Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy Research Articles

Evaluating the Role of EUS-FNA in the Diagnosis of Metastasis to the Pancreas: Results From a Tertiary Cancer Center

Introduction: Metastasis to the pancreas is less than 5% of all tumors detected in the pancreas. Accurate diagnosis of isolated metastasis to the pancreas can lead to metastatectomy with improvement in survival in certain types of primary cancers. Furthermore, in patients with more than 1 malignancy, identifying the source of the metastasis is important for further management. To evaluate the role of EUS-FNA in the diagnosis of metastasis to the pancreas. Methods: The study was approved by the institutional review board. Retrospective chart review was conducted to identify all patients suspected to have a metastatic lesion to the pancreas on imaging (CT, MRI, PET) and confirmed on FNA (EUS-FNA or IR-guided biopsy) between 2002 and 2014. Results: A total of 70 patients (median age: 64 years [range: 35-83]; males: 43 [61%]) were found to have metastatic pancreatic lesions. EUS-FNA was performed in 54 patients and detected the pancreatic lesions in all patients with one mild pancreatitis. Among the 54 patients who had an EUS-FNA, 22 patients had multiple lesions, 32 patients had single lesions (head [15], body [9], tail [8]). A 22 G needle was used in 17 patients, and 25 G needle was used in 29 patients, and both needles used in 1 patient (missing information on needle size in 7 patients). A median of 3 passes (range:1-7) were done. Rapid onsite evaluation was performed on all patients for specimen adequacy. Specimens obtained via EUS-FNA were diagnostic in 53/54 patients. Specimens obtained via IR-guided biopsy were diagnostic in 17/19 patients. EUS-FNA was diagnostic in 2 patients who had previously undergone a non-diagnostic IR-guided biopsy. IRguided biopsy was diagnostic in 2 patients who had previously undergone a non-diagnostic EUS-FNA. Thus the accuracy was 98% for EUS-FNA and 89% for IR-guided biopsy. Immunoperoxidase stains were performed and contributory to the diagnosis on 35 patients (26 with a cellblock and 9 with cell smears). Cytomorphologic comparison with the primary tumor was used to make a diagnosis on the other 35 patients (13 with a cellblock and 22 with cell smears). There were 7 patients with more than 1 primary cancer, with diagnosis provided by immunostaining in 6 patients (5 with cellblock and 1 with cellsmear) and cytomorphologic comparison with primary tumors in 1 patient. Conclusion: EUS-FNA has a high diagnostic yield and low complication rate in patients with metastasis to the pancreas. Immunocytochemistry and comparison of the cytomorphology with the primary cancer when possible enable accurate diagnosis especially in patients with more than one primary cancer.

P2-36-4 - A Case Report-The Diagnostic Treatment by Imatinib Led to Curative Resection of Intestinal Gist

Introduction: Before the treatment of gastrointestinal stromal tumor (GIST), performing the pathological diagnosis including the immunohistochemistry of c-kit is essential. However,it is sometimes difficult to get the specimes of GIST owing to the localization. We have experienced a case that huge GIST difficult to get the biopsy specimens was complete resected with the aid of diagnostic injection of imatinib.Clinical course: A 60 years of age male noticed large mass in his abdomen since August 2013. Therefore he visited to our department. We palpated approximate 20cm huge hard mass without mobility in his lower abdomen. A CT scan showed 17 cm homogeneous enhanced mass with relatively clear border and including necrotic components spreading lower abdomen to pelvis. This tumor was most probably suspected intestinal GIST as imaging. However, it is difficult to perform EUS-FNA or echo-guided biopsy owing to the localization. If we performed surgery, huge blood loss and loss of function was anticipated. Therefore we tried the diagnostic treatment with imatinib 400mg/day. Severe adverse events were not observed. Tumor progression was not obsereved by palpitation, furthermore CT showed tumor shrinkage after two week administration of imatinib. We continued imatinib treatment, however he suffered whole body diffuse itching skin rash about two months after this treatment. This was diagnosed toxic eruption due to imatinib. Although the CT scanning showed more shrinkage, we could not continue imatinib. We performed an operation on December 6.This surgery attained the curative en bloc resection. The pathological findings showed that this tumor was malignant jejunum GIST with c-kit positive and 45/50HPF mitotic counts. Post operative course was good and the recurrence was not observed at this writing.Summary: The diagnostic imatinib treatment is considered to be one of the treatment choice, when GIST is suspected by the imaging and biopsy specimens are difficult to acquire.

