Ultrasound-guided Fine-needle Aspiration Research Articles

Limited Utility of Routine Surveillance Ultrasound in Differentiated Thyroid Cancer Patients With Undetectable Postoperative Thyroglobulin Levels.

Neck ultrasound (US) and serum thyroglobulin (Tg) measurements are mainstays of long-term differentiated thyroid cancer (DTC) surveillance. Given the high sensitivity of serum Tg, we aimed to assess the utility of neck US in DTC patients who underwent total thyroidectomy and have undetectable serum Tg. We performed a retrospective cohort analysis of DTC patients who underwent a total thyroidectomy at our institution (2010-2023) and received US-guided fine needle aspiration (FNA) during their surveillance. Patients were categorised into three lab categories based on serum Tg and Tg antibody (Tg Ab) status before the biopsy: (1) 'Negative Tg' if undetectable Tg ( < 0.2 ng/dL) and Tg Ab, (2) 'Positive Tg' if detectable Tg and undetectable Tg Ab, and (3) 'Positive Tg Ab' if detectable Tg Ab. To calculate the positive predictive value (PPV) of neck US, we defined the 'true positive' of US as findings that prompted an FNA biopsy resulting with DTC, and 'false positive' findings prompting an FNA biopsy that did not result as DTC. A total of 118 patients were included, encompassing 146 FNA biopsies: 33 (23%) had Negative Tg, 84 (57%) had Positive Tg, and 29 (20%) had Positive Tg Ab lab results before their biopsies. The PPV of neck US in the setting of Negative Tg was 3% (one true positive, 32 false positives), while the PPV was 50% (42 true positives, 42 false positives) for Positive Tg, and 52% (15 true positives, 14 false positives) for Positive Tg Ab cohorts. Sub-analysis of the Positive Tg cohort using different serum Tg level cutoffs revealed a PPV of 29% at just detectable serum Tg of 0.2 ng/dL, and PPV of 38% for Tg < 1.0 ng/dL. The PPV stabilised at 58% for Tg levels ≥ 1 ng/dL. With the low PPV of neck US, high cost of surveillance, and the advent of ultra-sensitive serum Tg measurements, future guidelines should consider reducing routine neck US surveillance in patients with undetectable serum Tg and only performing it when there is a rise in serum Tg levels.

Incidental Mucinous Neoplasms of the Pancreas: Performance of the AGA, European, and IAP Guidelines in Advising Further Management after Endoscopic ultrasound-guided fine-needle Aspiration Biopsy.

We compared the performance of AGA-2015, ESG-2018, and IAP-2024 guidelines in referring patients for surgery versus surveillance when applied to incidental after diagnosis by EUS-FNA. Single-center, retrospective study with prospective data collection. PLs identified incidentally on CT or MRI/MRCP performed for other diseases with inconclusive imaging results were eligible for analysis. After EUS-FNA and microhistological diagnosis, each of the guidelines was applied; sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were compared. 140 asymptomatic patients (mean age 64.7y, 61% female) had a confirmed diagnosis of MN. Of these, 42 (30%) had "high rik stigmata" and 16 (11.4%) were malignant. AGA-2015, ESG-2018, and IAP-2024, criteria would have advised surgery unnecessarily in 66%, 15%, and 46%, respectively (P<0.001). AGA-2015, ESG-2018, and IAP-2024, and criteria failed to identify 59%, 46.1%, and 33.3% of HGD/IC, respectively (P=1.00). The AGA-2015 criteria were highly specific, while IAP-2024 had superior sensitivity. All had moderate sensitivity to indicate surgery, and all missed similar numbers of malignant lesions. Performing EUS-FNA before application of guidelines seems appropriate to guide further management of asymptomatic PLs, preventing unnecessary surgery and referring patients appropriately for surveillance. The ESG-2018 guideline proved most accurate for this purpose.

Ultrasound-guided Percutaneous Fine-needle Aspiration Performed by In-training Pulmonologist: A Comparative Study With Interventional Radiologists.

