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Facciorusso A, Arvanitakis M, Crinò SF, Fabbri C, Fornelli A, Leeds J, Archibugi L, Carrara S, Dhar J, Gkolfakis P, Haugk B, Iglesias Garcia J, Napoleon B, Papanikolaou IS, Seicean A, Stassen PMC, Vilmann P, Tham TC, Fuccio L. Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review. Endoscopy 2025; 57:390-418. [PMID: 40015316 DOI: 10.1055/a-2524-2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
This Technical and Technology Review from the European Society of Gastrointestinal Endoscopy (ESGE) represents an update of the previous document on the technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including the available types of needle, technical aspects of tissue sampling, new devices, and specimen handling and processing. Among the most important new recommendations are:ESGE recommends end-cutting fine-needle biopsy (FNB) needles over reverse-bevel FNB or fine-needle aspiration (FNA) needles for tissue sampling of solid pancreatic lesions; FNA may still have a role when rapid on-site evaluation (ROSE) is available.ESGE recommends EUS-FNB or mucosal incision-assisted biopsy (MIAB) equally for tissue sampling of subepithelial lesions ≥20 mm in size. MIAB could represent the first choice for smaller lesions (<20 mm) if proper expertise is available.ESGE does not recommend the use of antibiotic prophylaxis before EUS-guided tissue sampling of solid masses and EUS-FNA of pancreatic cystic lesions.
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Affiliation(s)
- Antonio Facciorusso
- Department of Experimental Medicine, Section of Gastroenterology, University of Salento, Lecce, Italy
| | - Marianna Arvanitakis
- Department of Gastroenterology, Digestive Oncology and Hepatopancreatology, HUB Hôpital Erasme, Brussels, Belgium
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Adele Fornelli
- Pathology Unit, Ospedale Maggiore "C.A. Pizzardi", AUSL Bologna, Bologna, Italy
| | - John Leeds
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Livia Archibugi
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Carrara
- Department of Biomedical Sciences, Humanitas Pieve Emanuele University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jahnvi Dhar
- Department of Gastroenterology and Hepatology, Punjab Institute of Liver and Biliary Sciences, Mohali, India
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece
| | - Beate Haugk
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Julio Iglesias Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago, Spain
| | - Bertrand Napoleon
- Department of Gastroenterology, Hôpital privé Jean Mermoz, Lyon, France
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodastrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Andrada Seicean
- Department of Gastroenterology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Pauline M C Stassen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Peter Vilmann
- Gastroenterology Unit, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Belfast, Northern Ireland
| | - Lorenzo Fuccio
- Department of Medical Sciences and Surgery, University of Bologna, Bologna, Italy
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Mo S, Yi N, Qin F, Zhao H, Wang Y, Qin H, Wei H, Jiang H, Qin S. EUS-based intratumoral and peritumoral machine learning radiomics analysis for distinguishing pancreatic neuroendocrine tumors from pancreatic cancer. Front Oncol 2025; 15:1442209. [PMID: 40104505 PMCID: PMC11913666 DOI: 10.3389/fonc.2025.1442209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 02/03/2025] [Indexed: 03/20/2025] Open
Abstract
Objectives This study aimed to develop and validate intratumoral, peritumoral, and combined radiomic models based on endoscopic ultrasonography (EUS) for retrospectively differentiating pancreatic neuroendocrine tumors (PNETs) from pancreatic cancer. Methods A total of 257 patients, including 151 with pancreatic cancer and 106 with PNETs, were retroactively enrolled after confirmation through pathological examination. These patients were randomized to either the training or test cohort in a ratio of 7:3. Radiomic features were extracted from the intratumoral and peritumoral regions from conventional EUS images. Following this, the radiomic features underwent dimensionality reduction through the utilization of the least absolute shrinkage and selection operator (LASSO) algorithm. Six machine learning algorithms were utilized to train prediction models employing features with nonzero coefficients. The optimum intratumoral radiomic model was identified and subsequently employed for further analysis. Furthermore, a combined radiomic model integrating both intratumoral and peritumoral radiomic features was established and assessed based on the same machine learning algorithm. Finally, a nomogram was constructed, integrating clinical signature and combined radiomics model. Results 107 radiomic features were extracted from EUS and only those with nonzero coefficients were kept. Among the six radiomic models, the support vector machine (SVM) model had the highest performance with AUCs of 0.853 in the training cohort and 0.755 in the test cohort. A peritumoral radiomic model was developed and assessed, achieving an AUC of 0.841 in the training and 0.785 in the test cohorts. The amalgamated model, incorporating intratumoral and peritumoral radiomic features, exhibited superior predictive accuracy in both the training (AUC=0.861) and test (AUC=0.822) cohorts. These findings were validated using the Delong test. The calibration and decision curve analyses (DCA) of the combined radiomic model displayed exceptional accuracy and provided the greatest net benefit for clinical decision-making when compared to other models. Finally, the nomogram also achieved an excellent performance. Conclusions An efficient and accurate EUS-based radiomic model incorporating intratumoral and peritumoral radiomic features was proposed and validated to accurately distinguish PNETs from pancreatic cancer. This research has the potential to offer novel perspectives on enhancing the clinical utility of EUS in the prediction of PNETs.
