FNA Needle Research Articles

EUS characteristics of celiac ganglia with cytologic and histologic confirmation

Celiac ganglia have not been previously identified by EUS. To assess whether celiac ganglia can be detected by EUS and to define their characteristics. Retrospective review followed by prospective study. Retrospective characterization was performed of all celiac ganglia that were incidentally identified by EUS-guided FNA or tru-cut needle biopsy from January 2004 to October 2005. We also prospectively assessed if these structures could be visualized in consecutive patients undergoing curved linear-array EUS. Seven patients with celiac ganglia diagnosed by EUS-guided FNA (n = 7) and/or tru-cut needle biopsy (n = 1) were reviewed. Twenty-two patients were prospectively evaluated by curved-linear-array EUS. Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. EUS features and detection rate of celiac ganglia. All retrospectively evaluated celiac ganglia were identified anterior to the aorta, slightly to the left, and cephalad to the celiac artery take-off, and medial to the left adrenal gland. The mean distance from the celiac artery take-off was 10 mm (+/-3 mm); mean size was 13 mm (+/-3 mm) by 6 mm (+/-2 mm). They appeared as hypoechoic and multilobulated structures with hyperechoic strands. Celiac ganglia with sonographic features as described above were identified in 16 of 22 prospectively evaluated patients (73%). Small number of patients; no tissue confirmation of prospectively evaluated patients. Celiac ganglia can be identified with curved linear-array EUS in the majority of patients. Their typical EUS appearance allows distinction from celiac lymph nodes.

Prospective study of a Trucut needle for performing EUS-guided biopsy with EUS-guided FNA rescue

EUS-guided FNA (EUS-FNA) is an accurate technique for sampling extraintestinal masses and lymph nodes. The use of a Trucut needle to perform EUS-guided biopsy (EUS-TCB) may improve the results or simplify the procedure. To date, few studies have prospectively assessed the performance and the safety of EUS-TCB. Patients with a known or a suspected malignancy referred for a diagnostic and/or staging EUS examination were enrolled in a prospective study. EUS-guided biopsy was performed first with a 19-gauge Trucut needle. If the Trucut failed to obtain an adequate sample or when the "in room" touch preparation was benign, EUS-FNA was performed with a standard 22-gauge FNA needle. The objective of the study was to assess the yield of detection of malignancy and the safety of EUS-TCB in patients with known or suspected malignancies and to investigate if EUS-FNA has a role for rescue in cases of Trucut failure. Thirty-nine lesions underwent EUS-TCB in 30 patients. Sufficient follow-up was available for all patients. By using EUS-TCB, we were able to obtain a sample for diagnosis in all but 3 patients (one pancreatic mass and two lymph nodes) in which technical problems arose. In these patients, the diagnosis was obtained in two cases by EUS-FNA and in the other one by EUS-TCB from the primary pancreatic tumor. The yield of detection of malignancy for EUS-TCB was 84%. No complications were recorded in any patients at 1 and 7 days of follow-up. The sample size is limited to generalize conclusions. EUS-TCB is a safe and an accurate procedure to obtain a histologic diagnosis in patients with known or suspected malignancies. EUS-FNA can serve as a rescue technique in cases of Trucut failure.

Prospective Comparison of a 19 Versus 22 Gauge Needle for Performing Endosonography Guided Fine Needle Aspiration Biopsy of Solid Pancreatic Neoplasms

Background: EUS FNA is a sensitive method for diagnosing solid pancreatic neoplasms. To date, a comparison of larger gauge to standard gauge needles has not been performed. Aim: Determine if a 19 gauge EUS FNA needle can safely provide a higher diagnostic yield in solid pancreatic masses than a 22 gauge needle. Methods: Patients referred for an EUS FNA with a known or suspected solid pancreatic neoplasm were randomized to undergo biopsy with a 19 gauge or 22 gauge needle. The primary endpoint was diagnostic accuracy after four needle passes.