Ultrasound (US)-guided fine-needle aspiration (FNA) is a minimally invasive procedure that can be performed by an in-training pulmonologist. This is a retrospective study of 73 patients who underwent US-guided FNA by pulmonologist and interventional radiologist. Comparable diagnostic yield was found in this study (88.0% vs 81.3%, P = 0.460), but a higher number of second diagnostic procedures was seen in the Interventional Radiology group (22.9% vs 16.0%, P = 0.488). No significant complications were reported in the pulmonary group. In-training pulmonologists can safely perform US-guided FNA for thoracic and extrathoracic lesions.

The necessity of fine-needle aspiration biopsy in surgical decision-making for thyroid nodules larger than 3 cm.

Ultrasound-guided fine-needle aspiration biopsy (FNAB) is an essential diagnostic tool for detecting malignancy in thyroid nodules. The objective of this study was to evaluate the necessity of FNAB in the treatment decision-making process for thyroid nodules exceeding 3 cm in size. The records of patients who underwent thyroidectomy in our center between 2018 and 2023 were retrospectively reviewed. The study included patients with an index nodule size exceeding 3 cm. Exclusion criteria were missing data, treatment for a different oncological condition, recurrent disease, and purely cystic nodule. Patients were categorized into 2 groups based on the size of the index nodule: Group 1 included nodules measuring between 3 to 4 cm, and Group 2 included nodules 4 cm and larger. Demographic data, FNAB results, and histopathological findings were recorded. The specificity, sensitivity, false negative, and false positive rates of FNAB were calculated. There were 1935 patients who underwent thyroidectomy within the specified date range. In 359 of these patients, the index nodule size was 3 cm or more. There were 188 patients with nodule size between 3 and 4 cm. The mean age was 50.42 ± 13.34 years, and 257 patients were female (F/M ratio = 2.5/1). Fine needle aspiration biopsy was performed on 237 patients, resulting in 65 false negatives. Both the incidence of malignancy and the rate of FNAB false negatives were higher in nodules measuring 4 cm or larger. This study identified a high malignancy rate and a significant rate of false negatives in FNAB of thyroid nodules larger than 3 cm. These findings highlight the importance of carefully considering these factors in the surgical planning of such nodules.

A Novel Training Model to Improve Diagnostic Accuracy of Cervical Fine-Needle Aspiration.

This study aims to improve the diagnostic yield of cervical fine-needle aspiration (FNA) through training on a novel liver model. Ultrasonography-guided fine-needle aspiration (US-FNA) is crucial for diagnosing head and neck lumps but requires meticulous execution. Limited resources often hinder systematic teaching, making practical models essential for training. Fifteen otorhinolaryngology residents trained using a liver model with inserted Sensorium spheres to simulate cervical masses. The training involved viewing an instructional video, performing US-FNA on the model, and completing pre- and posttraining self-assessments. Performance was evaluated using visual analog scales (VAS), an adapted version of objective structured assessment of ultrasound skills (adapted OSAUS), and timing of procedures. Clinical impact was assessed by comparing diagnostic rates of US-FNA before and after training. Participants reported increased comfort and proficiency in US-FNA techniques posttraining. Adapted OSAUS scores improved significantly for image recognition and both in-plane and out-of-plane techniques. The diagnostic yield of US-FNA in clinical practice increased from 71% to 85%. No significant influence of gender, preferred ultrasound orientation, age, or experience on the learning curve was found. However, male participants showed a more substantial benefit from the training. The liver model effectively enhances US-FNA skills, reflected in improved clinical diagnostic rates. Training on such models should be incorporated into medical education to reduce inconclusive punctures and enhance patient satisfaction. This study demonstrates the feasibility and effectiveness of a cost-efficient, reproducible model for US-FNA training, emphasizing the importance of practical training in medical education.

Intracystic Glucose Measurement for On-Site Differentiation Between Mucinous and Non-Mucinous Pancreatic Cystic Lesions.

