Ultrasound-guided Fine Needle Research Articles

Endoscopic Ultrasound Guided-Tissue Acquisition in Pancreatic Melanoma. Report of Two Cases and Literature Review.

We present two cases of primary melanomas that during their surveillance developed metastasis to the pancreas. After an initial approach, tissue samples of the pancreatic lesions were obtained by endoscopic ultrasound guided-fine needle biopsy (EUS-FNB). The histopathological report was compatible, in both cases, with a metastatic melanoma.

A pilot study for single cell RNA-sequencing of patient-derived pancreatobiliary cancer organoid.

739 Background: For precision medicine, patient-derived organoid (PDO) is regarded as one of the promising models. However, current PDOs were mainly derived from surgical specimens. We aimed to analyze the single cell RNA-sequencing (scRNA-seq) of PDO from various sampling methods with different pathologic outcomes. Methods: In 2021, three pancreatic cancer and one gallbladder cancer samples were collected from surgical specimen, endoscopic ultrasound guided-fine needle biopsy (EUS-FNB), and endoscopic retrograde cholangiopancreatography (ERCP)-guided biopsy. The samples were mechanically dissociated with dissociation buffer and incubated using shaking incubator. Dissociated cells were seeded into growth factor reduced Matrigel. From these PDOs, we generated scRNA-seq data in each experimental design, and corrected batch effects that could occur when multiple samples are considered simultaneously in downstream analysis. Marker genes representing each cell subcluster were identified, and statistical hypothesis tests were performed to identify genes differentially expressed according to differences in biopsy methods and/or pathological results. Results: We found the optimal 8 types of sub cell-type clusters with a resolution parameter of 0.3 in clustering analysis based on the Uniform Manifold Approximation and Projection (UMAP) algorithm in terms of silhouette score. As a result of examining the expression levels of KRT19, a marker gene for malignant ductal cells, and RGS5, a stellate marker gene, which showed the same pattern as the existing PDAC transcriptome studies, it was confirmed that most of the cells derived from PDOs were malignant ductal cells. Finally, we identified a heterogeneous effect on gene expression patterns in ductal cells depending on not only pathological positivity, but also biopsy methods for organoid. Conclusions: According to our scRNA-seq, most cells were malignant cells and EUS-FNB could be a good sampling method for PDOs. However, further analysis about a heterogeneous effect on gene expression patterns is necessary.[Table: see text]

Pancreatic Cystic Lesions: A Focused Review on Cyst Clinicopathological Features and Advanced Diagnostics.

Macroscopic, endomicroscopic, and histologic findings and correlation are an integral part of the diagnostic evaluation of pancreatic cystic lesions (PCLs), as complementing morphologic features seen by different specialties are combined to contribute to a final diagnosis. However, malignancy risk stratification of PCLs with worrisome features can still be challenging even after endoscopic ultrasound guided-fine needle aspiration (EUS-FNA) with cytological evaluation. This review aims to summarize cyst clinicopathological features from the pathologists' perspective, coupled with knowledge from advanced diagnostics-confocal laser endomicroscopy and cyst fluid molecular analysis, to demonstrate the state-of-art risk stratification of PCLs. This review includes illustrative photos of surgical specimens, endomicroscopic and histologic images, and a summary of cyst fluid molecular markers.

P-292 Endoscopic ultrasound guided-fine needle aspiration for the diagnosis of secondary pancreatic lesions. Experience of a reference center

It is estimated that about 2% to 5% of pancreatic malignant tumors are metastatic lesions. Lung, kidney and breast cancer as well as melanoma are the most common primary tumors affecting the pancreas. Histologic or cytologic confirmation is essential for differential diagnosis from the much more common primary adenocarcinoma of the pancreas. The aim of this study is to assess the diagnostic value and safety of endoscopic ultrasound guided-fine needle aspiration (EUS-FNA) of pancreatic tumors in patients with extra-pancreatic malignancy.