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Affiliation(s)
- Shuangyang Mo
- Gastroenterology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Gastroenterology Department/Clinical Nutrition Department, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Nan Yi
- Gastroenterology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengyan Qin
- Gastroenterology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huaying Zhao
- Gastroenterology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Gastroenterology Department/Clinical Nutrition Department, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Yingwei Wang
- Gastroenterology Department/Clinical Nutrition Department, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Haiyan Qin
- Gastroenterology Department/Clinical Nutrition Department, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Haixiao Wei
- Gastroenterology Department/Clinical Nutrition Department, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Haixing Jiang
- Gastroenterology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shanyu Qin
- Gastroenterology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Dhar J, Samanta J, Nabi Z, Aggarwal M, Conti Bellocchi MC, Facciorusso A, Frulloni L, Crinò SF. Endoscopic Ultrasound-Guided Pancreatic Tissue Sampling: Lesion Assessment, Needles, and Techniques. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2021. [PMID: 39768901 PMCID: PMC11727853 DOI: 10.3390/medicina60122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/15/2024] [Accepted: 12/03/2024] [Indexed: 01/12/2025]
Abstract
Endoscopic ultrasound (EUS)-guided tissue sampling includes the techniques of fine needle aspiration (FNA) and fine needle biopsy (FNB), and both procedures have revolutionized specimen collection from the gastrointestinal tract, especially from remote/inaccessible organs. EUS-FNB has replaced FNA as the procedure of choice for tissue acquisition in solid pancreatic lesions (SPLs) across various society guidelines. FNB specimens provide a larger histological tissue core (preserving tissue architecture) with fewer needle passes, and this is extremely relevant in today's era of precision and personalized molecular medicine. Innovations in needle tip design are constantly under development to maximize diagnostic accuracy by enhancing histological sampling capabilities. But, apart from the basic framework of the needle, various other factors play a role that influence diagnostic outcomes, namely, sampling techniques (fanning, aspiration or suction, and number of passes), collection methods, on-site evaluation (rapid, macroscopic, or visual), and specimen processing. The choice taken depends strongly on the endoscopist's preference, available resources at the disposal, and procedure objectives. Hence, in this review, we explicate in detail the concepts and available literature at our disposal on the topic of EUS-guided pancreatic tissue sampling to best guide any practicing gastroenterologist/endoscopist in a not-to-ideal set-up, which EUS-guided tissue acquisition technique is the "best" for their case to augment their diagnostic outcomes.
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Affiliation(s)
- Jahnvi Dhar
- Department of Gastroenterology, Adesh Medical College and Hospital, Kurukshetra 136134, India;
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | - Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India;
| | - Manik Aggarwal
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Maria Cristina Conti Bellocchi
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (L.F.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
- Clinical Effectiveness Research Group, Faculty of Medicine, Institute of Health and Society, University of Oslo, 0372 Oslo, Norway
| | - Luca Frulloni
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (L.F.)
| | - Stefano Francesco Crinò
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (L.F.)