Pancreatic cystic lesions (PCLs) are frequently detected incidentally and vary from benign to malignant. Accurate differentiation between mucinous (M-PCLs) and non-mucinous PCLs (NM-PCLs) is essential for appropriate management. This study aims to validate the accuracy of on-site glucose measurement using a glucometer with a cut-off of 50 mg/dL for distinguishing M-PCLs from NM-PCLs. In this prospective multicenter study, conducted at three European academic hospitals, patients who underwent endoscopic ultrasound-guided fine-needle aspiration for PCLs between 2019 and 2020 were included. On-site glucose measurement was performed using a conventional glucometer. Data on demographics, clinical features, EUS findings, and histopathology were collected. Fifty patients were enrolled, with 37 having glucose levels < 50 mg/dL and 13 ≥ 50 mg/dL. M-PCLs were more common in the <50 mg/dL group (81%) compared to the ≥50 mg/dL group (23%, p < 0.001). The median CEA was higher in the <50 mg/dL group (146 ng/mL) than in the ≥50 mg/dL group (3 ng/mL, p = 0.047). On-site glucose testing < 50 mg/dl demonstrated a sensitivity of 93.2%, a specificity of 76.5%, and an accuracy of 89% for detecting M-PCLs with an AUC of 0.74 and an OR of 14.29 (p < 0.001). In comparison, CEA > 192 ng/mL had a sensitivity of 55.6%, a specificity of 87.5%, and an accuracy of 75.8% for M-PCLs, with an AUC of 0.65 and an OR of 4.44. On-site glucose measurement using a glucometer with a cut-off of <50 mg/dL is a highly accurate, rapid, and cost-effective method for differentiating M-PCLs from NM-PCLs. Our results validate the glucose cut-off in a multicentric prospective cohort supporting its integration into standard diagnostic protocols for PCLs.

Fine Needle Aspiration Cytological Diagnosis of Primary Breast Large-Cell Neuroendocrine Carcinoma/Squamous Cell Carcinoma.

Primary breast large-cell neuroendocrine carcinoma (LCNEC)/squamous cell carcinoma (SCC), also referred to as mixed neuroendocrine/non-neuroendocrine neoplasms of the breast (Br-MiNENs), represents an exceedingly rare malignancy. We report the first case of primary breast LCNEC/SCC diagnosed via ultrasound-guided fine-needle aspiration (FNA) biopsy of the left supraclavicular and left internal mammary lymph nodes. The patient, a 40-year-old female, underwent a lumpectomy followed by breast-conserving surgery and was diagnosed with primary breast LCNEC. Notably, within merely four months following the breast-conserving surgery, PET-CT revealed lymph node enlargement, prompting the performance of FNA. FNA cytology of metastatic lymph nodes revealed two distinct tumor components, allowing for clear differentiation between LCNEC and SCC in the smear. The diagnosis was further corroborated by immunocytochemical (ICC) staining of the cell blocks. Subsequently, histopathological re-examination of the breast mass revealed occult SCC components comprising less than 1% of the tumor cells. Additionally, the case exhibited triple-negative breast cancer, with PIK3CA, TP53, RB1, and BCL2L11 mutations identified through next-generation sequencing (NGS). Br-MiNEN is exceedingly rare, and its cytological diagnosis poses significant challenges. It is recommended that a detailed and objective description of each tumor component and its proportion be provided. This report provides the first detailed description of the FNA cytology of LCNEC/SCC, thereby enhancing cytopathologists' comprehension of this tumor. Auxiliary studies, including ICC staining and molecular biology assays, are crucial for accurate diagnosis, therapy, and prognosis.

High Diagnostic Yield of Fine Needle Biopsy for Pancreatic Serous Cystadenomas - a Multi-Center Study.