Fast Classification of Thyroid Nodules with Ultrasound Guided-Fine Needle Biopsy Samples and Machine Learning

A rapid classification method was developed for the malignant and benign thyroid nodules with ultrasound guided-fine needle aspiration biopsy (FNAB) samples. With probe electrospray ionization mass spectrometry, the mass-scan data of FNAB samples were used as datasets for machine learning. The patients were marked as malignant (98 patients), benign (110 patients) or undetermined (42 patients) by experienced doctors in terms of ultrasound, the B-Raf (BRAF) gene, and cytopathology inspections. Pairwise coupling was performed on 163 ions to generate 3630 ion ratios as new features for classifier training. With the new features, the performance of the multilayer perception (MLP) classifier is much better than that with the 163 ions as features directly. After training, the accuracy of the MLP classifier is as high as 92.0%. The accuracy of the single-blind test is 82.4%, which proved the good generalization ability of the MLP classifier. The overall concordance is 73.0% between prediction and six-month follow-up for patients in the undetermined group. Especially, the classifier showed high accuracy for the undetermined patients with suspicious for papillary carcinoma diagnosis (90.9%). In summary, the machine learning method based on FNAB samples has potential for real clinical applications.

Role of Ultrasound Guided Fine Needle Aspiration Cytology in Intra-abdominal lesion

Introduction: All of the imaging techniques have advantages and disadvantage in various parts of the body. In intraabdominal lesion ultrasonography guided FNAC has advantage over computerised tomography guided FNAC because CT is very costly and not freely available. CT gives high dose of radiation and therefore should not be used in pregnant women and in small children whereas ultrasonography has no radiation effects and hence can be safely used in these cases. Mobile version of CT is not available and therefore it cannot be used in faraway places whereas ultrasonography machine is mobile. Thus, with localization by ultrasonography diagnosis of the malignancy and staging can be accomplished through FNAC. Method: Total of 100 cases who came for FNAC of intraabdominal masseswere included in the study, irrespective of their age, sex or possible nature of mass. Ultrasound guided Fine needle aspiration was done in all.The aim of the present study was to assess the feasibility of ultrasound guided Fine needle aspiration cytology of routine procedure for detection of abdominal lesion. Result: Total of 100 cases were studied. In the 80(80%) cases, aspirates were positive for malignancy and in 17(17%) cases were negative for malignancy. There were 3% false negative cases encountered. There were no false positive cases. Ultrasound was used for mass localization. In 80 positive cases of malignancy, 36 cases from liver, 10 from lymph node, 7 from gall bladder, 6 from stomach, 6 from ovary, 3 from urinary bladder, 1 from pancreas, I from uterus, 3 from miscellaneous sites. Conclusion: Percutaneous fine needle aspiration cytology is reliable method of diagnosing the various pathological lesions of abdomen. Its diagnostic accuracy is further increased when performed under Radiological guidance. Of all modalities of guidance at present is the most suitable.

Gastroblastoma: Cytologic Findings with Resection and Molecular Correlation

Abstract Casestudy Gastroblastoma is a rare tumor with biphasic components showing epithelial and mesenchymal differentiation. To date, <15 cases have been reported, with molecular confirmation of the recently identified MALAT1-GLI1 translocations only in a subset. Aspiration cytologic and small biopsy findings have not yet been reported. We present a case of gastroblastoma, arising in a 22-year-old female. Results A CT scan was performed, showing a 7 cm heterogeneous mass in the distal stomach and pancreas, clinically suspected to represent at gastrointestinal stromal tumor (GIST). She underwent two preoperative samples, including endoscopic ultrasound guided-fine needle aspiration and core biopsy, followed by a distal gastrectomy. Diff- Quik stained touch preparations performed on the core needle biopsy during rapid on-site evaluation showed a hypercellular neoplasm composed of large, three-dimensional aggregates of neoplastic cells in a background of numerous isolated single cells and bare nuclei. The neoplastic cells were bland with spindled to epithelioid nuclei, occasional nuclear grooves, and small nucleoli. Immunostains were only helpful in excluding GIST (CD117 and DOG1 negative). Distal gastrectomy showed a nodular/plexiform tumor with variably epithelioid to spindle cell cytology and solid to focally myxoid/microcystic architecture. Pancytokeratins CAM5.2 (patchy) and AE1/AE3 (very focal) were positive, with negative S100, SMA, Desmin, Melan-A, Inhibin, Calretinin, and Synaptophysin. Based on the age, location, histology and immunophenotype, gastroblastoma was suspected, and multiplex NGS-based fusion sequencing identified a MALAT1-GLI1 fusion. Staging studies were negative for metastasis at presentation. Conclusion Based on this experience, we recommend consideration of gastroblastoma for a gastric tumor in a young patient, especially if encountering a cytologic sample showing non-pleomorphic epithelioid and spindle cell cytology. Lack of expression of GIST, smooth muscle, neuroendocrine, and neural sheath-associated markers should particularly raise consideration of this rare neoplasm. While in this case molecular studies clinched the diagnosis upon resection, increasingly used GLI1 immunostain may be of use prospectively for diagnosis of limited samples.

