Sampling Of Solid Lesions Research Articles

Comparing fine needle biopsy techniques in solid pancreatic lesions: A prospective randomized study

IntroductionEndoscopic ultrasound-guided fine-needle biopsies (EUS-FNB) are the best technique for sampling solid pancreatic lesions. However, the most appropriate biopsy technique has not been standardized using Fine Needle Biopsy (FNB) needles. The aim of this work was to identify the best biopsy technique to achieve the best tissue integrity and cause the least blood contamination. Material and methodsPatients ≥18 years of age with solid pancreatic lesions who underwent EUS-FNB at our institution from January 2020 to May 2021 were consecutively selected. Three passes were performed with each of the threee techniques to obtain tissue: suction with 10 ml of vacuum, capillary, and wet. An independent pathologist evaluated the received tissue integrity and the degree of blood contamination of each sample according to scales. ResultsSeventy-five patients were recruited for our study. A superior tissue integrity was observed using the wet-suction technique in lesions located in the body and/or tail of the pancreas, and an average score of 4.40 (p = 0.027) was assigned for this technique. Regarding the contamination of the sample in the whole cohort, the simple-suction technique shown a higher contamination, 1.55 (p < 0.001). There was no statistically significant difference among the techniques when evaluating tissue integrity or contamination in lesions larger or smaller than 3 cm. ConclusionWhen performing EUS-FNB for solid pancreatic lesions located in the head/uncinated process, the three methods provided similar diagnostic yields. The wet-suction technique had a higher score in tissue integrity when lesions were located in the body and/or tail of the pancreas.

Wet- versus dry-suction techniques for EUS-FNA of solid lesions: A systematic review and meta-analysis.

The optimal sampling techniques for EUS-FNA remain unclear and have not been standardized. To improve diagnostic accuracy, suction techniques for EUS-FNA have been developed and are widely used among endoscopists. The aim of this study was to compare wet-suction and dry-suction EUS-FNA techniques for sampling solid lesions. We performed a comprehensive literature search of major databases (from inception to June 2020) to identify prospective studies comparing wet-suction EUS-FNA and dry-suction EUS-FNA. Specimen adequacy, sample contamination, and histologic accuracy were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Six studies including a total of 418 patients (365 wet suction vs. 377 dry suction) were included in our final analysis. The study included a total of 535 lesions (332 pancreatic lesions and 203 nonpancreatic lesions). The pooled odds of sample adequacy was 3.18 (CI: 1.82–5.54, P = 0.001) comparing wet- and dry-suction cohorts. The pooled odds of blood contamination was 1.18 (CI: 0.75–1.86, P = 0.1). The pooled rate for blood contamination was 58.33% (CI: 53.65%–62.90%) in the wet-suction cohort and 54.60% (CI 49.90%– 59.24%) in the dry-suction cohort (P = 0.256). The pooled odds of histological diagnosis was 3.68 (CI 0.82–16.42, P = 0.1). Very few adverse events were observed and did not have an impact on patient outcomes using either method. EUS-FNA using the wet-suction technique offers higher specimen quality through comparable rates of blood contamination and histological accuracy compared to dry-suction EUS-FNA.

Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis.

Background/AimsStudies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques. MethodsWe performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed. ResultsEleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64). ConclusionsFNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.

An exclusive fine-needle biopsy approach to sampling solid lesions under EUS guidance: a prospective cohort study.

BackgroundEndoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is increasingly utilized to enhance the cytological yield of sampling solid lesions, but its superiority over existing fine-needle aspiration (FNA) platforms has not been clearly demonstrated. The aim of our study was to compare the diagnostic accuracy and procedural outcomes of FNB using a new Franseen-tip needle to that of a traditional FNA in sampling solid lesions under EUS guidance.MethodsConsecutive patients with solid lesions referred for EUS-FNB sampling were included. Procedure-related outcomes were collected prospectively including patient demographics, number of passes performed, diagnostic sample adequacy, adverse events, and recovery time. The Acquire needle was used to sample all lesions in the study group. Consecutive EUS-FNA procedures performed to sample solid lesions using the Expect needle were utilized as controls.ResultsThere were 180 patients undergoing EUS-FNB compared to 183 patients undergoing EUS-FNA procedures for solid-lesion sampling. The procedure time was significantly shorter in patients who underwent FNB compared to FNA (mean: 37.4 vs 44.9 minutes, P < 0.001). Significantly fewer passes were performed in the FNB cohort compared to the FNA group (mean: 2.9 vs 3.8, P < 0.001). The cytologic diagnostic yield was significantly higher in the FNB group compared to the FNA group (98.3% vs 90.2%, P = 0.003). No significant difference in the incidence of adverse events was observed between the FNB and FNA groups (1.1% vs 0.5%, P = 0.564).ConclusionsAn FNB-exclusive approach to sampling solid lesions under EUS guidance is safe and feasible, and may result in fewer overall passes, shorter procedure time, and improved diagnostic adequacy. FNB may replace FNA as the primary sampling modality of choice in all solid lesions.