Comparison of Imaging Characteristics of CT, MRI, PET, and EUS in the Evaluation of Metastasis to the Pancreas: Results From a Single Tertiary Cancer Center

Introduction: Metastasis to the pancreas is less than 5% of all tumors detected in the pancreas. Differentiating a metastatic implant from a primary pancreatic carcinoma is important for management and prognosis. The purpose of the study was to identify the clinical presentation and imaging characteristics of metastastic lesions to the pancreas. Methods: The study was approved by the institutional review board. Retrospective review was conducted to identify all patients suspected to have a metastatic lesion to the pancreas on imaging (CT, MRI, PET) and confirmed on FNA (EUS-FNA or IR-guided biopsy) between 2002 and 2014. Results: A total of 70 patients (median age: 64 years [range: 35-83 years); males 43 [61%]) were found to have synchronous metastatic pancreatic lesions (n=6) or metachronous metastatic pancreatic lesions (n=64) detected after a median of 35 months after primary cancer (range: 1-304 months). The common primary cancers to metastasize to the pancreas were renal (29), melanoma (8), lung (9), colon (3), and breast (3). The majority of patients (n=60; 85%) were asymptomatic. Surveillance CT scan detected the pancreatic lesion in all patients. Of the 70 patients, CT showed multiple pancreatic lesions in 26, diffuse infiltration in 1, and a single lesion in 43: head (19), body (11), and tail (13). MRI detected pancreatic lesions in 11/13 patients. PET scan showed increased uptake in the lesions in 26/31. EUS showed pancreatic lesions in 54/54. Of the 54 patients, EUS showed multiple lesions in 22, and a single lesion in 32: head (15), body (9), tail (8). One patient had a purely cystic lesion (1 anechoic), 43 had solid lesions (41 hypoechoic, 1 heterogenous, and 1 isoechoic), and 10 had solid-cystic lesions (3 hypoechoic, 1 isoechoic, and 6 heterogenous). The border of the lesion was well defined (31 patients) and irregular (23 patients). Thirteen patients had PD dilation: head (6), body (3), tail (1), and multiple (3). Most of the patients (25/29) with pancreatic metastasis from renal cancer had well-defined borders. CBD dilation was seen in 8 patients (3 had multiple lesions and 5 with single lesions all located in the head). Five patients had both CBD and PD dilation. No specific primary cancer was associated with PD or CBD dilation. A total of 13 patients underwent metastatectomy. Four of 13 patients who underwent surgery died (median 120 months; range: 66-412). Conclusion: Metastasis to the pancreas can occur after several years of remission of the primary cancer, especially in RCC and is often found on routine surveillance CT as a pancreatic mass. Metastasis to the pancreas is usually solitary with no predilection for the location in the pancreas. Metastasis from RCC is most common and has a well-defined border on EUS.

Abstract 1861: S100P is a potential biomarker in distinguishing mucinous from non-mucinous pancreatic cysts and predicting invasive adenocarcinoma