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Crinò SF, Zorzi A, Tavian P, De Pretis N, Facciorusso A, Dhar J, Samanta J, Sina S, Manfrin E, Frulloni L, Conti Bellocchi MC. Same versus separate sessions of endoscopic ultrasound-guided fine-needle biopsy and endoscopic retrograde cholangiopancreatography for distal malignant biliary obstruction: a propensity score-matched study. Expert Rev Gastroenterol Hepatol 2024; 18:551-559. [PMID: 39222013 DOI: 10.1080/17474124.2024.2399176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Same-session endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) is an attractive policy for patients with distal malignant biliary obstruction (DMBO) requiring fine-needle biopsy (FNB) and biliary drainage. However, scanty and conflicting data exists regarding safety and efficacy when comparing these two procedures performed in same versus separate sessions. METHODS Single-center, retrospective, propensity score-matched study including patients with DMBO who underwent EUS-FNB followed by ERCP during the same or separate sessions. The primary outcome was the safety of the procedure [number of patients experiencing adverse events (AEs), overall AEs, its severity, post-ERCP pancreatitis (PEP)]. Secondary outcomes were successful ERCP, use of advanced cannulation techniques, EUS-FNB adequacy, length of hospital stay, overall procedure time, and time to recurrent biliary obstruction. RESULTS After propensity matching, 87 patients were allocated to each group. AEs developed in 23 (26.4%) vs. 17 (19.5%) patients in the same and separate sessions group, respectively (p = 0.280). The overall number, the severity of AEs, and the rate of PEP were similar in the two groups. Secondary outcome parameters were also comparable in the 2 groups. CONCLUSIONS Same-session EUS-FNB followed by ERCP with biliary drainage is safe and does not impair technical outcomes of tissue adequacy and biliary cannulation.
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Affiliation(s)
- Stefano Francesco Crinò
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Alberto Zorzi
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Piero Tavian
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Nicolò De Pretis
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Antonio Facciorusso
- Department Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sokol Sina
- Department of Pathology and Diagnostics, University Hospital of Verona, Verona, Italy
| | - Erminia Manfrin
- Department of Pathology and Diagnostics, University Hospital of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Maria Cristina Conti Bellocchi
- Department of Medicine, Diagnostic and Interventional Endoscopy of the Pancreas, The Pancreas Institute, University Hospital of Verona, Verona, Italy
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Mastrosimini MG, Manfrin E, Remo A, De Bellis M, Parisi A, Pedron S, Luchini C, Brunelli M, Ammendola S, Bernardoni L, Conti Bellocchi MC, Gabbrielli A, Facciorusso A, Pea A, Landoni L, Scarpa A, Crinò SF. Endoscopic ultrasound fine-needle biopsy to assess DAXX/ATRX expression and alternative lengthening of telomeres status in non-functional pancreatic neuroendocrine tumors. Pancreatology 2023; 23:429-436. [PMID: 37169669 DOI: 10.1016/j.pan.2023.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/02/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND/OBJECTIVES Death domain-associated protein (DAXX) and/or α-thalassemia/mental retardation X-linked (ATRX) chromatin remodeling genes mutations and alternative lengthening of telomeres (ALT) activation are associated with more aggressive behavior of non-functional pancreatic neuroendocrine tumors (NF-PanNETs). We aimed to evaluate the reliability of such markers on endoscopic-ultrasound fine-needle biopsy (EUS-FNB) specimens. METHODS Patients who underwent EUS-FNB and subsequent surgical resection for PanNETs between January 2017 and December 2019 were retrospectively identified. Immunohistochemistry (IHC) to evaluate DAXX/ATRX expression and fluorescence in situ hybridization (FISH) for ALT status were performed. Primary outcome was the concordance rate of markers expression between EUS-FNB and surgical specimens. Secondary aims were association between markers and lesion aggressiveness, their diagnostic performance in predicting aggressiveness, and agreement of preoperative and post-surgical Ki67-based grading. RESULTS Forty-one NF-PanNETs (mean diameter 36.1 ± 26.5 mm) were included. Twenty-four showed features of lesion aggressiveness. Concordance of expressions of DAXX, ATRX, and ALT status between EUS-FNB and surgical specimens were 95.1% (κ = 0.828; p < 0.001), 92.7% (κ = 0.626; p < 0.001), and 100% (κ = 1; p < 0.001), respectively. DAXX/ATRX loss and ALT-positivity were significantly (p < 0.05) associated with metastatic lymphnodes and lymphovascular invasion. The combination of all tumor markers (DAXX/ATRX loss + ALT-positivity + grade 2) reached an accuracy of 73.2% (95%CI 57.1-85.8) in identifying aggressive lesions. Pre- and post-operative ki-67-based grading was concordant in 80.5% of cases (k = 0.573; p < 0.001). CONCLUSION DAXX/ATRX expression and ALT status can be accurately evaluated in a preoperative setting on EUS-FNB samples, potentially improving the identification of patients with increased risk and poorer prognosis.