Distinguishing serous cystadenoma, a benign pancreatic cyst, from potentially malignant mucinous pancreatic cystic lesions carries significant clinical and prognostic implications; and while endoscopic ultrasound-guided fine needle aspiration is the standard diagnostic tool, its low diagnostic yield often results in additional workup. This study evaluates diagnostic yield of fine needle biopsy (FNB) on lesions suggestive of serous cystadenoma on endoscopic ultrasound. Patients with microcystic EUS appearance were identified through retrospective chart review in two institutions. Prior cross sectional imaging diagnosis was also obtained. All microcystic lesions with classic "honeycomb" appearance for serous cystadenoma on EUS were targeted for FNB and their pathology evaluated. Patients were identified through database search from 2015 to 2022 and procedure information was obtained through a retrospective chart review from two large academic centers. Thirty-one patients with suspected serous cystadenoma who underwent EUS-FNB were included. EUS FNB was successful in obtaining diagnosis in 96.8% of patients. Serous cystadenoma was diagnosed via EUS FNB in 27 of 31 patients (87.1%). Of the remaining four patients, there was one invasive pancreatic ductal adenocarcinoma, one pancreatic neuroendocrine tumor, one intraductal papillary mucinous neoplasm, and one nondiagnostic sample. EUS-FNB sampling for histopathology is a safe and accurate diagnostic tool for pancreatic serous cystadenoma. When microcytic lesions are found on endoscopic ultrasound, our study results suggest that fine needle biopsy for histopathology should be considered as the initial diagnostic evaluation tool given the demonstrated improved diagnostic yield for serous cystadenoma.

Core-Needle Biopsy May Predict Prognosis Preoperatively in Parotid Cancer.

Salivary gland tumors are challenging to diagnose, and preoperative false-negative results often lead to unexpected malignancy diagnosis after parotidectomy. This study aimed to investigate the clinical utility of preoperative core needle biopsy (CNB) diagnosis in patients undergoing primary parotidectomy and its prognostic implications for parotid gland cancers. We conducted a retrospective cohort study involving 615 patients who underwent preoperative CNB and parotidectomy for primary parotid tumors from 2003 to 2023 at a tertiary referral hospital. Of these, 102 patients diagnosed with primary parotid malignancy post-parotidectomy were analyzed for survival outcomes. DFS and predictive factors were assessed through univariable and multivariable analyses. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CNB were calculated and compared to that of another cohort of 547 patients undergoing ultrasound-guided fine-needle aspiration (FNA) and parotidectomy during the same period. In the CNB group, the 5-year predicted DFS was 86.9% (95% CI, 79.2%-95.3%). Multivariable analysis identified male sex (HR, 8.48; 95% CI, 1.05-68.76) and "malignant on CNB" (HR, 8.20; 95% CI, 1.01-66.15) were significantly associated with decreased DFS. CNB demonstrated significantly higher sensitivity (89.0% [95% CI, 81.2%-94.4%]) and NPV (97.6% [95% CI, 95.7%-98.8%]) compared to FNA (sensitivity 45.2% [95% CI, 33.5%-57.3%]; NPV 90.8% [95% CI, 87.7%-93.3%]). Preoperative CNB may predict the prognosis of parotid cancer. Patients with a preoperative "malignant" diagnosis on CNB had a poorer prognosis compared to those with a "less-than-malignant" diagnosis. CNB also exhibited greater sensitivity than FNA in detecting parotid gland malignancies.

Transesophageal endosonography in the diagnosis of sarcoidosis: a narrative review.

Transesophageal endosonography, including endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA), has been applied to the diagnosis of benign as well as malignant diseases. This narrative review summarizes the recent use of EUS-(B)-FNA in diagnosing sarcoidosis. A comprehensive and systematic online literature search of PubMed was conducted using the keywords ("sarcoidosis"), and ("EUS" OR "EUS-FNA" OR "EUS-B" OR "EUS-B-FNA" OR "endoscopic ultrasound guided fine needle aspiration" OR "endoscopic ultrasound using the EBUS scope guided fine needle aspiration" OR "endoscopic ultrasound using the EBUS bronchoscope" OR "transesophageal" OR "transesophageal endoscopic ultrasound guided fine needle aspiration" OR "transesophageal bronchoscopic ultrasound guided fine needle aspiration"). Most EUS-FNA procedures were performed under moderate sedation, primarily using midazolam, with 22-gauge needles. The diagnostic sensitivity of sarcoidosis in mediastinal lymph node sampling is as high as 75-100% for EUS-FNA and 70-86% for EUS-B-FNA, much higher than that of traditional bronchoscopic procedures, such as transbronchial lung biopsy (TBLB) and conventional transbronchial needle aspiration (TBNA). The complications associated with EUS-(B)-FNA have thus far included only a few cases of mediastinitis, successfully treated with antibiotics, as well as lymph node hematoma, and sore throat. EUS-FNA and EUS-B-FNA provide high diagnostic yields in patients with sarcoidosis. The safety profile is acceptable, although there is a slight risk of infectious complications. EUS-B-FNA, a minimally invasive and well-tolerated procedure, offers a viable alternative to endobronchial ultrasound-guided TBNA (EBUS-TBNA) for the diagnosis of sarcoidosis, particularly in patients with cough and poor respiratory function; this procedure can easily be performed by pulmonologists.