TRANSMUCOSAL MICROBIAL TRANSMISSION DURING ENDOSCOPIC ULTRASOUND GUIDED FINE-NEEDLE ASPIRATION UTILIZING DIFFERENT NEEDLE STYLET TECHNIQUES

Purpose: One of the rare, but serious complications of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) is infection. This is especially true for cystic lesions. We have previously described (AJG 2003; 98:AB 853) the use of topical bacteriocidal agents in reducing this risk utilizing an in-vitro model. We hypothesized that using different FNA needle stylet techniques could further reduce this risk. Methods: 15ml conical tubes filled with aerobic blood culture media had sterilized bovine tripe (small intestine) fastened over the top, forming a conical tube-tripe unit (CTTU). 5 groups often CTTUs were studied using 22 gauge EUS-FNA needles to puncture the tripe into the culture media. Uncontaminated control group consisted of FNA x1 through uncontaminated tripe. The surface of the other 4 CTTUs were inoculated with 50 ml of 1.5 × 108 organisms/ml of E. coli and Enterococcus sp. The 4 groups had FNA x1 with stylet maneuvering as follows: withdrawn 2cm before tripe puncture then advanced (control/standard, group 1), stylet flush with the needle bevel and no manipulation (group 2), stylet withdrawn 2cm before tripe puncture then removed (group 3), and stylet absent (group 4). After FNA, 1ml of the culture media was obtained and mixed in pour plate agar media for quantitative culture and incubated along with the conical tubes. Microbial evaluation after 48 hours was performed. Any bacterial growth on either the plate or conical tube media was counted as evidence of contamination. Groups were compared by the Kruskal-Wallis nonparametric rank test, p-value <0.05 was considered statistically significant. Results: All stylet techniques performed produced growth in conical tube media. Uncontaminated control group had no growth of E. coli or Enterococcus sp. See tableTable 1Conclusions: This in-vitro study confirms our hypothesis that different stylet techniques affect bacterial contamination during FNA. Groups 2 and 4 had the lowest bacterial concentration suggesting that manipulation of the stylet results in increased bacterial deposition across the mucosal barrier, and that needle puncture of the mucosa itself causes minimal bacterial transmission. Since these stylet variations are simple to perform, we recommend they be considered for clinical use.

Pre-Operative Identification of Malignancy in Cystic Lesions of Pancreas by EUS-FNA

Background: Cytologic and biochemical analysis of the cyst aspirate obtained by EUS-FNA is of limited value in identifying malignancy in cystic pancreatic neoplasms. In this study, we evaluated the safety and accuracy of performing EUS-FNA of the cyst wall and the septum(a) for identifying malignancy in these lesions. Materials and methods: 41 consecutive patients who had EUS-FNA for suspected cystic neoplasm of the pancreas with abnormal CT or MRI demonstrating a hypodense lesion in pancreas were included. Patients were excluded if they had a history of moderate or severe acute pancreatitis (requiring hospitalization for more than 5 days) within 6 months prior to EUS-FNA. Five patients who met the inclusion criteria were subsequently excluded from final analysis because of 1) insufficient follow up (n=2) or 2) had EUS-FNA aspirates characteristic of a psuedocsyt (n=3). Complete aspiration of the cyst was attempted and then FNA of the cyst wall was done. In case of multiloculated cysts, the thickened areas of the cyst wall or the septum(a) were targeted with the FNA needle. FNA specimens were assessed immediately by an attending cytologist. 1-6 passes were made till a preliminary diagnosis malignancy could be made or when both, the endosonographer and the cytologist were satisfied about adequacy of sampling. Final diagnosis was based on definitive cytology that was positive for malignancy, surgical pathology or clinical follow-up of at least one year. Results: The size of cysts ranged from 1 cm to 8 cm. Three patients developed cyst infection that was successfully treated with intravenous antibiotics. There were no other procedure related complications. In 12 patients, a cytologic diagnosis of malignancy was made (11 definite, 1 suspicious). Fourteen patients were diagnosed to have benign mucinous neoplasm by EUS-FNA and three of these patients had a final diagnosis of malignancy. Ten patients were diagnosed with non-mucinous benign cystic lesions and all of these patients have no clinical evidence of malignancy after 1 year follow-up. EUS-FNA was 80% sensitive and 92% accurate for diagnosing malignancy in our study patients. Conclusions: EUS-FNA of the cyst wall and solid components of the cyst is safe and accurate in pre-operative identification of malignancy in cystic neoplasms of the pancreas.