Efficacy of rapid on-site evaluation for diagnosing pulmonary lesions and mediastinal lymph nodes: a systematic review and meta-analysis

Although rapid on-site evaluation (ROSE) is gradually becoming an integral part of the modern Interventional Pulmonology, the clinical benefit of ROSE is still a matter of controversy. The objective of this meta-analysis was to clarify whether ROSE is effective in diagnosing pulmonary lesions and mediastinal lymph nodes, synchronously, to assess circumstances under which ROSE makes more sense. MEDLINE and EMBASE were searched for studies comparing any outcome between ROSE and no-ROSE group in diagnosing pulmonary lesions and mediastinal lymph nodes. Statistical calculations were conducted using Review Manager, version 5.3, and Stata Release 12.0. Meta-analysis was completed using a random-effects model when I2≥50% or a fixed-effect otherwise. Heterogeneity was assessed by the I2-statistic test. Publication bias was assessed by the Begg's test. This Literature search yielded 27 studies altogether. The pooled risk difference of adequate rate was 0.12 [95% confidence intervals (CI): 0.07-0.16, I2=0%], the combined risk difference (RD) of diagnostic yield was 0.14 (95% CI: 0.09-0.18, I2=57%) while the pooled RD of sensitivity for malignancy was 0.10 (95% CI: 0.06-0.14, I2 =20%). Significant heterogeneity only existed in diagnostic yield (I2=57%, P=0.001). Further subgroup analysis documented a higher increase in diagnostic yield when sampling solid pulmonary lesions than sampling hilar/mediastinal lymph nodes 0.16 (95% CI: 0.12-0.20, I2=0%) versus 0.08 (95% CI: 0.04-0.13, I2=10%) and when applied to patients with suspected/diagnosed lung cancer than unselected patients 0.12 (95% CI: 0.06 to 0.18) versus 0.11 (95% CI: -0.07 to 0.28). ROSE is a useful technology in diagnosing pulmonary lesions and mediastinal lymph nodes, especially when sampling solid pulmonary lesions or applied to patients with suspected lung cancer.

An Exclusive Fine Needle Biopsy Approach to Sampling Solid Lesions Under EUS Guidance: A Case-Controlled Study: Presidential Poster Award

An Exclusive Fine Needle Biopsy Approach to Sampling Solid Lesions Under EUS Guidance: A Case-Controlled Study: Presidential Poster Award

A multicenter evaluation of a new EUS core biopsy needle: Experience in 200 patients

Background and Objectives:We present a multicenter study of a new endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle (Acquire, Boston Scientific, Natick, MA). The aim of the study was to analyze the needle's clinical performance when sampling solid lesions and to assess the safety of this device.Methods:We performed a multicenter retrospective study of patients undergoing EUS-FNB during July 1–November 15, 2016.Results:Two hundred patients (121 males and 79 females) underwent EUS-FNB of solid lesions with the Acquire needle. Lesions included solid pancreatic masses (n = 109), adenopathy (n = 45), submucosal lesions (n = 34), cholangiocarcinoma (n = 8), liver lesions (n = 6), and other (n = 8). Mean lesion size was 30.6 mm (range: 3–100 mm). The mean number of passes per target lesion was 3 (range: 1–7). Rapid onsite cytologic evaluation (ROSE) by a cytologist was performed in all cases. Tissue obtained by EUS-FNB was adequate for evaluation and diagnosis by ROSE in 197/200 cases (98.5%). Data regarding the presence or absence of a core of tissue obtained after EUS-FNB were available in 145/200 procedures. In 131/145 (90%) of cases, a core of tissue was obtained. Thirteen out of 200 patients (6.5%) underwent some form of repeat EUS-based tissue acquisition after EUS-FNB with the Acquire needle. There were no adverse events.Conclusion:Overall, this study showed a high rate of tissue adequacy and production of a tissue core with this device with no adverse events seen in 200 patients. Comparative studies of different FNB needles are warranted in the future to help identify which needle type and size is ideal in different clinical settings.