Impact of endoscopic ultrasound-guided fine needle aspiration on positive peritoneal lavage cytology in patients with resectable pancreatic body and tail cancer.

A recent study has demonstrated that the timing of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) significantly influences the peritoneal lavage cytology (CY) outcomes in pancreatic body-tail cancer. The aim of this study was to clarify the impact of EUS-FNA on CY positivity in patients with resectable pancreatic body-tail cancer. Patients with anatomically resectable pancreatic body-tail cancer surgically resected at Hiroshima University Hospital were enrolled, and elated clinicopathological factors, including EUS-FNA variables and CY positivity rate, were analyzed. Of the 129 eligible patients, 16 (12%) had positive CY. The EUS-FNA rates of the CY-positive and CY-negative groups were not significantly different (63% vs. 52%, p = .440). Multivariate analysis revealed that lymph node metastasis was the only independent risk factor for CY positivity (odds ratio: 5.734, p = .031). A total of 10 (14%) of the 69 patients who underwent EUS-FNA had positive CY; however, needle specifications and the interval between EUS-FNA and CY examination did not differ between the CY-positive and CY-negative groups. CY positivity rates were comparable for intervals ≤14 days and ≥15 days (17% vs. 14%, p = 1.000). EUS-FNA may not affect CY positivity in patients with resectable pancreatic body-tail cancer, regardless of the timing.

Endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy in the diagnosis of gastrointestinal lymphomas.

The role of endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy (EUS-FNA/B) in the clinical management of gastrointestinal lymphoma has not been extensively studied. This study investigates the use of EUS-FNA/B in the diagnosis of first-time and recurrent gastrointestinal lymphomas at a large academic institution. A total of 40 patients who had final diagnosis of lymphoma according to the World Health Organization (WHO) classification of tumors of hematopoietic lymphoid tissues who underwent EUS-FNA/B were included in the study. Cases with concurrent forceps mucosal biopsies or lost to clinical follow-up were excluded. The diagnostic accuracy and clinical use of EUS-FNA/B was investigated by comparing EUS-FNA/B diagnosis with the final diagnosis. EUS-FNA/B diagnoses were concordant with the final WHO diagnosis for as high as 72.5% of the cases. Of the remaining 27.5%, 17.5% had enough cytologic features for lymphoma diagnosis with incomplete phenotyping, while the remaining 10.0% showed features suspicious for lymphoma. Cell block and flow cytometry quality significantly affected diagnostic accuracy. Number of passes between 1 and 5 yielded better diagnostic accuracy than 6 or more passes during FNA; however, no difference was identified during procedures that used FNB alone or combined with FNA. There is no significant difference in onsite adequacy diagnostic performance of EUS-FNA performed by cytopathologists or cytotechnologists. EUS-FNA/B with concurrent ancillary studies such as immunocytochemistry in cell block and flow cytometry can be helpful in efficient first and recurrent diagnoses of gastrointestinal lymphomas.

A case of malignant lymphoma of the extrahepatic bile duct diagnosed by detailed imaging examination and endoscopic ultrasound-guided fine needle aspiration.