The Sonobrush: A Novel EUS-Guided Biopsy Device for Pancreatic Masses

Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has become a powerful technique in the diagnostic evaluation of pancreatic masses. Accuracy of current EUS-FNA techniques are limited due to a low cellular yield, particularly in pancreatic carcinoma. The aim of this study was to determine the feasibility, safety and efficacy of a novel EUS-guided brush biopsy in the acquisition of tissue from solid pancreatic masses. Methods: Patients referred for EUS-FNA evaluation of pancreatic masses were candidates for the study. Masses were first aspirated in a standardized fashion using two passes of a 22 ga FNA needle (Wilson-Cook). Following FNA, a 19 ga needle containing a brush device was placed into the mass (Mediglobe). The brush was gently agitated within the mass to obtain cellular tissue. FNA samples were analyzed by direct smear. Brush biopsy samples were rinsed in saline and processed by either ThinPrep (Cytyc Corp.) and/or a cell block. Ease of use was ranked on a 5 point subjective scale (1=very easy →5= very difficult). Also recorded were: length of time required, cellularity of the sample (graded from 0=acellular → 3=high cellularity) and ability of the device to provide an accurate diagnosis. Results: Eleven patients were enrolled with 6 women and an average age of 65.5 years. The sonobrush deployed successfully in all cases and there were no complications. Average time for brush biopsy was 137 seconds as compared to 85 seconds for regular FNA. Ease of use of FNA was rated with an average of 1.6 while brush biopsy ranked an average of 2.1. Average cellularity of cytologic sampling by FNA was 2.7, 1.4 for sonobrush thin preps and 2.0 for sonobrush cell block preparations. FNA was diagnostic in 11/11 cases: 8 adenocarcinomas and 2 endocrine tumors (PETs). Sonobrush was diagnostic in 7/11. In three cases, however, Sonobrush produced small architecturally important tissue fragments that enhanced cytological diagnosis (one adenocarcinoma was found to be invasive; tissue in cell blocks of the 2 PETs allowed confirmatory ancillary studies.) Conclusion: EUS-guided brush biopsy is a feasible and safe means of obtaining tissue for the diagnosis of pancreatic masses and may complement FNA. In addition, larger groups of cells obtained by this technique may allow for more specific diagnosis in some cases. Further studies are required to delineate the full potential of this new device.

One Step Endoscopic Drainage of Pancreatic Pseudocysts: Use of a New Therapeutic Echo Endoscope

Background: Different methods have been proposed for pancreatic pseudocysts (PPC) drainage. We describe our experience in endoscopic drainage of PPC with a one step technique using a new therapeutic echo endoscope with a linear curved array transducer, a 3.7 mm working channel and an elevator (Olympus GF-UCT140-AL5). Methods: 12 patients (8 men, 4 women; mean age 53.9, range 28-77) were referred from October 2002 to October 2003 for endoscopic pseudocyst drainage. The mean size of the pancreatic cysts was 11.2 cm (6.5-25 cm). Either monitored anesthesia with Propofol or general anesthesia was used to sedate the patients. The Olympus GF-UCT140-AL5 was passed into the stomach; the optimal localization of the puncture site was determined. Color Doppler was used to rule out gastric varices and large vessels. Under real time ultrasound guidance a 19 gauge FNA needle (EchoTip, Wilson-Cook) was then inserted into the pseudocyst. A 0.025″ Jagwire (Boston Scientific) was passed through the needle under fluoroscopy and coiled into the pseudocyst. A Needle Knife (HPC-3) was introduced over the wire. Under EUS and endoscopic guidance an electrosurgical puncture was performed using the Needle Knife. The tract was dilated with a 10 mm balloon followed by the placement of 1 to 3 10-Fr double pigtail stents. The stents were removed in 1 to 3 months after the resolution of the cyst. Results: Drainage was not attempted on 2 patients due to large gastric varices on the first and a malignant mass in the cyst of the second, both diagnosed only by EUS. Drainage was attempted on 10 patients; placement of the 10-Fr double pigtail stents was successful in 9 patients. In one case drainage could not be achieved. In one other patient with a large cyst and internal debris surgery was required for a cyst infection that did not resolve with endoscopic management. 8/10 patients had complete resolution of their symptoms and cysts. One patient required 2 procedures due to the presence of debris in the cyst. There were no significant bleeding or other complications noted. Conclusion:In our experience EUS is essential prior to endoscopic drainage of PPC as it affected the clinical management of 2/12 patients. Endoscopic drainage of PPC using the new therapeutic echo endoscope with EUS guided wire placement and puncture allows a safe one step procedure without exchanging scopes.

