric layer are important features for differential diagnosis of benign and malignant lesions. Key words: Endoscopic ultrasonography; Large gastric folds

Endoscopic ultrasonography in diagnosis of duodena] cysts

Objective To investigate the diagnostic value of endoscopic ultrasonography （EUS） for duodenal cysts. Methods Clinical manifestations, results of conventional gastroscopy and EUS, as well as follow-up, of patients with duodenal cysts were retrospectively analyzed. Results A total of 105 patients with duodenal cysts presented with no lesion-related symptoms, but displayed characteristic imaging changes under EUS, which could reveal the origin, size and nature of duodenal cysts, and differentiate it from other submucosal lesions. A maximum follow-up of 5 years showed no changes in duodenal cysts. Conclusion Duodenal cyst is a benign disease, and EUS plays a very important role in diagnosis of the disease. Key words: Endoscopic uhrasonography ; Duodenal cyst ; Diagnosis ; Treatment

Diagnostic value of endoscopic ultrasonography in preoperative TN staging of esophageal carcinoma

Diagnostic value of endoscopic ultrasonography in preoperative TN staging of esophageal carcinoma

Clinicopathological characteristics of gastrointestinal mesenchymal tumors and diagnostic value of endoscopic ultrasonography

Gastrointestinal mesenchymal tumors (GIMTs) are tumors which arise from mesenchymal cells other than lymphocytes or epithelial cells and include gastrointestinal stromal tumors (GISTs), smooth muscle tumors, neurogenic tumors, fibroblast tumors, and liparomphalus. Here, we studied the clinicopathologic characteristics of GIMTs and determined the diagnostic value of endoscopic ultrasonography (EUS) in GIMTs. The morphological characteristics of 415 GIMT cases were observed using light microscopy. The expression of CD117, CD34, smooth muscle actin (SMA), S-100, and Ki-67 were detected using immunohistochemistry. EUS results were retrospectively analyzed in 76 cases. Among the 415 GIMT cases, there were 229 GIST cases, 178 smooth muscle tumor cases, and eight neurogenic tumor cases. Diffuse strong expression of CD117 was observed in 202 (88.2%) GISTs and strong expression of CD34 was observed in 135 (59.0%) GISTs. SMA and S-100 expression was detected in smooth muscle tumors (leiomyomas/leiomyosarcoma) and neurogenic tumors, respectively. Of the 12 cases with GISTs, nine cases with positive ki-67 expression and accompanied with more mitosis were pathologically diagnosed as malignant GISTs. Most of the borderline and malignant tumors were found in male patients. EUS was 98.7% accurate in determining GIMT locations, 82.9% accurate in diagnosing GIMTs, and 80.3% accurate in differentiating benign from malignant tumors. GISTs, rather than leiomyomas, are the most common GIMTs. Immunohistochemical markers, such as CD117, CD34, SMA, and S-100, can differentiate GISTs from smooth muscle and neurogenic tumors. The expression of Ki-67 in patients with significant karyokinesis supports a malignant tumor diagnosis. EUS is an accurate method for detecting GIMTs and differentiating between benign and malignant tumors. Use of endoscopic ultrasound-guided fine-needle aspiration biopsies may enable clinicians to make more accurate diagnoses than currently used methods.

Diagnostic value of endoscopic ultrasonography and CT in T, N stage of preoperative esophageal cancer

To evaluate the preoperative endoscopic ultrasonography (EUS) and CT in the diagnosis of TN stage of esophageal cancer. Fifty-one hospitalized patients with esophageal cancer in our center from July 2002 to January 2004 were enrolled in this study. According to UICC (1997) TNM clinical stage, the TN stage results of esophageal cancer by EUS and CT examination of above 51 cases were compared with the postoperative pathological TN stage. (1)The accuracy rates of T and N stage by EUS were 82.4%(42/51) and 88.0%(45/51) respectively. The accuracy rates of T and N stage by CT were 52.9%(27/51) and 51.0%(26/51) respectively. The accuracy rates of T and N stage by combination of EUS and CT were 86.3%(44/51) and 90.0%(46/51). (2)The consistent condition among EUS, CT or combination of EUS and CT with pathology: The Kappa of EUS to T and N stage were 0.700(P<0.001) and 0.763(P<0.001). The Kappa of CT to T and N stage were 0.275(P=0.002) and 0.006(P=0.964). The Kappa of EUS+CT to T and N stage were 0.769(P<0.001) and 0.801(P<0.001). (3)Significant differences were found between EUS and CT:PT=0.001(chi(2)=10.079) and PN<0.001(chi(2)=16.730). No significant difference was found between EUS+CT and EUS. EUS can be used as important and main preoperative examination because of presenting high accuracy rate in the diagnosis of T and N stage of esophageal cancer. EUS+CT does not improve accuracy rate significantly in TN stage diagnosis of esophageal cancer.