A 70-year-old woman presented to our hospital with abdominal pain. Imaging examinations showed diffuse and extensive wall thickening at the perihilar bile duct; however, the degree of stricture was mild, and the mucosal epithelium was smooth. A transpapillary biopsy was performed considering cholangiocarcinoma and IgG4 sclerosing cholangitis as differential diagnoses; however, no pathologic diagnosis was obtained. Peroral cholangioscopy revealed a regular epithelium at the stricture, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the enlarged lymph node confirmed the diagnosis of diffuse large B-cell lymphoma. Multiagent chemotherapy was administered, which led to complete remission. Because primary bile duct malignant lymphomas are rare and specific, clinical, and imaging findings are lacking, and many of those reported so far have been diagnosed by postoperative pathology. As chemotherapy is the first-line treatment for malignant lymphoma, obtaining an accurate diagnosis is crucial. Our findings support that smooth and mild biliary strictures with mainly submucosal wall thickening may be characteristic imaging findings of primary bile duct malignant lymphoma, and that peroral cholangioscopy and EUS-FNA may be helpful for an accurate diagnosis.

Peripancreatic Head Paraganglioma Versus Neuroendocrine Tumor: A Roller Coaster Diagnostic Dilemma in Fine Needle Aspiration Cytology Requiring a Note That “A Definite Diagnosis Cannot Be Concluded”

Cytologic diagnosis of extra-adrenal paraganglioma presenting as a peripancreatic mass is challenging, with a high rate of diagnostic error. We present a case of a peripancreatic mass identified by radiology as a gastrointestinal stromal tumor. Endoscopic ultrasound-guided fine-needle aspiration (FNA) of the mass showed a moderately cellular tumor composed of small-to-medium-sized neoplastic cells with round-to-oval nuclei arranged singly and in loose clusters. The cells were positive for neuroendocrine markers (synaptophysin and chromogranin) and negative for CD117. A diagnosis of neoplasm with a neuroendocrine tumor (NET) was made based on FNA cytology. The subsequent surgical resection of the tumor revealed peripancreatic paraganglioma with immunohistochemistry positive for synaptophysin, chromogranin, and S100. The latter delineated the sustentacular cells. Although paraganglioma is a well-recognized tumor, a detailed comparison of peripancreatic paraganglioma versus pancreatic/gastrointestinal NET is still lacking.

Abstract A024: Tissue biomarkers in the tumor microenvironment predicting the development of cachexia in pancreatic cancer patients

Abstract Pancreatic ductal adenocarcinoma (PDAC) poses significant challenges due to its aggressive nature and the limited efficacy of existing treatments. The complex interactions within the tumor microenvironment (TME) and tumor cell itself remain poorly understood, particularly in relation to cancer cachexia, which is characterized by weight loss, muscle wasting, systemic inflammation, and metabolic disturbances, and has a profound impact on PDAC outcomes. This study investigated the role of the TME in the development of cachexia in PDAC patients, focusing on the potential of cachexia-related proteins as tissue biomarkers in the TME. In this retrospective study, tissue samples from 13 PDAC patients obtained via Endoscopic Ultrasound-Guided Fine Needle Aspiration at the time of diagnosis were analyzed using immunofluorescence staining, supplemented by epidemiological data. The initial classification of cachexia based on epidemiological data, including patients body mass index and three-month weight changes, was further refined through body composition trend analysis during 180 days after the diagnosis with consecutive computed tomography images. These detailed classification criteria allowed for a more realistic classification of cachexia compared to the conventional classification of cachexia based on weight change, resulting in 5 patients being classified as cachexia and 8 as non-cachexia. We selected NAMPT (nicotinamide phosphoribosyl transferase) as a candidate tissue biomarker, a rate-limiting enzyme crucial in the NAD+ salvage pathway, due to its significant role in cellular metabolism, and the regulation of energy depletion and consumption in muscle cells. We hypothesized that NAMPT is closely linked to the mechanisms of cachexia because NAD+ is essential for muscle regeneration. Additionally, PTHLH (Parathyroid Hormone-Like Hormone), selected as another candidate marker, plays a critical role by being secreted from tumor cells, promoting cancer cell growth and metastasis. The overexpression of PTHLH can lead to malignant hypercalcemia, which may trigger severe systemic inflammatory responses in cancer patients, contributing to the development of cachexia. We utilized the coordinated expression of these two proteins as potential tissue biomarkers predicting cachexia at the time of diagnosis of PDAC. In our study, PTHLH expression was significantly elevated in the cachexia group, while NAMPT expression was higher in the non- cachexia group. Although both markers are known to be overexpressed in most metastatic pancreatic cancers, their correlations vary depending on the presence of cachexia. These findings suggest that even in metastatic pancreatic cancer, these markers can serve as precise biomarker signatures that determine the possibility of developing cachexia. To further validate our findings, we are currently testing a larger validation set (cachectic PDAC patients=100, non-cachectic PDAC patients=100) to determine whether the expression of these two markers can be utilized as biomarkers for the early detection of cachexia. Citation Format: Hyun Jung Kee, Jinhee Lee, Ju Young Bae, Hia Jung, Jeehoon Kim, Galam Leem, Hee Seung Lee, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Moon Jae Chung. Tissue biomarkers in the tumor microenvironment predicting the development of cachexia in pancreatic cancer patients [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A024.