Abstract Introduction. Our previous publications demonstrated that S100P was a highly sensitive biomarker in identifying pancreatic mucinous neoplasms (PMNs) and invasive ductal adenocarcinomas (ADCs) on both cytological and surgical specimens. When working on pancreatic cystic lesions, there are two important undertakings: 1) distinguishing mucinous neoplasms from non-mucinous cysts and 2) predicting the presence of invasive adenocarcinomas. In this study, we investigated the potential utility of S100P for these purposes. Design. Thirty pancreatic cystic fluid samples obtained by EUS-FNA biopsy were retrieved from Geisinger Biospecimen Bank. Diagnosis was based on definitive cytological diagnosis in all cases and additional surgical pathology confirmation in 11 cases. These 30 samples included 7 benign cysts in Group 1, 14 PMNs in Group 2, and 9 ADCs in Group 3. The S100P protein level of each sample was quantitatively measured by enzyme-linked immunoassay (ELISA) (CircuLex S100P ELISA kit, MBL International Corporation) according to the vendor's protocol. Results. The results are summarized in Table 1. Marked elevation of S100P was seen in 6 of 9 ADCs (2129.81 + 1834.34 ng/ml), in contrast to the moderate increase in Group 2 (666.67 + 1439.91 ng/ml) and the minimal increase in Group 1 (22.27 + 18.62 ng/ml). Using 50 ng/ml as a cutoff value to differentiate a PMN/ADC (Group 2 and Group 3) from a benign cyst (Group 1), the sensitivity, specificity, positive predictive value and negative predictive value for identifying a PMN/ADC were 60.9%, 100%, 100%, and 43.8%, respectively. Conclusion. These preliminary data suggest that S100P is a useful biomarker in identifying invasive adenocarcinomas and in distinguishing mucinous neoplasms from non-mucinous cysts. Caution should be taken since some ADCs may show only mildly increased S100P levels, similar to some PMNs and non-mucinous cysts. Additional study in a large series of cases is needed to substantiate the current findings. Table 1.Summary of S100P protein level (ng/ml) in 30 pancreatic cysts by ELISACase #Benign CystsMucinous NeoplasmsAdenocarcinomas12.515.4812.6722.596.6413.2135.0410.8544.07428.0918.371849.20530.6219.802162.98643.2929.402831.67743.75120.483076.958137.954441.439158.684736.0810221.7711285.6012290.78133385.19144628.37 Citation Format: Wenyi Mi, David L. Diehl, Jianhi Shi, Joseph Blansfield, Marie Hunsinger, Wannian Yang, Fan Lin. S100P is a potential biomarker in distinguishing mucinous from non-mucinous pancreatic cysts and predicting invasive adenocarcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1861. doi:10.1158/1538-7445.AM2014-1861

A feasibility study of full-field optical coherence tomography for rapid evaluation of EUS-guided microbiopsy specimens

Rapid on-site evaluation of cytologic specimens is a way of determining the adequacy of fine-needle aspiration (FNA). However, alternatives may be useful when the presence of a cytotechnologist and/or pathologist is not possible. To evaluate the feasibility of using full-field optical coherence tomography (FFOCT) for FNA specimen quality assessment. FFOCT images were acquired on gastric, pancreatic, pelvic, and lymph-node formalin-fixed FNA specimens and were compared with histology of the same samples. Pathology suite in a hospital. Fourteen patients undergoing gastric, pancreatic, pelvic, or lymph-node EUS-guided FNA biopsy. FFOCT imaging on formalin-fixed samples before histologic procedures. FFOCT imaging feasibility and visibility of normal and abnormal features on images. FFOCT imaging was possible. Blood, mucus, muscle, collagen, and digestive mucosa could be identified as well as abnormal architectural features including infiltrative pancreatic ductal carcinoma and a neuroendocrine neoplasm. Lesions at the individual cell level could not be detected. The study was performed on a limited number of cases. FFOCT offers rapid, noninvasive, nondestructive imaging of FNA biopsy specimens. In the future, it could be performed in the endoscopy suite to improve detection of satisfactory specimens and obviate the need for rapid on-site evaluation.

Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses

Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, differential diagnosis remains a clinical challenge. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting. EUS-guided FNA and FNB, by obtaining cytological and/or histological samples, are able to diagnose pancreatic lesions with high sensitivity and specificity. In this context, several methodological features, trying to increase the diagnostic yield of EUS-guided FNA and FNB, have been evaluated. In this review, we focus on the role of rapid on-site evaluation (ROSE). From data reported in the literature, ROSE may increase diagnostic yield of EUS-FNA specimens by 10%-30%, and thus, diagnostic accuracy. However, we should point out that many recent studies have reported adequacy rates of > 90% without ROSE, indicating that, perhaps, at high-volume centers, ROSE may not be indispensable to achieve excellent results. The use of ROSE can be considered important during the learning curve of EUS-FNA, and also in hospital with diagnostic accuracy rates < 90%.