Endoscopic Ultrasound-Guided Celiac Plexus Block for Managing Abdominal Pain Associated With Chronic Pancreatitis: A Prospective Single Center Experience

In our previous randomized trial, we suggested a possible role for endoscopic ultrasound (EUS) guided celiac plexus block in the treatment of abdominal pain associated with chronic pancreatitis. The purpose of this study was to evaluate our prospective experience with EUS-guided celiac plexus block for controlling pain attributed to chronic pancreatitis, including follow-up on response rates and complications. All subjects enrolled had documented chronic pancreatitis by ERCP and EUS criteria and presented with chronic abdominal pain unresponsive to current treatment options. All were treated with EUS-guided celiac plexus block under the guidance of linear array endosonography using a 22-gauge FNA needle (GIP, Mediglobe Inc., Tempe, AZ) inserted on each side of the celiac area, followed by injection of 10 cc bupivacaine (0.25%) and 3 cc (40 mg) triamcinolone on each side of the celiac plexus. Individual pain scores, based on a visual analog scale (0-10), were determined preblock and postblock by a nurse at 2, 7, 14 days and monthly thereafter. Subjects also rated their overall comfort level during the EUS procedure. EUS-guided celiac plexus block was performed in 90 subjects (40 males, 50 females) having a mean age of 45 yr (range 17-76 yr) between July 1, 1995 and December 30, 1996. A significant improvement in overall pain scores occurred in 55% (50/90) of patients. The mean pain score decreased from 8 to 2 post EUS celiac block at both 4 and 8 wk follow-up (p < 0.05). In 26% of patients there was persistent benefit beyond 12 wk, and 10% still had persistent benefit at 24 wk, including three patients who were pain-free between 35 and 48 wk. Younger patients (<45 yr of age) and those having previous pancreatic surgery for chronic pancreatitis were unlikely to respond to the EUS-guided celiac block. Three patients experienced diarrhea post EUS celiac block, which resolved in 7-10 days; however, it is unclear whether this diarrhea was due to the block or to refractory disease. A cost comparison between the EUS ($1200) and CT ($1400) techniques shows the EUS celiac block to be less costly and perhaps more cost efficient in a subset of subjects. EUS-guided celiac plexus block appears to be safe, effective, and economical for controlling pain in some patients with chronic pancreatitis. Younger patients (<45 yr) and those having prior pancreatic surgery for chronic pancreatitis do not appear to benefit from this technique. Prophylactic antibiotics should be considered if acid suppressing agents are being taken.

Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience

OBJECTIVE: In our previous randomized trial, we suggested a possible role for endoscopic ultrasound (EUS) guided celiac plexus block in the treatment of abdominal pain associated with chronic pancreatitis. The purpose of this study was to evaluate our prospective experience with EUS-guided celiac plexus block for controlling pain attributed to chronic pancreatitis, including follow-up on response rates and complications. METHODS: All subjects enrolled had documented chronic pancreatitis by ERCP and EUS criteria and presented with chronic abdominal pain unresponsive to current treatment options. All were treated with EUS-guided celiac plexus block under the guidance of linear array endosonography using a 22-gauge FNA needle (GIP, Mediglobe Inc., Tempe, AZ) inserted on each side of the celiac area, followed by injection of 10 cc bupivacaine (0.25%) and 3 cc (40 mg) triamcinolone on each side of the celiac plexus. Individual pain scores, based on a visual analog scale (0–10), were determined preblock and postblock by a nurse at 2, 7, 14 days and monthly thereafter. Subjects also rated their overall comfort level during the EUS procedure. RESULTS: EUS-guided celiac plexus block was performed in 90 subjects (40 males, 50 females) having a mean age of 45 yr (range 17–76 yr) between July 1, 1995 and December 30, 1996. A significant improvement in overall pain scores occurred in 55% (50/90) of patients. The mean pain score decreased from 8 to 2 post EUS celiac block at both 4 and 8 wk follow-up ( p < 0.05). In 26% of patients there was persistent benefit beyond 12 wk, and 10% still had persistent benefit at 24 wk, including three patients who were pain-free between 35 and 48 wk. Younger patients (<45 yr of age) and those having previous pancreatic surgery for chronic pancreatitis were unlikely to respond to the EUS-guided celiac block. Three patients experienced diarrhea post EUS celiac block, which resolved in 7–10 days; however, it is unclear whether this diarrhea was due to the block or to refractory disease. A cost comparison between the EUS ($1200) and CT ($1400) techniques shows the EUS celiac block to be less costly and perhaps more cost efficient in a subset of subjects. CONCLUSIONS: EUS-guided celiac plexus block appears to be safe, effective, and economical for controlling pain in some patients with chronic pancreatitis. Younger patients (<45 yr) and those having prior pancreatic surgery for chronic pancreatitis do not appear to benefit from this technique. Prophylactic antibiotics should be considered if acid suppressing agents are being taken.

3488 A prospective evaluation of endoscopic ultrasound-guided fine needle aspiration biopsy utilizing a new disposable 22 gauge fna needle device: results of diagnostic accuracy and complications from a large single center series.

EUS-guided FNA is useful for obtaining a tissue diagnosis in suspicious GI lesions. Previous studies utilized a reusable 22 gauge EUS FNA needle system (GIP, Mediglobe, Tempe, AZ).We report our experience with a new disposable EUS-guided FNA needle (Echotip, Wilson-Cook,Winston- Salem,NC. METHODS:188 subjects (98M/90F)mean age 61 yrs (range: 16- 87, SD 14.1) underwent EUS-guided FNA between December,97 and December,99. EUS-guided FNA was performed with linear array EUS (FG36UX, Pentax, Orangeburg, NY)using this new disposable FNA device. Data was collected for: lesion types sampled, # of passes performed, specimen adequacy, complications and diagnostic accuracy. Operating characteristics of the study group were also calculated and compared to the GIP EUS FNA studies for similar lesion types using the reusable GIP device. The gold standard was positive cytology,surgical path,long term follow-up. RESULTS: 201 lesions were targeted for a total of 643 FNA passes (mean 3.2 passes, range:1-6). Cytology was positive for malignancy in 57% of pancreatic masses, 53% of mediastinal nodes, 31% of submucosal masses, 25% of regional nodes and 100% of peri-rectal lesions.The FNA had a diagnostic cytology in 87% that was confirmed by surgery in 18%, positive cytology in 51% or long term follow up(median 10 months, range 1-24 months)in 59/188 or 31%. This new disposable EUS FNA needle had an overall sensitivity of 89% and a specificity of 100% for the cytological diagnosis of pancreatic masses,lymphadenopathy, and submucosal masses.Our findings are similar to the operating characteristics published for the GIP FNA needle. There were no complications noted. In 8 cases (4%) the new FNA needle had to be replaced due to suboptimal functioning. Common problems included poor visualization of the needle tip as it was inserted into the target lesion, excessive bending of the catheter and failure of the catheter to completely exit the biopsy channel.These earlier problems have been rectified. One useful feature of this device is the self-locking syringe which simplifies aspiration. CONCLUSIONS: EUS-guided FNA with this new disposable FNA needle device appears to: 1) be technically safe and accurate for obtaining diagnostic tissue of suspicious lesions accessible via the GI tract and 2) provides similar accuracy as reported in previous studies using the reusable GIP FNA device.