Dysphagia Caused by Submucosal Tumor-Like Esophageal Cancer: Two Case Reports.

Esophageal squamous cell carcinoma is an aggressive and globally prevalent malignancy that rarely presents as submucosal tumor-like lesions, leading to significant diagnostic challenges. We present two examples of primary esophageal squamous cell carcinoma in which complete intramural invasion mimicked submucosal tumor-like lesions. Initial biopsies suggested benign hyperplasia; however, subsequent endoscopic ultrasound-guided fine needle aspiration confirmed the diagnosis of esophageal squamous cell carcinoma. Both patients received appropriate treatment and showed favorable outcomes. The histopathological feature of intramural esophageal squamous cell carcinoma, characterized by growth confined within the esophageal wall without mucosal epithelial invasion, represents an exceedingly rare and complex pattern. The diagnostic challenges presented by this form of esophageal squamous cell carcinoma highlight the critical role of detailed histopathological examination, with endoscopic ultrasound-guided fine needle aspiration being indispensable for accurate diagnosis and effective management of submucosal tumor-like lesions.

Diagnostic dilemma: a collision of pancreatic neuroendocrine tumor G3 and adenocarcinoma with extensive fibrosis.

An 82-year-old man presented with intermittent abdominal pain and elevated liver enzymes. Blood tests showed normal levels of tumor markers (CEA, CA19-9, NSE). Contrast-enhanced computed tomography (CE-CT) revealed a 20mm hypovascular mass in the pancreatic head. Magnetic resonance imaging indicated low intensity on both T1- and T2-weighted images and high intensity on diffusion-weighted images. Endoscopic ultrasonography visualized an irregular hypoechoic mass. Initially, it was diagnosed as pancreatic ductal adenocarcinoma (PDAC) based on imaging. Subsequent histopathological analysis via endoscopic ultrasound-guided fine-needle aspiration revealed a neuroendocrine tumor (NET). The preoperative diagnosis was changed to a pancreatic NET grade1. Consequently, a pancreaticoduodenectomy was performed. Histopathological examination of the resected specimen unveiled a mixed tumor-NET-Grade1/Grade3 and invasive PDAC. No clear transition between the NETs and PDAC was observed. The high grade of NET with significant fibrosis contributed to decreased enhancement of CE-CT. Finally, we diagnosed this case as a pancreatic collision tumor involving both NET and PDAC components, with lymph node metastases attributed to the NET components. In this case, achieving an accurate preoperative diagnosis was challenging despite utilizing both imaging and biopsy diagnostics. This unique case underscores the difficulties encountered in the preoperative assessment of mixed tumors.

Contrast-Enhanced Ultrasound for Diagnosing Thyroid Nodules With Indeterminate Cytology: A Retrospective Study.