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Affiliation(s)
- Maria Gaia Mastrosimini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Andrea Remo
- Department of Pathology, ULSS9 "Scaligera", Verona, Italy
| | - Mario De Bellis
- Department of Surgery, Division of General and HPB Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Alice Parisi
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Serena Pedron
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Serena Ammendola
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Laura Bernardoni
- Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | | | - Armando Gabbrielli
- Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
| | - Antonio Pea
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy; ARC-NET Applied Research on Cancer Centre, University of Verona, Verona, Italy
| | - Stefano Francesco Crinò
- Digestive Endoscopy Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
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Wu B, Bai Y, Yu S, Li X, Wu X. Endoscopic pancreatic duct stenting combined with 3D laparoscopic pancreatic tumor resection: Three case reports. Medicine (Baltimore) 2023; 102:e33733. [PMID: 37171331 PMCID: PMC10174417 DOI: 10.1097/md.0000000000033733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/21/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
RATIONALE This study explored the safety and feasibility of 3D laparoscopy and intraoperative ultrasound techniques, which made minimally invasive pancreatic surgery more precise and detailed. PATIENT CONCERN Case 1 was a 51-year-old man with a primary complaint of pancreatic tumor. Case 2 was a 60-year-old woman with complaints of tinnitus for 1 week. Case 3 was a 21-year-old woman with complaints of epigastric pain and abdominal distension for 1 day. DIAGNOSIS Case 1 and Case 2 were diagnosed with pancreatic neuroendocrine tumors, and Case 3 was diagnosed with an infected solid pseudopapillary tumor of the pancreas. INTERVENTIONS All 3 patients underwent laparoscopic pancreatic surgery in our hospital. OUTCOMES All cases received the same perioperative management and no localized stenosis or dilatation of the pancreatic duct was found during follow-up. LESSONS With the development of minimally invasive surgery and the application of 3D laparoscopy and intraoperative ultrasound technology, pancreatic tumors that are tightly adhered to the main pancreatic duct can successfully be removed using 3D laparoscopic operation.
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Affiliation(s)
- Bo Wu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, PR China
| | - Yang Bai
- Department of Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Shi’an Yu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, PR China
| | - Xuemin Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, PR China
| | - Xiaokang Wu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, PR China
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Facciorusso A, Chandan S, Gkolfakis P, Ramai D, Mohan BP, Lisotti A, Conti Bellocchi MC, Papanikolaou IS, Mangiavillano B, Triantafyllou K, Manthopoulou E, Mare R, Fusaroli P, Crinò SF. Do Biliary Stents Affect EUS-Guided Tissue Acquisition (EUS-TA) in Solid Pancreatic Lesions Determining Biliary Obstruction? A Literature Review with Meta-Analysis. Cancers (Basel) 2023; 15:1789. [PMID: 36980675 PMCID: PMC10046620 DOI: 10.3390/cancers15061789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
There is a paucity of evidence regarding whether biliary stents influence endoscopic ultrasound-guided tissue acquisition using either fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA), among patients with head of pancreas (HOP) lesions. We aimed at assessing the diagnostic accuracy of endoscopic ultrasound-guided tissue sampling in patients with or without bile duct stents. A total of seven studies with 2458 patients were included. The main aim was to assess overall pooled diagnostic accuracy. A pairwise meta-analysis was performed using a random effects model. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). We found that pooled accuracy was 85.4% (CI 78.8-91.9) and 88.1% (CI 83.3-92.9) in patients with and without stents, respectively. There was no statistically significant difference between the two (OR 0.74; p = 0.07). Furthermore, patients with metal stents demonstrated a significant difference (OR 0.54, 0.17-0.97; p = 0.05), which was not seen with plastic stents. EUS-FNB showed poorer diagnostic accuracy with concurrent biliary stenting (OR 0.64, 0.43-0.95; p = 0.03); however, the same was not observed with EUS-FNA. Compared to plastic stents, metal biliary stenting further impacted the diagnostic accuracy of EUS-guided tissue acquisition for pancreatic head lesions. There was no difference in the rate of procedure-related adverse events between the stent and no-stent groups.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Saurabh Chandan