4561 Idiopathic liver masses: diagnosis by eus-guided fine needle aspiration.

The introduction of FNA to the diagnostic capability of EUS has significantly expanded its role. EUS FNA of pancreatic neoplasms, submucosal tumors and lymph node metastasis has been well described. EUS FNA of other solid organs such as the liver has not gained widespread acceptance. Space occupying lesions of the liver such as primary tumors (hepatocellular and cholangiocarcinoma) and metastatic disease frequently require a tissue Dx. EUS may provide a cost effective method of tissue Dx and staging. AIM: To determine the diagnostic capability and safety of EUS-guided FNA in the Dx of idiopathic liver masses. METHODS: 16 pts (9-W and 7- M, age range 49-83, mean 64 years) with liver masses underwent evaluation by EUS. Presenting symptoms included weight loss=14, jaundice=9, abdominal pain=13, evaluation of abnormal LFTs=14, evaluation of known CA=3, anemia=8. 11-pts had abnormal CT scan demonstrating space occupying lesions. 5-pts had a history of cancer (3 colon, 1 pancreas, 1 breast). Exams were carried out using the Olympus EU-M20 radial array echoendoscope and Pentax 32 UA linear array endoscope. FNA needle used was the 22 gauge Wilson-Cooke product. 11-pts had multiple lesions (3-12 cm) while 5-pts had single lesions (4-15 cm). A cytopathologist was present in all cases for bed-side assessment of tissue harvested. RESULTS: A mean of 3.4 FNA passes were performed (range 1-6/pt). EUS FNA was 100% accurate with respect to tissue Dx. Final Dx included metastatic=7 (3 colon, 3 pancreas, 1 breast), Hepatocellular Ca (HCCA)=2, Cholangiocarcinoma (CCA)=2, and unknown primary=5. No complications were seen during EUS-guided FNA. CONCLUSION: 1. EUS can detect small lesions within the liver not previously detected by CT. 2. EUS-guided FNA can confirm the Dx of primary malignancy and/or liver metastasis, this can be done safely and effectively. 3. EUS may allow the diagnosis of unsuspected pancreatic cancer in this sub-population. The introduction of FNA to the diagnostic capability of EUS has significantly expanded its role. EUS FNA of pancreatic neoplasms, submucosal tumors and lymph node metastasis has been well described. EUS FNA of other solid organs such as the liver has not gained widespread acceptance. Space occupying lesions of the liver such as primary tumors (hepatocellular and cholangiocarcinoma) and metastatic disease frequently require a tissue Dx. EUS may provide a cost effective method of tissue Dx and staging. AIM: To determine the diagnostic capability and safety of EUS-guided FNA in the Dx of idiopathic liver masses. METHODS: 16 pts (9-W and 7- M, age range 49-83, mean 64 years) with liver masses underwent evaluation by EUS. Presenting symptoms included weight loss=14, jaundice=9, abdominal pain=13, evaluation of abnormal LFTs=14, evaluation of known CA=3, anemia=8. 11-pts had abnormal CT scan demonstrating space occupying lesions. 5-pts had a history of cancer (3 colon, 1 pancreas, 1 breast). Exams were carried out using the Olympus EU-M20 radial array echoendoscope and Pentax 32 UA linear array endoscope. FNA needle used was the 22 gauge Wilson-Cooke product. 11-pts had multiple lesions (3-12 cm) while 5-pts had single lesions (4-15 cm). A cytopathologist was present in all cases for bed-side assessment of tissue harvested. RESULTS: A mean of 3.4 FNA passes were performed (range 1-6/pt). EUS FNA was 100% accurate with respect to tissue Dx. Final Dx included metastatic=7 (3 colon, 3 pancreas, 1 breast), Hepatocellular Ca (HCCA)=2, Cholangiocarcinoma (CCA)=2, and unknown primary=5. No complications were seen during EUS-guided FNA. CONCLUSION: 1. EUS can detect small lesions within the liver not previously detected by CT. 2. EUS-guided FNA can confirm the Dx of primary malignancy and/or liver metastasis, this can be done safely and effectively. 3. EUS may allow the diagnosis of unsuspected pancreatic cancer in this sub-population.