Factors affecting cytological results of endoscopic ultrasound guided-fine needle aspiration during learning

BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a standard procedure used to obtain tissue samples for diagnosis of solid retroperitoneal tumours. However, this procedure demands high technical expertise and requires a strong learning curve. Our aim was to identify factors associated with false-negative EUS-FNA results during the learning for endoscopists.MethodsOur retrospective analysis was based on the EUS-FNA specimens collected by two novice endoscopists in 200 patients with retroperitoneal lesions who had confirmed image- or tissue-based diagnoses of malignancy or benign lesions.ResultsIn the first 40 performances endoscopists, the false-negative diagnostic rate of EUS-FNA was higher among patients with chronic pancreatitis than in patients without chronic pancreatitis. Patients who underwent FNA through the trans-duodenal puncture route also had lower success cytological diagnosis rate than through the trans-gastric puncture route. The rate of successful cytological diagnoses with EUS-FNA improved after 40 procedures and was not influenced by chronic pancreatitis presentation or difference puncture route.ConclusionRegarding the learning curve, more than 40 procedures were required to achieve a stable success rate of EUS-FNA. Chronic pancreatitis and trans-duodenal puncture route are the predictive factors for a false-negative FNA cytological result during learning.Trial registrationThis was a retrospective study.

2812 Impact of Rapid On-Site Evaluation (ROSE) on Endoscopic Ultrasound-Guided FNA of Pancreatic Cysts: A Five-Year Comparative Study Between Two Academic Institutions

INTRODUCTION: Endoscopic Ultrasound Guided-Fine Needle Aspiration (EUS-FNA) is considered the modality of choice for diagnosing intermediate pancreatic lesions. Rapid-on site evaluation (ROSE), when performed by a cytopathologist, has been suggested to improve the diagnostic yield of EUS-FNA. Prior studies were inconsistent regarding the benefit of ROSE. In our study, we evaluated the diagnostic yield of EUS-FNA in the presence of an on-site cytopathologist providing real-time feedback to the endoscopist compared to EUS-FNA alone in two academic hospitals. METHODS: We conducted a 2010-2015 retrospective chart review of all EUS-FNA performed at two academic medical centers (UT and UR). The policy at UT is to perform all EUS-FNA with ROSE, whereas it is not routinely done at UR. Cases where included when surgical pathology was available. Patients’ demographics, pancreatic cyst characteristics and EUS techniques were analyzed. EUS-FNA were considered valuable when it provided a classifying cytopathologic diagnosis. Student T-test and Analysis of Variance (ANOVA) were performed when appropriate for descriptive purposes. RESULTS: Forty-five cases (13 at UT, 32 at UR) were identified. EUS FNAs coupled with ROSE (UT) rendered 100% (13/13) valuable diagnoses, while those done with no cytopathologist on site (UR) had valuable diagnosis in 37.5% of the cases (12/32, P < 0.0001). The sensitivity of EUS-FNA at UT was 85% compared to 33% at UR. There was no statistically significant difference in gender, age, site or size of the tumor. The mean number of needle passes at UT was 1.9 (range 1-6) vs. 1.1 (range 1-3) at UR. The majority of needles used were 19G (55%) at UT vs 22G (83%) at UR (P < 0.001). Only one patient at UR had a minor cyst bleeding to the main pancreatic duct that required no therapeutic action. CONCLUSION: The results highlight the advantage of bed-side cytopathologist interaction with the endoscopist during EUS-FNA of pancreatic cysts. Absence of malignant cells despite suspicious ultrasound findings may have prompted more needle passes. The use of 19G needle may have improved outcomes with no significant increase of complications. In addition to the small sample size and the retrospective nature, the study is limited by the variability in personnel experience (endoscopists and cytopathologists) and the techniques used, indicating that further studies are necessary to confirm these findings.