- Gastroenterology Unit, CHI Health Creighton University Medical Center, Omaha, NE 68007, USA
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 801385, USA
| | - Babu P. Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 801385, USA
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, 40026 Imola, Italy
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37100 Verona, Italy
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 10431 Athens, Greece
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Via Gerenzano 2, 21053 Castellanza, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 10431 Athens, Greece
| | - Eleni Manthopoulou
- Department of Gastroenterology, St. Savvas Oncology Hospital of Athens, 10431 Athens, Greece
| | - Ruxandra Mare
- Gastroenterology Unit, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, 300226 Timisoara, Romania
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, 40026 Imola, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37100 Verona, Italy
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Wang GC, Huang GJ, Zhang CQ, Ding Q. Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm: A case report. World J Gastroenterol 2023; 29:1235-1242. [PMID: 36926671 PMCID: PMC10011950 DOI: 10.3748/wjg.v29.i7.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Pancreatic neuroendocrine neoplasms (PNENs) are a rare group of neoplasms originating from the islets of the Langerhans. Portal vein tumor thrombosis has been reported in 33% of patients with PNENs. While the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), these approaches may be impeded by gastric varices, poor access windows, or anatomically contiguous critical structures. Obtaining a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been reported.
CASE SUMMARY A 72-year-old man was referred to our hospital for abdominal pain and melena. Abdominal contrast-enhanced magnetic resonance imaging revealed a well-enhanced tumor (size: 2.4 cm × 1.2 cm × 1.2 cm) in the pancreatic tail with portal vein invasion. Traditional pathological diagnosis via EUS-FNA was not possible because of diffuse gastric varices. We performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy forceps. Histopathologic examination revealed a pancreatic neuroendocrine neoplasm (G2) with somatostatin receptors 2 (+), allowing systemic treatment.
CONCLUSION Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological diagnosis. Although well-designed clinic trials are required to obtain more definitive evidence, this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.
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Affiliation(s)
- Guang-Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Guang-Jun Huang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Qian Ding
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Pallio S, Crinò SF, Maida M, Sinagra E, Tripodi VF, Facciorusso A, Ofosu A, Conti Bellocchi MC, Shahini E, Melita G. Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours. Cancers (Basel) 2023; 15:1285. [PMID: 36831627 PMCID: PMC9954263 DOI: 10.3390/cancers15041285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Gastrointestinal Stromal Tumors (GISTs) are subepithelial lesions (SELs) that commonly develop in the gastrointestinal tract. GISTs, unlike other SELs, can exhibit malignant behavior, so differential diagnosis is critical to the decision-making process. Endoscopic ultrasound (EUS) is considered the most accurate imaging method for diagnosing and differentiating SELs in the gastrointestinal tract by assessing the lesions precisely and evaluating their malignant risk. Due to their overlapping imaging characteristics, endosonographers may have difficulty distinguishing GISTs from other SELs using conventional EUS alone, and the collection of tissue samples from these lesions may be technically challenging. Even though it appears to be less effective in the case of smaller lesions, histology is now the gold standard for achieving a final diagnosis and avoiding unnecessary and invasive treatment for benign SELs. The use of enhanced EUS modalities and elastography has improved the diagnostic ability of EUS. Furthermore, recent advancements in artificial intelligence systems that use EUS images have allowed them to distinguish GISTs from other SELs, thereby improving their diagnostic accuracy.