A small number of thyroid nodules cannot be clearly diagnosed using ultrasound-guided fine needle aspiration biopsy. Contrast-enhanced ultrasound (CEUS) has high diagnostic performance for thyroid nodules. We explored the value of CEUS for diagnosing thyroid nodules with indeterminate cytology. Between September 2019 and July 2022, 27,646 patients with thyroid nodule(s) underwent conventional ultrasound (CUS) in our hospital. From these patients, 597 nodules were subjected to CEUS and ultrasound-guided fine needle aspiration biopsy and 116 thyroid nodules with indeterminate cytology diagnose were enrolled in this study. The independent risk factors for predicting malignancy were determined using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were drawn for CUS, CEUS, and CEUS combined with CUS. The area under the curve (AUC) was calculated and compared. Of the 116 thyroid nodules, 40 (34.5%) were benign and 76 (65.5%) were malignant. Univariate analysis showed that the shape, echogenicity, margin, microcalcification, enhancement intensity, enhancement homogeneity, wash in, and wash out were significantly different between benign and malignant thyroid nodules (all p < 0.05). Multivariate logistic regression analysis showed that taller-than-wide, irregular margin, microcalcification, hypo-enhancement, heterogeneity enhancement, synchronous/slower wash in, and synchronous/slower wash out were independent risk factors for malignancy (all p < 0.05). ROC curve analysis showed that the AUC of CUS and CEUS were 0.769 and 0.848, respectively. No significant difference was observed in the AUC between the two modalities (p > 0.05). However, the AUC (0.934) of the CUS combined with CEUS was significantly higher than that of CEUS or CUS alone (both p < 0.05). CEUS is helpful in diagnosing thyroid nodules with indeterminate cytology. CUS combined with CEUS is highly valuable for predicting malignancy.

Multi-site Ultrasound-guided Fine Needle Aspiration to Study Cells and Soluble Factors From Human Lymph Nodes.

Lymph nodes (LNs) are specialized secondary lymphoid tissues essential to the priming and maintenance of adaptive immune responses, including the B cell germinal center response; thus, they are central to immunity. However, the anatomically restricted and time-resolved nature of immune priming means that sampling disease-relevant human LNs requires specialized techniques. This article describes the application of ultrasound-guided fine-needle aspiration (FNA) to sample LNs, using cervical LNs of the head and neck as an exemplar. This minimally invasive technique allows collection of both immune cells and cell-free material that are relevant to both neuroimmune diseases and basic lymphatic functions. Downstream use of cellular material can include multiplexed flow cytometry, single-cell transcriptome sequencing (RNA-seq), and B cell cultures. The cell-free supernatant can be used for proteomics or other similar 'omics approaches. This unit describes collection of samples by FNA as well as processing and storage of samples for downstream assays. © 2024 The Author(s). Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Sampling of human cervical lymph nodes by ultrasound-guided fine-needle aspiration Alternate Protocol: Sampling of human lymph nodes by ultrasound-guided fine-needle aspiration with negative pressure Basic Protocol 2: Processing and storage of human lymph node samples.

Primary Adrenal Neuroblastoma in an Adult: A Rare Case Report

ABSTRACT Neuroblastoma (NB), an embryonal malignancy originating from neural crest cells, is predominantly a pediatric disease, making adult cases exceedingly rare. This case report documents the presentation and diagnostic process of a 23-year-old female diagnosed with adrenal NB, a condition scarcely encountered in adults. The patient presented with abdominal pain and a palpable mass. Imaging through computed tomography scan revealed a large necrotic mass in the left adrenal region. Ultrasound-guided fine-needle aspiration cytology (FNAC) showed round cells with scant cytoplasm and characteristic nuclear features, suggesting a round cell tumor, potentially NB. Surgical excision confirmed the diagnosis of poorly differentiated NB with low mitotic-karyorrhectic index. Adult NB, with an incidence of 1 in 10 million per year, has a notably worse prognosis compared to pediatric cases. The literature lacks consensus on optimal treatment protocols for adult patients, though a multimodal approach including surgery, chemotherapy, and possibly radioactive iodine therapy is often employed. This case underscores the utility of FNAC in preliminary diagnosis and highlights the clinical challenges posed by adult NB, emphasizing the need for more comprehensive studies to develop standardized treatment guidelines.