Fine-needle Aspiration In Patients Research Articles

Metagenomic Next-Generation Sequencing-Based Fine-Needle Aspiration in Patients With Suspected Infected Pancreatic Necrosis.

Fine-needle aspiration (FNA) is no longer recommended for diagnosing infected pancreatic necrosis (IPN) due to a high false-negative rate. Metagenomic next-generation sequencing (mNGS) is a valuable tool for identifying potential pathogens. We hypothesized that adding mNGS to the standard FNA procedure may increase diagnostic accuracy. This is a prospective, single-arm feasibility study enrolling patients with acute necrotizing pancreatitis complicated by suspected IPN. Computed tomography-guided FNA was performed immediately after enrollment, and the drainage samples were subjected to culture and mNGS assays simultaneously. Confirmatory IPN within the following week of the index FNA procedure was the reference standard. The diagnostic performance of FNA-mNGS and the impact of mNGS results on treatment were evaluated. Historical controls were used for comparison of clinical outcomes. There was no significant difference between mNGS and culture in the positive rate (75% vs 70%, P = 0.723). The accuracy of FNA-mNGS was 80.0%, with a sensitivity of 82.35%, specificity of 66.67%, positive predictive value of 93.3%, and negative predictive value of 40.0%. The results of the mNGS led to treatment change in 16 of 20 patients (80%), including implementing percutaneous catheter drainage (n = 7), expanding antibiotic coverage (n = 2), percutaneous catheter drainage and expanding coverage (n = 4), narrowing antibiotic coverage (n = 1), and discontinuation of antibiotics (n = 2). The FNA-mNGS approach was not associated with improved clinical outcomes compared with the historical control group. The addition of mNGS to standard FNA has comparable diagnostic accuracy with culture-based FNA and may not be associated with improved clinical outcomes.

A comparative analysis of core needle biopsy and repeat fine needle aspiration in patients with inconclusive initial cytology of thyroid nodules.

To assess and compare the effectiveness of ultrasound-guided core needle biopsy (CNB) in comparison to repeat fine-needle aspiration(rFNA) for thyroid nodules that yield inconclusive results following the initial fine-needle aspiration (FNA). A cohort of 471 patients who received an inconclusive cytological diagnosis following the initial FNA were included in this study. These patients subsequently underwent either CNB (n=242) or rFNA (n=229). The inconclusive FNA results encompassed categories I, III, and IV of The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC), as well as the ultrasound images indicating malignancy despite FNA results falling under TBSRTC category II. This study assessed the sampling satisfaction rate, diagnostic efficacy, and complications associated with CNB compared to rFNA. Additionally, the impact of repeat puncture time and nodule size on diagnostic efficacy was analyzed. Following repeat punctures, the satisfaction rate of the CNB sampling was found to be significantly higher than that of rFNA (83.9% vs 66.8%). The diagnostic rate in the CNB group was significantly greater compared to that of the rFNA group (70.7% vs 35.8%). In patients with nodule maximum diameters ranging from 5 mm to 20 mm, the diagnostic accuracy was significantly higher in the CNB group compared to that in the rFNA group. In patients with intervals less than 90 days, between 90 days and one year, the diagnostic rate in the CNB group was found to be higher compared to that in the rFNA group. In CNB, not immediately adjacent to the capsule was a risk factor for nodular puncture bleeding (37.0% vs 22.7%.). CNB demonstrated higher rates of satisfaction and diagnosis compared to the rFNA. The diagnostic effectiveness of CNB was not influenced by the time interval or the size of the thyroid nodule. Therefore, in cases where the initial FNA diagnosis of thyroid nodules is inconclusive, CNB should be considered as a viable option for re-puncture.

455 Fine-Needle Aspiration, Ultrasound and Thyroidectomies in Patients with Thyroid Nodules Presenting to a District General Hospital – a Retrospective Audit