7009 Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: one year md anderson cancer center experience.

Aim: A prospective evaluation of EUS-FNA of solid pancreatic lesions over a one-year period at a quarternary referral center. Methods: 104 consecutive patients undergoing EUS for suspected pancreatic malignancy at MDACC from 11/1/98 to 10/31/99 were prospectively entered into this study. Procedures were performed using the Pentax FG36-UX echoendoscope, Hitachi EUB-525 processor and Wilson-Cook EUS N-1 22 gauge FNA needle. Passes were made until the endosonographer felt adequate material had been obtained. The aspirate was collected by a cytopathology technician who smeared slides in the room. Examination of the slides was performed by a cytopathologist after the procedure had been completed. Final diagnosis was based on biopsy results, surgical specimen, or clinical follow-up. Data collected included size of mass, number of needle passes, complications of procedure, and final diagnosis. 20 patients with pancreatic cysts on EUS were excluded from further analysis. Results: The average age of patients was 64.6 years. The average size of the mass was 3.2cm (range 1.3 - 7cm). The average number of needle passes was 2.5 (range 1 - 5) per patient. No complications occurred. 79 of 84 patients had malignant pancreatic tumors. EUS-FNA correctly identified 73 while cytology showed atypia in one and suspicious for malignancy in another. In the remaining 4 malignant lesions, FNA was non diagnostic due to poor cellularity. There were no false positives. Of the 5 benign lesions, no mass was seen on EUS. 3 of the 5 benign lesions were shown to have chronic pancreatitis. Of the 4 patients with non - diagnostic FNA specimens later proven to be malignant, one had chronic pancreatitis with no mass seen on EUS while 3 had masses clearly identified by EUS. 2 of these 4 patients were found to have adenocarcinoma while the other 2 had a neuroendocrine tumor. Of the 2 patients with atypia or suspicious lesions, surgical resection specimen showed an islet cell carcinoma in one and adenocarcinoma in the other. Among patients in whom adequate cellularity was obtained (counting atypia and suspicious findings on FNA as signs of malignancy), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 100%, 100%, 100%,100%, and 95% respectively. Conclusions: EUS-FNA in the hands of an experienced endosonographer is a remarkably powerful tool with a high sensitivity and specificity at diagnosing pancreatic cancer.

Human leukocyte differentiation antigens of the sixth international workshop: What can we expect to see in the clinic?

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the standard diagnostic procedure for many intrathoracic and intra-abdominal lesions. Next-generation fine-needle biopsies (FNBs) can increase diagnostic yield by procuring tissue suitable for histological processing. We evaluate the diagnostic yield and operating characteristics of the SharkCore (SC; Medtronic Corp., Minneapolis, MN) FNB in a tertiary referral facility.We performed a single-center retrospective review of SC-FNB–acquired tissue between January 2014 and March 2018. Patient demographic data, endoscopic features, and pathology data were obtained from the electronic medical record. Diagnostic yield was assessed by the ability to obtain a definitive diagnosis, defined as malignant or benign interpretations. Operating characteristics were also calculated.A total of 179 lesions were sampled with the SC-FNB in 157 patients (mean age: 63 years, 57% male). Of these, 31 lesions were concomitantly sampled with a conventional FNA needle. Most lesions were pancreatic (49%). Diagnostic yield was 86%, which was independent of lesion location, lesion size and needle gauge. Diagnostic accuracy was highest when both histology and cytology specimens were analyzed concurrently (96.5%). In patients with a history of chronic pancreatitis, accuracy, sensitivity, and negative predictive value were reduced (71.4%, 20.0%, and 69.2%, respectively). Rapid onsite evaluation (ROSE) occurred in 64.8% of cases and was more likely to be diagnostic at the time of rapid evaluation if SC-acquired tissue was utilized versus FNA-acquired tissue (P = 0.03); however, final diagnostic yield did not differ between needles (P = 0.13).SC-FNB shows high diagnostic yield and accuracy and provides diagnostic tissue for ROSE. SC-FNB is an effective alternative to conventional FNA.