Comparison of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreatobiliary Diseases: A Prospective Study

To compare the diagnostic value of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in: (a) patients with a dilated biliary tree unexplained by ultrasonography (US) (group 1), and (b) the diagnosis of choledocholithiasis in patients with nondilated biliary tree (group 2). Patients were prospectively evaluated with EUS and MRCP. The gold standard used was surgery or EUS-FNA and ERCP, intraoperative cholangiography, or follow-up when EUS and/or MRCP disclosed or precluded malignancy, respectively. Likelihood ratios (LR) and pretest and post-test probabilities for the diagnosis of malignancy and choledocholithiasis were calculated. A total of 159 patients met one of the inclusion criteria but 24 of them were excluded for different reasons. Thus, 135 patients constitute the study population. The most frequent diagnosis was choledocholithiasis (49% in group 1 and 42% in group 2, P= 0.380) and malignancy was more frequent in group 1 (35%vs 7%, respectively, P < 0.001). When EUS and MRCP diagnosed malignancy, its prevalence in our series (35%) increased up to 98% and 96%, respectively, whereas it decreased to 0% and 2.6% when EUS and MRCP precluded this diagnosis. In patients in group 2, when EUS and MRCP made a positive diagnosis of choledocholithiasis, its prevalence (42%) increased up to 78% and 92%, respectively, whereas it decreased to 6% and 9% when any pathologic finding was ruled out. EUS and MRCP are extremely useful in diagnosing or excluding malignancy and choledocholithiasis in patients with dilated and nondilated biliary tree. Therefore, they are critical in the approach to the management of these patients.

Surgical Management of Small Gastrointestinal Stromal Tumors of the Stomach

Small gastrointestinal stromal tumors (GISTs) (< 3 cm) occasionally are found in the stomach during endoscopy. There is no consensus about the surgical management of these small tumors, although this clinical issue is crucial because some of the tumors show unexpected malignant behavior. In this study, we evaluated the clinical management of patients with gastric GISTs who underwent surgical resection. Altogether, 31 patients with gastric GISTs were examined retrospectively. Surgical resection was fundamentally indicated for the patients with gastric GISTs suspected to be malignant by endoscopy or endoscopic ultrasonography (EUS). The malignant grade of the GISTs was evaluated by the mitotic rate, tumor size, and MIB-1 index. EUS was useful for differentiating benign from malignant GISTs; but by limiting the study to patients with small tumors (< 3 cm), the diagnostic value of EUS was not satisfactory for defining the surgical indication. Tumors that were < 50 mm were successfully treated by laparoscopic surgery. Of the 31 patients, 4 had a relapse of the disease, and 1 of those 4 patients had a small tumor (30 mm). All of the recurrences were classified in the high risk category. Surgery is indicated for gastric GISTs that are > or = 20 mm or are suspected to be malignant based on EUS findings. Laparoscopic resection is feasible and is recommended as the treatment of choice for patients with tumors < 50 mm. Risk assessment can be most useful for predicting recurrence.

Diagnostic Value of Endoscopic Ultrasonography- Guided Fine-Needle Aspiration Cytology ofMediastinal Masses in Patients with Intrapulmo nary Lesions and Nondiagnostic Bronchoscopy

Several procedures are available for the cytopathological diagnosis of mediastinal lesions. The purpose of this study was to evaluate the diagnostic value of endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) in patients with mediastinal mass lesions/lymph node enlargement. All patients had intrapulmonary lesions on chest X ray and/or CT scan, and inconclusive findings by endobronchial forceps biopsy and/or brush cytology. EUS-guided FNA was performed in 16 patients using a modified oblique forward-viewing gastroscope with an electronic multielement curved linear ultrasound transducer. After the region of interest was localized, a 22-gauge Vilmann-Hancke needle was introduced via the 2-mm biopsy channel. The cytological diagnosis of EUS-guided FNA was conclusive for cancer in 9 patients and in the other 7 patients the aspirated samples revealed a benign lesion. In 10 patients the final diagnosis was cancer, thus EUS-guided FNA was diagnostic for malignancy in all but 1 of the lesions (sensitivity 90.0%). In 1 patient epitheloid cell granuloma was detected by cytological examination of the FNA. Following tuberculostatic treatment the lesions disappeared completely on CT scan and EUS. The overall accuracy in this study amounted to 93.7%. From this and other studies discussed, it is assumed that the procedure is an accurate and safe technique to examine nodular lesions suggestive of metastatic lymph node involvement.

Diagnostic value of endoscopic ultrasonography guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy

Diagnostic value of endoscopic ultrasonography guided fine-needle aspiration cytology of mediastinal masses in patients with intrapulmonary lesions and nondiagnostic bronchoscopy

Endoscopic ultrasonography for diagnosing anomalous pancreaticobiliary junction

Background: Anomalous pancreaticobiliary junction (a long common channel) is associated with choledochal cyst or biliary malignancy. We conducted a prospective study to assess the diagnostic value of endoscopic ultrasonography for anomalous pancreaticobiliary junction. Methods: In 188 adult patients with pancreatobiliary disease, the length of the common channel demonstrated by endoscopic ultrasonography was compared with that demonstrated by ERCP. In 25 patients with anomalous pancreaticobiliary junction (the common channel <15 mm on ERCP), diagnostic accuracy of endoscopic ultrasonography for associated pancreatobiliary diseases was evaluated. Results: On endoscopic ultrasonography, the length of the common channel measured 16.3 ± 5.8 mm (4 to 27 mm) in patients with anomalous junction; 12 mm or longer in 22 (88%) of 25 patients. In patients with a normal junction, endoscopic ultrasonography demonstrated the channel to be shorter than 7 mm. Endoscopic ultrasonography detected choledochal cyst (in 19 patients), gallstones (in 7), and acute pancreatitis (in 2). This imaging precisely differentiated gallbladder lesions, including carcinoma (4 patients) and mucosal hyperplasia (10 patients) in 14 of 16 patients. Endoscopic ultrasonography could be performed safely in outpatients. Conclusions: Endoscopic ultrasonography is a useful imaging method for patients with suspected anomalous pancreaticobiliary junction. (Gastrointest Endosc 1997;45:261-7.)