Abstract Aim To determine whether fine-needle aspiration, ultrasound and thyroidectomies were being performed appropriately in patients with thyroid nodules, and to compare the percentage of malignant cases for each histological classification with the national standards. Method Patients undergoing thyroidectomy in Northwest Anglia Trust (East of England) between October 2021 – October 2022 was identified retrospectively using the OPSC-4 codes. Medical records of 132 patients were retrieved, and data points extracted. Results We identified 103 female and 29 patients. The female cohort had a younger age distribution (median 52y) compared to the male cohort (59y). 42 patients underwent total thyroidectomy, 89 underwent hemithyroidectomy and 1 underwent lobectomy. 21% of the specimen was reported to be malignant, of which 74% was papillary cell carcinoma, 15% follicular cell carcinoma and 11% Hurthle cell carcinoma. Our percentage of malignancy in the Thy1a/c category was higher (5%) compared to the national figures of malignancy risk reported by RCPath (4%), whilst the rest were lower than the national figures (Thy2 = 0%, Thy3a = 13%, Thy3f = 19%, Thy4 = 50%, Thy5 = 94%). 100% of Thy3, Thy4 and Thy5 patients underwent diagnostic hemithyroidectomy. 15 patients did not have documentation of the U classification prior to thyroidectomy. There was 84% compliance with repeat FNAC requirements prior to surgery and 97% compliance with MDT discussion. Conclusions Current BAETS guideline states that thyroid nodules with benign appearances (U1 and U2) do not need to be followed-up, however we found a 15% of malignancy in these patients. Costs, risks and benefits of regularly undertaking fine needle aspiration in these patients must be considered.

Evaluation of results of pericardial drainage by ultrasound-guided fine-needle aspiration in patients with pericardial effusion after cardiac surgery at hanoi heart hospital

Background: Pericardial effusion is a relatively common complication after cardiac surgery, in which a large proportion of cardiac tamponade causes hemodynamic disturbances, and can have serious consequences.
 Objective: "Evaluation of the efficacy and safety of pericardial drainage with ultrasound-guided fine-needle aspiration". 
 Method: Cross-sectional, retrospective. Accept all patients with pericardial effusion after cardiac surgery were recruited at the Emergency Department and the Intensive Care Unit who performed pericardial aspiration from May 2021 to October 2022.
 Results: There were 46 patients included in the study; the average age is 52.04 ± 12.46 years, the youngest is 26 years, the oldest is 81 years old; The group of patients with heart valve disease had the highest rate of pericardial effusion, accounting for 93.4%; patients with atrial septal defect have recurrent pericardial effusion after surgery; there is a higher rate of recurrence and need for surgical conversion with the use of a sheet + pigtail device compared with a catheter; 36 (78.3%) patients did not have recurrent effusion and 10 (21.7%) patients had relapse; 100% of patients are alive after pericardial drainage.
 Conclusion: The results of treatment of pericardial effusion with fine needle aspiration pericardial drainage under the guidance of ultrasound after cardiac surgery are positive, the use of the catheter is initially shown to be safer than the use of sheat + pigtail.

Evaluating the potential role of human papilloma virus infection in breast carcinogenesis via real-time polymerase chain reaction analyzes of breast fine needle aspiration samples from Greek patients.

Human papilloma virus (HPV), in addition to its known clinical contribution to cervical cancer is probably actively involved in the development of breast tumors in various populations worldwide. Predominant HPV types in breast cancer patients vary geographically. The present study further examines HPV incidence in Greece, based on molecular analysis of clinical cytological samples. Greek patient fine needle aspiration (FNA) biopsy samples were examined using RT-PCR and immunohistological staining. FNA biopsy samples were collected from 114 female patients, diagnosed between the years 2018 and 2021, 57 with C5 diagnosed breast cancer lesions and 57 diagnosed with benign diseases. A total of three different HPV types were identified within the patient sample. HPV-39 was found only in the control group, in 1.8% of patients, while HPV-59 was present in both control and study groups in 1.8% and 3.5% respectively. HPV-16, on the other hand, was present only in the study group in 12.3% of cases. HPV type presence was statistically differentiated between histological groups. HPV-16 was exclusively in IDC, HPV-39 was present in one cyst diagnosed sample and HPV-59 was present in 3 samples that included fibroadenoma, IDC and LN diagnosis. More international comparative studies are required to investigate population differences and HPV genotype distribution to offer definite answers to the effect that certain HPV types might have a role in breast cancer, as this study also supports, albeit in a cofactory role.

Increased incidence of positive peritoneal lavage cytology early after fine needle aspiration in patients with pancreatic ducal adenocarcinoma

BackgroundThe influence of fine needle aspiration (FNA) on peritoneal lavage cytology (CY) in pancreatic ductal adenocarcinoma (PDAC) is unknown. MethodsWe retrospectively analyzed 29 patients with resectable left-sided PDAC undergoing FNA prior to CY examination. We assessed clinical factors related to CY+, scored the tumor diameter (<20 mm = 0, ≥20 mm = 1) and examination interval between FNA and CY (>18 days = 0, ≤18 days = 1), and investigated the probability of CY + by the sum of each score (0–2). ResultsThe probability of CY+ was 31%. The CY + group had larger tumors and shorter examination intervals than the CY− group. The CY + probability was 75%, 15%, and 13% for a score of 2, 1, and 0, respectively (P = 0.011). ConclusionA short interval between FNA and CY examination for a large tumor may be a risk factor for CY+ in patients with left-sided PDAC.

Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy.

Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA. We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology. We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications. EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.

Analysis of Diagnostic Value And Accuracy Of Ultrasound-guided Thyroid Fine Needle Aspiration in Patients with Thyroid Tumor

Analysis of Diagnostic Value And Accuracy Of Ultrasound-guided Thyroid Fine Needle Aspiration in Patients with Thyroid Tumor

Establishment of organoids using residual samples from saline flushes during endoscopic ultrasound-guided fine-needle aspiration in patients with pancreatic cancer.

Background and study aims In patients with pancreatic cancer (PC), patient-derived organoid cultures can be useful tools for personalized drug selection and preclinical evaluation of novel therapies. To establish a less invasive method of creating organoids from a patient’s tumor, we examined whether PC organoids can be established using residual samples from saline flushes (RSSFs) during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Methods Five patients with PC who underwent EUS-FNA were enrolled in a prospective study conducted at our institution. RSSFs obtained during EUS-FNA procedures were collected. An organoid culture was considered as established when ≥ 5 passages were successful. Organoid-derived xenografts were created using established organoids. Results EUS-FNA was performed using a 22- or 25-gauge lancet needle without complications. Patient-derived organoids were successfully established in four patients (80.0 %) with the complete medium and medium for the selection of KRAS mutants. Organoid-derived xenografts were successfully created and histologically similar to EUS-FNA samples. Conclusions Patient-derived PC organoids were successfully established using EUS-FNA RSSFs, which are produced as a byproduct of standard manipulations, but are usually not used for diagnosis. This method can be applied to all patients with PC, without additional invasive procedures, and can contribute to the development of personalized medicine and molecular research.

Preoperative axillary nodal staging of invasive lobular breast cancer with ultrasound guided fine needle aspiration in patients with suspicious ultrasound findings versus aspiration in all patients – A retrospective single institutional analysis

Introduction– At present, surgical strategies for breast cancer patients with >2 lymph nodes (LN) involved differ from those with no or lower degree of nodal involvement. Preoperative assessment of the axilla is less sensitive in patients with lobular carcinoma (ILC) than patients with other histological tumour types. Materials and methods– A retrospective analysis of axillary staging by palpation, axillary ultrasound (AXUS) and AXUS-guided fine-needle aspiration cytology (FNAC) of 153 patients with ILC diagnosed and operated on between January 2013 and December 2020 was performed. Patients had either sentinel node biopsy or axillary lymph node dissection according to current practice. In period 1, patients had FNAC only when AXUS suggested nodal involvement (n = 106), and in period 2, all ILC patients had axillary FNAC (n = 47). Results– Of the factors associated with >2LNs involvement, logistic regression suggested only AXUS/FNAC based staging as independent variable for all patients. Patients with AXUS-guided FNAC had a significantly higher proportion of true negative and lower proportion of true positive cases in the P2 period (0 vs 55% and 72% vs 11% for >2 LNs involvement, respectively; both p < 0.0001). Conclusions– AXUS-guided FNAC of all ILC patients did not result in improved preoperative identification of patients with >2 metastatic LNs but increased the false-negative rate of the assessment by producing false-negative results in patients who would not have undergone a biopsy due to negative AXUS findings.

The Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients with Endoscopic Biopsy Negative Upper Gastrointestinal Lesions

Objective To determine the diagnostic accuracy of endoscopic ultrasound guided (EUS) fine needle aspiration in patients who had inconclusive endoscopic biopsies of the same lesion Methodology This retrospective study was conducted at Pak Emirates Military Hospital, Rawalpindi, Pakistan from Jan 2018 to July 2020. Patients who underwent EUS guided FNAC from June 2017 to July 2020 were screened. The FNAC results of patients satisfying the inclusion ciritera were compared with either a surgical biopsy in patients in whom surgeries were done, while in the remaining patients, EUS FNAC results were compared with a 3 months radiological and/or 6 months clinical follow-up. The final diagnosis was defined based on the following criteria: (1) Malignant lesions (n=36), histopathologic diagnosis obtained based on surgery resected samples (n=18) or clinical diagnosis as neoplasm based on clinical follow-up of symptoms (n=30) or radiologic diagnosis based on imaging follow-up at 3 months (n=13) (2) Benign lesions (n=18), benign cytopathologic histopathologic findings and clinical follow-up with no evidence of malignant progression or metastasis. Results EUS-guided FNA cytology turned out to be malignant in 60 percent (n=36) of the specimens. 30 percent of the samples showed benign epithelial cytology ( n=18) while in 10 percent of the cases (n=6), the tissue samples were deemed insufficient for cytological diagnosis. The accuracy came out to be 66.6 percent (n=10 were true negative), sensitivity 93.4 percent, and specificity 100 percent. Conclusion EUS guided-FNA cytology of the sub-mucosal upper GI lesions is highly sensitive and specific for upper GI lesions, which are negative on endoscopic biopsies.