Comparison of modified wet suction technique and dry suction technique in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for solid lesions: study protocol for a randomized controlled trial

BackgroundSeveral suction techniques have been developed recently to enhance tissue acquisition when sampling solid lesions using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of this study is to determine whether a new modified wet suction technique (MWST) compared with the conventional dry suction technique (DRST) shall present better outcomes with respect to diagnostic yield and specimen quality of solid lesions in the intra-abdomen and mediastinum.Methods/designThis is a single-blind, randomized, controlled, superiority trial conducted at four large tertiary care centers in China. Two hundred and ninety-six patients with solid lesions referred for EUS-FNA will be randomly assigned to group A, using DRST for the first pass, or group B, using MWST for the first pass in a ratio of 1:1. Following a 2 × 2 cross-over design, the pass sequence for group A is DRST, MWST, DRST, MWST. For group B, the pass sequence is MWST, DRST, MWST, DRST. All procedures will be performed by experienced echoendoscopists, and the patients and assessors (cytologists and pathologists) will be blinded during the entire study. The primary outcome measure is the diagnosis yield. Secondary outcome measures are specimen quality, including assessment of quantity of cell, tissue integrity, and blood contamination.DiscussionTo our knowledge, this is the first large-scale randomized controlled trial to compare MWST with DRST when sampling solid lesions in the intra-abdomen and mediastinum. The results may contribute to future multicenter clinical trials in standardizing suction techniques during EUS-FNA.Trial registrationClinical Trials.gov, NCT02789371. Retrospectively registered on 6 June 2016.

Mo1255 Retrospective Evaluation of Diagnostic Yield for Sharkcoretm and Acquiretm Fine Needle Biopsy (FNB) Needles in Endoscopic Ultrasound (EUS) Guided Sampling of Solid Lesions

Mo1255 Retrospective Evaluation of Diagnostic Yield for Sharkcoretm and Acquiretm Fine Needle Biopsy (FNB) Needles in Endoscopic Ultrasound (EUS) Guided Sampling of Solid Lesions

Mo2072 Endoscopic Ultrasound-Guided FNA and Sharkcore FNB in Sampling Solid Lesions

Mo2072 Endoscopic Ultrasound-Guided FNA and Sharkcore FNB in Sampling Solid Lesions

Endoscopic ultrasound-guided fine needle aspiration: The wet suction technique

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has become a fundamental tool in obtaining cytopathological diagnosis of pancreatic tumors. When sampling solid lesions of the pancreas, the endosonographer can use two suction techniques to enhance tissue acquisition; the dry and the wet suction techniques. The standard dry suction technique relies on applying negative pressure suction on the proximal end of the needle after the stylet is removed with a pre-vacuum syringe. The wet suction technique relies on pre-flushing the needle with saline to replace the column of air with fluid followed by aspiration the proximal end by using a prefilled syringe with saline. A new modified wet suction technique (hybrid suction technique) relies on preloading the needle with saline, but having continuous negative pressure with a pre-vacuum syringe to avoid manual intermittent suction. Tissue acquisition can be enhanced by applying fluid dynamic principles to the current aspiration techniques, such as the column of water used in the needle of the wet technique. In this review, we will focus on EUS-FNA using the wet suction technique for sampling of pancreatic solid lesions.

Abscesses after Endoscopic Ultrasound Guided Fine Needle Aspiration: A Never Before Described Complication

Purpose: There is little evidence in the literature demonstrating bacteremia and infectious complications when sampling solid lesions of the upper GI tract. We however present a case of a patient who after routine diagnostic EUS FNA developed multiple hepatic abscesses and a retroperitoneal abscess involving the stomach. A 73 year old male was referred to our institution for a 3 cm well circumscribed mass in the pancreatic tail found on CT scan. A follow up MRI demonstrated the lesion along with several cystic lesions communicating with the main pancreatic duct; the largest measuring 1.5cm likely representing branch duct intrapancreatic mucinous lesions (IPMT). The liver during the MRI was noted to have no evidence hepatic metastases and no focal hepatic changes were seen either. EUS demonstrated a 2.1 cm hypoechoic mass in the pancreatic body with a cystic component with no regional adenopathy and a normal pancreatic head and duct. FNA was performed with a 25 gauge needle and tissues were obtained over the course of 3 passes. Pathology demonstrated well differentiated adenocarcinoma. Several weeks after the FNA, the patient returned for surgical removal of adenocarcinoma but upon entering the abdomen a startling discovery was made. Intraoperative ultrasound interrogation of the liver revealed several lesions ranging from 6-7 mm in size on the hepatic surface with the largest being 1.5cm in size on the posterior aspect of segment 2 of the liver. A biopsy was attempted but rather than tissue thick mucopurolent material was expressed through the site. Frozen section of the solid component was negative for malignant cells. The fluid culture later grew methicillin-resistant Staphylococcus aureus and Enterobacter aerogenes. Upon further exploration an abscess involving the retroperitoneum involving the anterior border of the pancreas and the posterior was of the stomach was found and drained and the surgery was aborted. A repeat CT scan was performed demonstrated multiple new hepatic lesions consistent with abscesses as was seen intraoperatively. The patient completed CT guided drainage of the abscesses and an extensive course of antibiotics and is currently doing well. To our knowledge this is the first reported case of hepatic abscesses secondary to a EUS FNA. Our proposed pathogenesis is the EUS needle may have introduced bacteria into the tail of the pancreas and through the portal drainage led to seeding of the liver. The retroperitoneal abscess was likely secondary to direct contact between the liver and stomach from the FNA tract. We feel clinicians should be made aware of this possible complication. We recommend further prospective studies in looking at prophylactic antibiotics after EUS FNA.