The Initial Impact of Implementing Rapid On-Site Evaluation of Endobronchial Ultrasound-Guided Transbronchial Fine Needle Aspirations in a University Setting

The Initial Impact of Implementing Rapid On-Site Evaluation of Endobronchial Ultrasound-Guided Transbronchial Fine Needle Aspirations in a University Setting

Diagnostic Utility of Clinical, Laboratory, Radiology Findings to Predict Malignant Outcome in Endoscopic Ultrasound Guided-Fine Needle Aspirations of Solid Pancreatic Lesions with Atypical Results

Diagnostic Utility of Clinical, Laboratory, Radiology Findings to Predict Malignant Outcome in Endoscopic Ultrasound Guided-Fine Needle Aspirations of Solid Pancreatic Lesions with Atypical Results

Su1202 ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION VERSUS FINE NEEDLE BIOPSY IN SOLID LESIONS: A MULTICENTER RETROSPECTIVE ANALYSIS

Endoscopic ultrasound guided-fine needle aspiration (EUS-FNA) has been a preferred technique for tissue sampling for several years. To overcome limitation of FNA cytology, fine needle biopsy (FNB) has recently been developed with the promise of histological tissue samples. The main objective of this study is to compare the accuracy of FNB versus FNA in determining the diagnosis of solid lesions.

UK national audit of safety checks for radiology interventions.

To reaudit the use of safety checklists in radiology departments in NHS departments throughout the UK. This audit was performed on behalf of The Royal College of Radiologists Audit Committee in 2016 and was sent to radiology audit leads at every NHS department in the UK to determine the use of safety checks in various modalities and subspecialties. Free-form text boxes gathered data on problems with checklist implementation. 109/177 (62%) trusts responded. 48% of respondents used safety checklists for all radiological procedures in all modalities. 50% used checklists for some procedures. 2% did not use a checklist. Checklist use had increased since the previous audit (98% 2016, compared to 94% in 2012) but implementation for different procedures remains variable. For example, in ultrasound-guided fine needle and breast stereotactic procedures (49%), use has not increased since 2012. Reasons for not using checklists include a perception that intervention suite checklists were not appropriate for minor procedures and the limited flexibility of radiology information systems. The limitations of checklists are discussed. Our reaudit shows that in spite of increased implementation, use of safety checks is variable. Local ownership and radiology information system flexibility are needed to support the culture of safety processes in radiology departments.

Biopsy Site Changes in Resected Mediastinal Lymph Nodes with Prior Endobronchial Ultrasound-Guided Transbronchial Fine Needle Aspiration (EBUS-TBNA)

Biopsy Site Changes in Resected Mediastinal Lymph Nodes with Prior Endobronchial Ultrasound-Guided Transbronchial Fine Needle Aspiration (EBUS-TBNA)

Clinical management of papillary thyroid microcarcinoma

Papillary thyroid microcarcinoma(PTMC)of the thyroid is defined as papillary thyroid carcinoma measuring<1 cm. The incidence of differentiated thyroid cancer is increasing greatly. However, roughly half of this increase is attributable to the identification of PTMC. Serum thyroid stimulating hormone, thyroid ultrasound and ultrasound guided thyroid fine needle aspiration cytology(FNAC)are still the cornerstone for its diagnosis. The active surveillance approach in which active treatment is delayed until the cancer shows signs of substantial progression could be considered in selected patients with low-risk PTMC. Active surgery is still the first line treatment for other PTMC patients, although thermal ablation may be an alternative option for low-risk patients with PTMC. (Chin J Endocrinol Metab, 2018, 34: 353-358) Key words: Papillary thyroid microcarcinoma; Active surveillance; Thermal ablation

Ultrasound-guided fine needle aspiration versus core needle biopsy: comparison of post-biopsy hematoma rates and risk factors.

To compare post-biopsy hematoma rates between ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy, and to investigate risk factors for post-biopsy hematoma. A total of 5304 thyroid nodules which underwent ultrasound guided biopsy were included in this retrospective study. We compared clinical and US features between patients with and without post-biopsy hematoma. Associations between these features and post-biopsy hematoma were analyzed. Post-biopsy hematoma rate was 0.8% (43/5121) for ultrasound guided-fine needle aspiration and 4.9% (9/183) for ultrasound guided-core needle biopsy (P < 0.001). For ultrasound guided-fine needle aspiration, gender, age, size, presence of vascularity, and suspicious US features were not associated with post-biopsy hematoma according to experience level. Post-biopsy hematoma occurred significantly more with ultrasound guided-core needle biopsy (9/179, 5.0%) than with ultrasound guided-fine needle aspiration (9/1138, 0.8%) (P < 0.001) in experienced performers and ultrasound guided-core needle biopsy was the only significant risk factor for post-biopsy hematoma (adjusted Odds Ratio, 6.458, P < 0.001). Post-biopsy hematoma occurred significantly more in ultrasound guided-core needle biopsy than in ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy was the only independent factor of post-biopsy hematoma in thyroid nodules.