Evaluation of DNA ploidy and S-phase fraction in fine needle aspirates from breast carcinoma.

The use of fine-needle aspiration (FNA) as a primary tool in the diagnosis of breast carcinoma provides opportunity for early proliferative characterization of the tumor. This study was undertaken to assess DNA ploidy and S-phase (SPF) fraction by flow cytometry in fine needle aspirates of patients with breast cancer. Fifty patients of breast cancer diagnosed on fine needle aspiration cytology (FNAC) and who subsequently underwent either mastectomy or lumpectomy were included. Material obtained by FNAC was subjected to DNA ploidy and SPF analysis. Immunohistochemical estimation of Ki-67 was done on histopathology sections. The proliferation markers (SPF and Ki-67) were compared with each other and with the histopathologic parameters. On DNA flow cytometry, 27 (54%) cases were aneuploid and 23 (46%) cases were diploid. The median SPF was 12.43% and 4.03% in aneuploid and diploid tumors respectively. Median Ki-67 among aneuploid tumors was 28.6% compared to 8.7% among diploid tumors. Aneuploid tumors were significantly associated with higher values of SPF and Ki-67, with Kappa 0.437 and agreement of 72%. Diploid tumors showed lower values of SPF and Ki-67, with Kappa 0.455 and agreement of 72.7%. Correlation among SPF and Ki-67 was highly significant with Kappa value 0.446, P value of .002 and agreement of 72.3%. DNA ploidy and proliferative activity by flow cytometric SPF estimation on fine needle aspirates from breast cancer can provide valuable prognostic and predictive information at the time of diagnosis in patients with breast cancer. This might help in selection of appropriate treatment modality.

The Outcome of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Cystic Neoplasms: A Systematic Review

Introduction: Pancreatic cancer is the sixth most common cause of death from cancer in the UK. Cystic pancreatic neoplasms are being recognized more with the increase in the use of the CT scan. EUS has been increasingly used to asses and identify lesions in the pancreas, however, it can’t differentiate between benign and malignant tumors alone. The role of EUS guided FNA cytology (EUS FNAC) is still controversial in the management of pancreatic cysts where neoplastic process is questioned. Aim: This systematic review is aiming to explore the currently available evidence assessing the role of EUS guided FNA cytology (EUS FNAC) in the management of pancreatic cystic neoplasms. Methods: A total of five studies with 597 patient EUS FNAC episodes were included in this systematic review. Results: The sensitivity of the EUS FNAC in the papers was variable between 46.7% to 91.7% while the sensitivity of the test was 100% for all the papers except for 1 paper which was 82.1%. CEA level was assessed in 3 papers, however, the cut off level was different. Conclusion: The high specificity of EUS FNAC qualify it as a useful adjunct to ascertain or exclude malignancy in the pancreatic cystic lesions. EUS FNAC cannot be used alone as a method of screening, given low sensitivity. Measuring CEA in the cyst fluid can be a good aide to increase the sensitivity and an identifiable cut off level should be proposed. Well-conducted and powered studies are needed to further explore the role of EUS FNAC in patients with pancreatic cystic neoplastic lesions.

Diagnostic accuracy of preoperative palpation- versus ultrasound-guided thyroid fine needle aspiration cytology: an observational study

ABSTRACT Background Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules. Methods A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed. Results A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy (p = 0.001), and had indeterminate findings (p = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology (p = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination (p = 0.95). Conclusion The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.

Accuracy of core needle biopsy compared to fine needle biopsy for the diagnosis of neoplasm in patients with suspected head and neck cancers: a systematic review protocol of diagnostic test accuracy.