How Good Is EUS-FNA in Diagnosing the Correct Etiology for a Solid Pancreatic Mass? A Meta-Analysis and Systematic Review

Background: The published data on accuracy of EUS-FNA in diagnosing the correct etiology for a solid pancreatic mass has been varied. Detecting the correct etiology for a pancreatic mass help in triaging patients for appropriate therapies and might obviate the need for invasive surgery. Aim: To evaluate the accuracy of EUS-FNA in diagnosing the correct etiology for a solid pancreatic mass. Method: Study Selection Criteria: EUS-FNA studies with a gold standard (either confirmed by surgery or appropriate follow-up) were selected. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Statistical Method: Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and by the DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. Results: Initial search identified 3610 reference articles, of these 360 relevant articles were selected and reviewed. Data was extracted from 69 studies (N= 6493) which met the inclusion criteria. Pooled sensitivity of EUS-FNA in diagnosing the correct etiology for solid pancreatic mass was 86.9% (95% CI: 85.9 - 87.9). EUS-FNA had a pooled specificity of 95.9% (95% CI: 94.9 - 96.7). The positive likelihood ratio of EUS was 14.7 (95% CI: 9.4 - 22.9) and negative likelihood ratio was 0.18 (95% CI: 0.15 - 0.23). The diagnostic odds ratio, the odds of having correct histologic etiology of pancreatic mass in positive as compared to negative EUS-FNA studies was 93.5 (95% CI: 58.6 - 149.1). All the pooled estimates calculated by fixed and random effect models were similar. SROC curves showed an area under the curve of 0.95. Egger bias, an indicator for publication bias, was 0.59 (95% CI = -0.23 to 1.43, p = 0.1525), and confirmed no publication bias. The p for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. Conclusions: EUS-FNA is an excellent diagnostic tool to detect the correct etiology for solid pancreatic mass. When available, EUS-FNA should be strongly considered as the first diagnostic tool for sampling solid pancreatic lesions to guide patient management.

Prospective Study of Bacteremia and Complications With EUS FNA of Rectal and Perirectal Lesions

Recent studies showed that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a low-risk procedure for causing bacteremia and infectious complications when sampling solid lesions of the upper gastrointestinal (GI) tract. As a result, antibiotics are not recommended for prophylaxis against endocarditis. Our aim was to prospectively evaluate the risk of bacteremia and other infectious complications in patients undergoing EUS FNA of lower GI tract lesions. Patients referred for EUS FNA of lower GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure antibiotic administration based on American Society for Gastrointestinal Endoscopy guidelines, had taken antibiotics within the prior 7 days, or if they had a cystic lesion. Blood cultures were obtained immediately before the procedure, after flexible sigmoidoscopy/radial EUS, and 15 minutes after EUS FNA. One hundred patients underwent a total of 471 FNAs (mean, 4.7 FNAs/patient; range, 1-10 FNAs/patient). Blood cultures were positive in 6 patients. Cultures from 4 patients (4.0%, 95% confidence interval, 1.6%-9.8%) grew coagulase-negative Staphylococcus (n = 2), Peptostreptococcus stomatis (n = 1), or Moraxella (n = 1), which were considered contaminants. Two patients (2.0%, 95% confidence interval, 0.6%-7%) developed bacteremia: Bacteroides fragilis (n = 1) and Gemella morbillorum (n = 1). No signs or symptoms of infection developed in any patient. EUS FNA of solid lesions in the lower GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for the prevention of bacterial endocarditis.