Ultrasound-Guided Thyroid Fine Needle Aspiration (USG-TFNA) Performance by Cytopathologists in Comparison to Other Specialty Practices

Ultrasound-Guided Thyroid Fine Needle Aspiration (USG-TFNA) Performance by Cytopathologists in Comparison to Other Specialty Practices

A Case of Inconspicuous Pancreatic Cancer with Invasion of the Celiac Axis and Superior Mesenteric Artery

A 66-year-old man was referred to our hospital due to carbohydrate antigen 19-9 (CA19-9) elevation. Further examination revealed no obvious malignancy, but abdominal enhanced computed tomography (CT) showed soft tissue density around the celiac axis and superior mesenteric artery (SMA). Although pancreatic cancer was considered as a possible diagnosis, there was no clear evidence within the pancreas itself. Furthermore the patient was observed without intervention. Another abdominal enhanced CT performed 10 months later showed a dilated pancreatic duct in the tail of the pancreas, along with a low density area measuring 10 mm in the body of the pancreas. Endoscopic ultrasound guided-fine needle aspiration (EUSFNA) led to a diagnosis of pancreatic cancer. In the present case, the tumor in the pancreas was inconspicuous, but it might be characterized by extensive extrapancreatic invasion.

A comparative study of free-hand fine needle aspiration cytology and ultrasound guided fi ne needle aspiration cytology in the diagnosis of thyroid swellings at BP Koirala Institute of Health Sciences- a tertiary care centre in Nepal

Background: Thyroid lesions are commonly encountered in clinical practice and it is mandatory to know and record the nature of pathology prior to definitive therapy. Fine needle aspiration cytology (FNAC) is a time tested, cheap, reliable and safe method to establish a cytological diagnosis of the nature of the disease. Ultrasound guided FNAC has the potential to reduce inadequacy rates and is regarded as the optimal cytological method for diagnosis. Objective: To compare the results of free-hand and ultrasound-guided FNAC of thyroid swellings and to find out the diagnostic reliability of free-hand FNAC and ultrasound-guided FNAC using histological diagnosis as the gold standard. Methods: Fifty-five patients with thyroid swelling who were subjected to free-hand and ultrasound-guided FNACs and who subsequently underwent surgery over one year were studied. Results: Ultrasound guided FNAC results revealed 72.75 % benign lesions and 25.45 % of malignant lesions, and free hand FNAC revealed 52.73 % benign and 16.36% malignant cases. A 14.55 % inadequacy rate was seen in the free hand group. Histological gold standard diagnosis comprised of 60 % benign and 40 % malignant cases. Sensitivity and specificity of free-hand and ultrasound guided FNAC in diagnosing malignancy of the thyroid were 56.25% and 100%; and 63.64% and 96.97% respectively. Conclusion: Free hand FNAC of thyroid swellings is more convenient and cost effective as compared to ultrasound guided FNAC. However, the diagnostic yield in ultrasound guided FNAC is significantly more in terms of accuracy especially in cystic and tiny lesions.Health Renaissance 2014;12(2): pp. 78-86

Autoimmune pancreatitis with colonic stenosis: an unusual complication and atypical pancreatographic finding

BackgroundType 1 autoimmune pancreatitis (AIP) often accompanies various systematic disorders such as sclerosing cholangitis, sialoadenitis, retroperitoneal fibrosis, interstitial pneumonitis and nephritis. Although rarely reported in acute pancreatitis, colonic stenosis is an uncommon complication in cases with AIP.Case presentationA 69-year-old Japanese man complained of abdominal pain and continuous diarrhea, resistant to intake of antimuscarinic and probiotic agents. A colonoscopy demonstrated a stenosis at the splenic flexure. Computed tomography revealed a focal enlargement of the pancreatic tail with a capsule-like rim, contacting with the descending colon. Endoscopic retrograde pancreatography (ERP) was unable to visualize the main pancreatic duct (MPD) at the pancreatic tail, despite a full contrast injection. A high serum IgG4 level (1060 mg/dL) and exclusion of pancreatic cancer by endoscopic ultrasound guided-fine needle aspiration suggested AIP, but did not fulfill the diagnostic criteria, and steroid therapy was initiated. One month after starting steroid intake, pancreatic swelling was minimized and the MPD was visualized by ERP, fulfilling the international consensus diagnostic criteria (ICDC) of AIP. Colonic stenosis was relieved and the patient’s symptoms disappeared.ConclusionThe present case is the first report of AIP developing colonic stenosis by the inflammatory infiltration. In this case, steroid therapy was effective for the diagnosis and treatment of pancreatic mass involving the descending colon.