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Affiliation(s)
- Socrate Pallio
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | | | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45201, USA
| | | | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology—IRCCS “Saverio de Bellis” Castellana Grotte, 70013 Castellana Grotte, Italy
| | - Giuseppinella Melita
- Human Pathology of Adult and Child Department, University of Messina, 98100 Messina, Italy
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10
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Armellini E, Facciorusso A, Crinò SF. Efficacy and Safety of Endoscopic Ultrasound-Guided Radiofrequency Ablation for Pancreatic Neuroendocrine Tumors: A Systematic Review and Metanalysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:359. [PMID: 36837560 PMCID: PMC9963038 DOI: 10.3390/medicina59020359] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
Introduction: The development of dedicated endoscopes and the technical evolution of endoscopic ultrasound (EUS) have allowed a direct approach to pancreatic neoplastic lesions both for diagnosis and treatment. Among the more promising targets are pancreatic neuroendocrine tumors (Pan-NETs). Aim: to describe the evolution of endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) with particular attention to the treatment of PanNETs, focusing on safety and clinical efficacy of the technique. Methods: MEDLINE, Scopus, and Cochrane Library databases were searched for studies reporting about EUS-RFA for the treatment of PanNETs. Studies with outcomes of interest were selected and results were reported to describe clinical success, complications, fol-low-ups, and electrodes used. Clinical success was defined as the disappearance of clinical symp-toms for functional (F-) PanNETs and as complete ablation per nonfunctional (NF)-PanNETs. The pooled data were analyzed by a random-effects model. Results: Nineteen studies were selected, including 183 patients (82 males, 44.8%) with 196 lesions (101 F-PanNETs and 95 NF-PanNETs). Pooled estimates for the overall AE rates for the clinical efficacy were 17.8% (95% CI 9.1-26.4%) and 95.1% (95% CI 91.2-98.9%) for F-PanNETs and 24.6% (95% CI 7.4-41.8%) and 93.4% (95% CI 88.4-98.4%) for NF-PanNETs. Conclusions: EUS-RFA appears to be a mini-invasive technique with a good safety and efficacy profile for the treatment of F- and NF-PanNETs. EUS-RFA could be of-fered as possible alternative to surgery for the treatment of low-grade NF- or F-PanNETs, especially for those patients that are not eligible or are at high-risk for surgery.
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Affiliation(s)
- Elia Armellini
- Gastroenterology Unit, Asst-Bergamoest, 24068 Bergamo, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
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Auriemma F, Dabizzi E, Facciorusso A, Carrara S, de Nucci G, Manes G, Lamonaca L, Paduano D, Ofosu A, Crinò SF, Repici A, Mangiavillano B. The role of rectal endoscopic ultrasonography plus fine needle aspirartion and fine needle biopsy in pelvic masses. Eur J Gastroenterol Hepatol 2023; 35:153-158. [PMID: 36574305 DOI: 10.1097/meg.0000000000002468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM The diagnostic role of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) and fine needle biopsy (FNB) of pelvic masses has not been well established. We aimed to evaluate the diagnostic accuracy of EUS plus FNA/FNB in suspected local recurrence of pelvic masses. MATERIALS AND METHODS All consecutive patients with a history of lower gastrointestinal and pelvic mass undergone EUS-FNA/FNB were included in the study. RESULTS In total 34 patients who underwent EUS-guided FNA or FNB of a perirectal mass were enrolled. The sampled lesion was a mass in 22 patients (64.7%) and a lymph node in 10 patients (29.4%). The univariate logistic regression analysis for diagnostic accuracy showed lesion size as a significant predictor of diagnostic accuracy [odds ratio (OR), 1.61; 1.08-2.27; P = 0.02]. Diagnostic sensitivity was 100% (71.5-100%) with EUS-FNB and 75% (34.9-96.8%) with EUS-FNA ( P = 0.12); specificity was 100% in both groups ( P = 1.0). Sample adequacy was 94.1% in the whole cohort, with 20/20 adequacy rate (100%) in the EUS-FNB group and 12/14 (85.7%) in the EUS-FNA group ( P = 0.28). CONCLUSION This is the first study demonstrating the diagnostic yield of EUS plus FNA/FNB in patients with pelvic masses comparing the two needles. Our results highlight the relevance of this technique, especially in undefined masses during oncological follow-up.