The diagnostic value of endoscopic ultrasound-guided fine-needle aspiration biopsy of cell block with immunostaining for pancreatic lesions

Objective To evaluate the diagnostic value of the cell block （CB） with immunostaining method by endoscopic ultrasound-guided fine-needle aspiration （EUS-FNA） biopsy for pancreatic lesions. Methods A total of 72 patients with pancreatic lesions underwent EUS-FNA at the First Affiliated Hospital of Guangxi Medical University from March 2012 to June 2013. The EUS-FNA samples of all patients were processed by conventional smear cytology, liquid-based cytology （LBC） and the cell block with immunos- taining. Results There were 61 pancreatic patients who were finally diagnosed as having pancreatic tumors, including 55 cases of pancreatic cancer, 2 pancreatic solid pseudopapillary tumor, 4 pancreatic endocrine tumors （PETs） , and 11 benign lesions： 4 chronic pancreatitis, 2 pancreatic tuberculosis ,4 pancreatitis and 1 pancreatic mucinous cystadenoma. The diagnostic sensitivity of conventional smear cytology, liquid-based cytology and cell block with immuno-staining method were 68. 9% （42/61）, 75.4% （46/61） and 90. 2% （ 55/61 ） , respectively. The diagnostic specificity of three methods were all 100.0%. The diagnostic accura- cy rates were 73.6% （53/72） ,79. 2% （57/72） and 91.7% （66/72）, respectively. The diagnostic accuracy rate of the cell block with immunostaining was higher than those of conventional smear cytology （ P 〈 0. 05） and the liquid-based cytology （P 〈 0. 05 ）. Conclusion Endoscopic ultrasound-guided fine-needle aspiration is a safe and effective method with high sensitivity and specificity in the diagnosis of pancreatic lesions. Cell block method combining immunohistochemistry helps to increase the diagnosis and histological diagnosis of pancreatic lesions. The cell block has a greater clinical value in the diagnosis of pancreatic lesions. Key words: Endosonography; Fine needle aspiration; Liquid-based cytology; Cell block ; Pancreatic lesions

Histo-cytological diagnosis of GIST: EUS FNA versus clamp biopsy, sensitivity, specificity and limitations

Histo-cytological diagnosis of GIST: EUS FNA versus clamp biopsy, sensitivity, specificity and limitations

Mo1447 Use of Real Time EUS Elastography in Targeting EUS-FNA Biopsy of Suspicious Pancreatic Masses: a Pilot Study

Mo1447 Use of Real Time EUS Elastography in Targeting EUS-FNA Biopsy of Suspicious Pancreatic Masses: a Pilot Study

Predictive value of intra-abdominal lymph nodes in pancreatic endoscopic ultrasonography–guided fine-needle aspiration biopsy

Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) biopsy is a commonly used method for the evaluation of pancreatic lesions. EUS-guided FNA of the intra-abdominal lymph nodes (LNs) can provide critical diagnostic information that is important for clinical management and tumor staging. This study examines the predictive value of intra-abdominal LN EUS-guided FNA biopsy associated with pancreatic lesions. Over a 10-year period, the pathology database was searched for patients with concurrent pancreas and intra-abdominal LN EUS-guided FNA biopsy. The corresponding reports were reviewed, and clinical information and diagnostic results were recorded. There were 252 cases where both a pancreas lesion and intra-abdominal LN were biopsied. Of this group, 182 LNs were classified as negative (72%), 47 as positive (19%), and 23 as atypical (9%). Within the negative LN cohort, the pancreas FNAs fell into the following diagnostic categories: benign (47%), malignant (30%), and atypical/suspicious (23%). Within the positive LN cohort, the pancreas lesion correlated with the following diagnostic categories: malignant (89%), atypical (4%), and suspicious (6%). A positive LN EUS-guided FNA biopsy had a 98% positive predictive value for malignancy. Within the atypical LN cohort, the pancreas correlated with the following diagnostic categories: malignant (57%), atypical/suspicious (26%), and benign (17%). An atypical LN diagnostic category is strongly associated with a malignant pancreas lesion. Apositive LN EUS-guided FNA biopsy has a 98% positive predictive value for pancreatic malignancy. Apositive diagnostic category for an intra-abdominal LN can provide strong predictive evidence of a corresponding malignancy of the pancreas.

Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm

In the expanded indications for endoscopic resection, Japanese guidelines for gastric cancer include differentiated cancers confined to the mucosa with an ulcer <30 mm. We describe a patient with lymph node metastasis after curative endoscopic submucosal dissection (ESD) for a tumor of this indication. The patient was a 70-year-old man with chronic hepatitis C. He underwent ESD for early gastric cancer in May 2010. Pathology revealed a moderately differentiated adenocarcinoma, 22 × 17 mm in size, that was confined to the mucosa with an ulcer. The horizontal and vertical margins were negative for the tumor. We diagnosed thiscase as curative resection of expanded indication and followed this patient with endoscopy, abdominal ultrasonography (AUS) or enhanced computed tomography (CT) approximately every 6 months. After 17 months, lymph node metastasis was detected with AUS and CT and diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy in August 2011. Distal gastrectomy with D2 dissection was carried out in December 2011. Although it is low, the possibility of recurrence should be borne in mind after endoscopic treatment of early gastric cancer, despite its inclusion in the expanded indications for endoscopic resection.

Primary gastric extra-uterine endometrial stromal sarcoma

Endometrial stromal sarcoma (ESS) is an uncommon uterine neoplasm, but its occurrence as an extra-uterine primary (EESS) is exceedingly unusual, and the fine-needle aspiration (FNA) cytopathology of EESS is rarely described. We hereby present 2 women with primary gastric EESS whereby the FNA cytopathology of this rare entity showed a population of cytologically monotonous oval-spindle shaped cells. This cytopathology is correlated with the subsequent histopathology. EESS is another, albeit rare, diagnostic consideration along with gastrointestinal stromal tumor, schwannoma, glomus tumor, and leiomyoma of cytologically bland neoplasms of the stomach that can be encountered using endoscopic ultrasound-guided FNA biopsy.

Effect of pancreatic juice cytology and/or endoscopic ultrasound‐guided fine‐needle aspiration biopsy for pancreatic tumor

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) can now provide a cytopathological diagnosis of pancreatic malignancy with higher success rates. However, EUS-FNA cannot be carried out for lesions of minimally invasive carcinoma because they cannot be detected by endoscopic ultrasonography, and in cases of intraductal papillary mucinous carcinoma (IPMC) because of the potential for needle tract seeding. A recent study has shown that pancreatic juice cytology (PJC) is useful for diagnosing pancreatic cancer. This study's aim was to evaluate whether PJC strengthens the diagnostic power of EUS-FNA for pancreatic masses. A total of 161 patients, who were suspected to have a pancreatic mass on conventional ultrasound and/or computed tomography, was enrolled. EUS-FNA was carried out in 121 cases, and PJC was performed in 83 cases. An adequate specimen was obtained for EUS-FNA in 96.0% and for PJC in 98.9%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.0%, 100%, 100%, 70.5%, and 89.5% for EUS-FNA, and 71.4%, 100%, 100%, 84.4%, and 88.8% for PJC, respectively. EUS-FNA and/or PJC for the diagnosis of pancreatic tumor had a sensitivity of 92.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 91.7%, and accuracy of 95.9%. The diagnostic accuracy of EUS-FNA and/or PJC was significantly higher than that of EUS-FNA alone or PJC alone. PJC improved the diagnostic utility of EUS-FNA for pancreatic tumor.

Value of endoscopic ultrasound-guided elastography in distinguishing between malignant and benign nodes in oesophageal cancers

Objective To assess endoscopic ultrasound (EUS)-guided elastography in the nodal staging of oesophageal cancers.Methods The 53 nodes were assessed in 50 patients with established oesophageal cancer undergoing EUS-guided fine needle aspiration biopsy (FNAB) of lymph nodes between March 2011 and January 2013.EUS-guided elastography and standard EUS of lymph nodes were performed before EUS-FNAB.Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study.Comparisons of elastography and standard EUS characteristics and accuracy in differentiating between benign and malignant lymph nodes were made.Results Elastography was more sensitive and specific in determining malignant nodal disease than standard EUS criteria.The sensitivity,specificity,positive predictive value,and negative predictive value for distinguishing between malignant and benign nodes were 83％,96％,95％,and 86％,respectively.The overall accuracy of elastography strain ratio was 90％.Conclusion EUS-guided elastography is superior in differentiating between benign and malignant lymph nodes to standard EUS characterisations,also appears complementary to current staging investigations and has the potential to improve the staging and management of this disease. Key words: Endoscopic ultrasound ; Elastography ; Oesophageal cancer; Lymph nodes

Cytological diagnosis of angiosarcoma arising in an immunosuppressed patient 6 years after multi‐visceral transplantation