The objective of this review is to determine the difference in diagnostic accuracy of core needle biopsy and fine needle aspiration for patients with a head and neck mass using surgical histopathology as a reference test. The risks and adverse events associated with each technique will also be compared. Tissue diagnosis is critical in evaluation of head and neck lesions to guide management. Options for tissue biopsy include surgical biopsy, fine needle aspiration and core needle biopsy. Studies that compare ultrasound-guided core needle biopsy and/or fine needle aspiration to investigate lumps in the thyroid, cervical lymph nodes, or salivary glands for malignancy in adult patients will be included. The comparator test will be definitive histology in form of surgical biopsy/excision. MEDLINE, Emcare, Embase, Web of Science and Cochrane Register of Diagnostic Accuracy Studies will be searched. Studies will be critically appraised by two independent reviewers for methodological quality, using the modified critical appraisal instrument QUADAS-2 and JBI SUMARI software. Two independent reviewers will extract data from papers included in the review using the standardized data extraction tool available in the JBI Reviewer's Manual. PROSPERO CRD42020140005.

Combined Endosonographic Mediastinal Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non–Small-Cell Lung Cancer in High-Risk Patients

Positron emission tomography (PET) with computed tomography (CT) is routinely utilized to investigate lymph node (LN) metastases in non-small-cell lung cancer. However, it is less sensitive in normal-sized LNs. This study was performed in order to define the prevalence of mediastinal LN metastases discovered on combined endosonography by endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) fine needle aspiration in patients with a radiologically normal mediastinum. This study consists of a retrospective, single-institution, tertiary care referral center review of a prospectively maintained database. Patients were identified from a cohort between January 2009 and December 2014. One hundred and sixty-one patients with biopsy-proven, non-small-cell lung cancer were identified in whom both the preendosonography CT and PET-CT were negative for mediastinal LN metastases. Combined endosonography (EBUS + EUS-FNA) was performed in all patients. Z test was used for statistical analysis. A P value of <0.05 was considered statistically significant. A total of 161 consecutive patients were included. Patients were staged if they had central tumor, tumor size >3 cm, N1 lymph node involvement on PET-CT/CT, or if there was low SUV (<2.5) in the primary tumor. A total of 416 lymph nodes were biopsied in the 161 patients using combined endosonography; 147 with EBUS and 269 with EUS. Mean and median number of lymph nodes biopsied per patient using combined EBUS/EUS was 2.5 and 3, respectively (mean and median EBUS: 0.91 and 2.5; mean and median EUS 1.6 and 3). Endosonographic staging upstaged 13% of patients with radiologically normal lymph nodes in the mediastinum, hilum, lobar, and sublobar regions (confidence interval 8.22-19.20). Twenty-one out of 161 patients (13%) with radiologically normal mediastinum were positive on combined EBUS/EUS staging. Out of 21 patients upstaged on endosonography, 15 (71%) had tumor size >3 cm. Six (28%) had occult N1 disease. Thirteen (61%) had occult N2 disease and 2 (9%) had adrenal involvement. None of the upstaged patients had N1 LN involvement on PET-CT or CT scan. Combined endosonographic lymph node staging should be considered in the pretreatment staging of high-risk patients with non-small-cell lung cancer in the presence of radiologically normal mediastinal lymph nodes due to the significant rate of radiologically occult lymph node metastases.

Fusion Image–Guided and Ultrasound-Guided Fine Needle Aspiration in Patients With Suspected Hepatic Metastases

The aim of this study was to compare the diagnostic adequacy of computed tomography (CT)-ultrasound (US) fusion image-guided fine needle aspiration (FNA) and US-guided FNA in patients with suspected hepatic metastases. Thirty consecutive patients of either sex with known or unknown primary malignancy suspected of having liver metastases on both US and CT, whose multiphasic contrast-enhanced computed tomography was performed using a 64-slice or a higher slice CT scanner, and who were referred for percutaneous FNA were included in this prospective study approved by the institutional review board of the study institute. CT-ultrasound fusion image-guided FNA of the largest lesion using electromagnetic tracking and with freehand ultrasound-guided FNA were performed in the same sitting. Value of fitness, which is a rough estimate of how well the fusion has been achieved, was recorded. Diagnostic adequacy of smears was assessed by a scoring system based on cellular material, background blood/clot, degree of cellular degeneration or trauma, and retention of architecture. The size of the lesions ranged from 1 to 10cm, and the depth of location of the lesions ranged from 1.4 to 9.3cm. The fusion fitness values ranged from 1.2 to 10mm. The scores of the smears did not correlate with lesion size, depth of location, and fusion fitness value. Diagnostic adequacy was seen in 90% and 93.3% of lesions sampled by fusion image guidance and ultrasound guidance, respectively (p= 0.655). All the lesions that yielded inadequate smears by fusion guidance were deep-seated lesions (>5cm). All the lesions that yielded inadequate smears by ultrasound guidance were small lesions (<3cm). No complications were encountered in any of the patients. Fusion image-guided FNA is a safe procedure with a high diagnostic adequacy rate. Fusion image-guided FNA is not better than US-guided FNA for conspicuous hepatic lesions; however, it may be useful in inconspicuous lesions.