Angiosarcoma is a rare and aggressive malignant tumor of soft tissue. It can arise in almost any part of the body, most commonly in the skin and the superficial soft tissue in the head and neck region. Although the etiology of angiosarcoma is unknown, there are several well-known risk factors, such as chronic lymphedema, exposure to radiation, toxins, and foreign bodies. It rarely occurs in transplant patients. Cytological criteria for the diagnosis of angiosarcoma have not been fully established, having been described only in a few cases, mostly fine-needle aspiration biopsies (FNAB). Herein, we present a case of angiosarcoma arising in an immunosuppressed patient status post multi-visceral transplantation and diagnosed by cytology. To the best of our knowledge, this is the first report of such a case in the English literature. The cytological findings from endoscopic ultrasound-guided FNAB and ascites fluid are discussed.

Can Endoscopic Real-time Elastography Help in Targeting EUS-FNA Biopsy of a Pancreatic Mass? A Pilot Study

Can Endoscopic Real-time Elastography Help in Targeting EUS-FNA Biopsy of a Pancreatic Mass? A Pilot Study

Rapid on‐site evaluation for endoscopic ultrasound‐guided fine‐needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures

Rapid on-site evaluation (ROSE) for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy of the pancreas provides immediate feedback regarding cellular adequacy to aid in obtaining a definitive diagnosis and has the potential to avoid repeat procedures. The objective of the current study was to measure the impact of ROSE service on the incidence of repeat EUS FNA biopsy procedures. Over a consecutive 3-year period, the pathology database at Washington University Medical Center was searched for patients with both an initial and subsequent EUS FNA biopsy demonstrating a solid lesion of the pancreas. These were divided temporally between the time before and after the introduction of ROSE service. Reports were reviewed and results were recorded. A total of 379 patients underwent ROSE service and 377 patients did not. The percentage of repeat non-ROSE EUS FNA cases was 5.8% and the percentage of repeat ROSE EUS FNA cases was 2.9%. The use of the ROSE service was found to decrease the number of repeat procedures by approximately 50% (P = .024). For those patients who underwent a repeat EUS-FNA procedure, the ROSE service provided a higher rate of definitive diagnosis among patients undergoing repeat procedures (67%) versus the non-ROSE cohort (27%). The use of ROSE for EUS-FNA biopsy of the pancreas was found to result in fewer patients undergoing repeat procedures. Patients who required a repeat procedure with the use of ROSE had a higher percentage of definitive diagnostic categorization on the repeat biopsy. Initial use of ROSE for EUS-FNA of solid pancreatic lesions was found to decrease the number of patients who required a repeat procedure.

Endosonographic Evaluation of the Adrenal Glands: Part I

The left adrenal gland is best visualized using endoscopic ultrasound (EUS) from a position in the upper body of the stomach, whereas the right adrenal gland may easily be examined using transabdominal ultrasound. The adrenal glands have a ‘seagull’ configuration, with a body and two long wings. Sonographically, five layers of the adrenals may be distinguished. Mass lesions are incidentally found in up to 5% of patients, only 15–20% of these ‘incidentalomas’ being clinically relevant. However, the adrenal glands are the fourth most frequent site of metastases in malignant disease. EUS-guided fine-needle aspiration biopsy of the left adrenal gland has a high yield and very low risk. This article is part of an expert video encyclopedia.

Tu1390 The Combination of Pancreatic Juice Cytology With Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy Raised the Diagnostic Ability for Pancreatic Tumor

Endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNA) can now provide a cytopathological diagnosis of pancreatic malignancy with higher success rates. However EUS-FNA can not detect minimal invasive carcinoma and intraductal papillary mucinous carcinoma (IPMC). Recent study has shown the usefulness of pancreatic juice cytology for pancreatic cancer. In present study, therefore we evaluated if the combination of pancreatic juice cytology strengthens the diagnostic power of EUS-FNA in pancreatic masses.

Su1536 EUS-Guided 19-Gauge Fine Needle Aspiration Biopsy for the Diagnosis of Both Left and Right Adrenal Lesions

Su1536 EUS-Guided 19-Gauge Fine Needle Aspiration Biopsy for the Diagnosis of Both Left and Right Adrenal Lesions