Diagnostic yield of endoscopic ultrasound-guided biopsy of focal liver lesions.

Endoscopic ultrasonography (EUS) has become an indispensable method for diagnosis and therapeutic procedures in gastroenterology. As experience with this technique grows, new indications continue to emerge. Due to the vicinity of the transducer to the liver, endoscopic ultrasonography provides detailed images of the liver segments and its vascular and biliary structures. Endosonographers have made an effort to define a clinical role for endoscopic ultrasound in liver diseases; however, not much is known about endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in hepatic focal lesions.This review summarizes the available evidence regarding the usefulness of endoscopic ultrasound-guided fine needle aspiration in patients with focal liver lesions.

Rol de la ecografía y punción con aguja fina en el manejo de la axila en pacientes con cáncer mamario, en la era posterior al ACOSOG Z0011

ObjectiveTo determine whether ultrasound and ultrasound-guided fine-needle aspiration in patients with breast cancer who meet the ACOSOG Z0011 selection criteria can identify those with high axillary involvement (more than 2 lymph nodes with macrometastases). Material and methodsA total of 115 consecutive patients with breast cancer (up to 5cm in diameter), with clinically negative axilla and pathologically positive axilla. All patients underwent preoperative axillary ultrasound. Ultrasound-guided fine-needle aspiration cytology was performed in patients with suspicious nodes on ultrasound. In all patients with positive cytology, lymphadenectomy was performed. In all patients with negative ultrasound and cytology, sentinel lymph node biopsy was performed, and when it was positive, lymphadenectomy was performed. The number of pathological lymph nodes was evaluated after lymphadenectomy. ResultsA total of 61 patients had positive ultrasound and axillary cytology. In 42 of them (69%), there were more than 2 pathological lymph nodes. There were 54 patients with negative ultrasound and axillary cytology. In 49 of them (90%), there were only 1 or 2 pathological lymph nodes. Axillary ultrasound and fine-needle aspiration cytology were able to identify 42 of the 47 patients (89%) with more than 2 pathological lymph nodes. ConclusionIn patients with breast cancer who meet the ACOSOG Z0011 selection criteria, ultrasound and ultrasound-guided fine-needle aspiration can accurately identify those with high axillary involvement (more than 2 lymph nodes with macrometastasis), which would benefit from lymphadenectomy.

Efficacy of surgeon-performed, ultrasound-guided lymph node fine needle aspiration in patients with thyroid pathologic conditions

BackgroundAlthough the concept of surgeon-performed fine needle aspiration of thyroid nodules is established, experience with surgeon-performed lymph node fine needle aspiration is scant. We aimed to study the efficacy of surgeon-performed lymph node fine needle aspiration in patients with thyroid pathologic conditions. MethodsThis is an institutional review board–approved study of patients with thyroid pathologic conditions who underwent surgeon-performed lymph node fine needle aspiration between 2002 and 2017. Efficacy and utility were analyzed. ResultsA total of 201 patients with benign nodular goiter (n = 30) and thyroid cancer (n = 200) underwent 230 lymph node fine needle aspirations (89 during preoperative workup, 141 at postoperative follow-up). Insufficient aspiration rate was 6% and indeterminate cytologic results 3%. In 91% of patients with suspicious lymph nodes, definite diagnosis could be obtained by fine needle aspiration; 51% (n = 118) of fine needle aspirations indicated metastasis from thyroid cancer and 40% (n = 91) benign findings. Sensitivity and specificity of lymph node fine needle aspiration in diagnosing nodal metastasis were 92% and 89%, respectively. Cytologic testing and thyroglobulin washout indicated 95% concordance. On logistic regression, spherical shape, microcalcifications, cystic appearance, and loss of hilum on ultrasound independently predicted lymph node metastasis. ConclusionOur data indicate that an adequate surgeon-performed lymph node fine needle aspiration is highly accurate in diagnosing nodal status in thyroid pathologic conditions. We recommend adoption of this technique, when feasible, to develop an efficient, comprehensive thyroid practice.