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Affiliation(s)
- Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA)
| | - Emanuele Dabizzi
- Unit of Gastroenterology and Operative Digestive Endoscopy, Bellaria Maggiore Hospital, AUSL Bologna, Bologna
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS - Humanitas Research Hospital, Via Manzoni, Rozzano
| | - Germana de Nucci
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Giampiero Manes
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA)
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA)
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS - Humanitas Research Hospital, Via Manzoni, Rozzano
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA)
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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12
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Mangiavillano B, Crinò SF, Facciorusso A, Di Matteo F, Barbera C, Larghi A, Rizzatti G, Carrara S, Spadaccini M, Auriemma F, Fabbri C, Binda C, Coluccio C, Marocchi G, Staiano T, Conti Bellocchi MC, Bernardoni L, Eusebi LH, Cirota GG, De Nucci G, Stigliano S, Manes G, Bonanno G, Ofosu A, Lamonaca L, Paduano D, Spatola F, Repici A. Endoscopic ultrasound-guided fine-needle biopsy with or without macroscopic on-site evaluation: a randomized controlled noninferiority trial. Endoscopy 2023; 55:129-137. [PMID: 36044915 DOI: 10.1055/a-1915-5263] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND : The advantage of using the macroscopic on-site evaluation (MOSE) technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) performed with 22G Franseen needles has not been investigated. We aimed to compare EUS-FNB with MOSE vs. EUS-FNB performed with three needle passes. METHODS : This randomized trial involved 10 Italian referral centers. Consecutive patients referred for EUS-FNB of pancreatic or nonpancreatic solid lesions were included in the study and randomized to the two groups. MOSE was performed by gross visualization of the collected material by the endoscopists and considered adequate when a white/yellowish aggregate core longer than 10 mm was retrieved. The primary outcome was diagnostic accuracy. Secondary outcomes were specimen adequacy, number of needle passes, and safety. RESULTS : 370 patients with 234 pancreatic lesions (63.2 %) and 136 nonpancreatic lesions (36.8 %) were randomized (190 EUS-FNB with MOSE and 180 with standard EUS-FNB). No statistically significant differences were found between EUS-FNB with MOSE and conventional EUS-FNB in terms of diagnostic accuracy (90.0 % [95 %CI 84.8 %-93.9 %] vs. 87.8 % [95 %CI 82.1 %-92.2 %]; P = 0.49), sample adequacy (93.1 % [95 %CI 88.6 %-96.3 %] vs. 95.5 % [95 %CI 91.4 %-98 %]; P = 0.31), and rate of adverse events (2.6 % vs. 1.1 %; P = 0.28). The median number of passes was significantly lower in the EUS-FNB with MOSE group (1 vs. 3; P < 0.001). CONCLUSIONS : The accuracy of EUS-FNB with MOSE is noninferior to that of EUS-FNB with three needle passes. MOSE reliably assesses sample adequacy and reduces the number of needle passes required to obtain the diagnosis with a 22G Franseen needle.
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Affiliation(s)
- Benedetto Mangiavillano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini - Castellanza, Varese, Italy
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianenrico Rizzatti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Carrara
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Marco Spadaccini
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini - Castellanza, Varese, Italy
| | - Carlo Fabbri
- Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì-Cesena, Italy
| | - Cecilia Binda
- Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì-Cesena, Italy
| | - Chiara Coluccio
- Endoscopy Unit, Morgagni-Pietrantoni Hospital, Forlì-Cesena, Italy
| | | | - Teresa Staiano
- Digestive Endoscopy Unit, Candiolo Cancer Institute IRCCS, Candiolo, Turin, Italy
| | | | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Leonardo Henri Eusebi
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanna Grazia Cirota
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Germana De Nucci
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | | | - Gianpiero Manes
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Giacomo Bonanno
- Digestive Endoscopy, Humanitas - Istituto Clinico Catanese, Catania, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini - Castellanza, Varese, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini - Castellanza, Varese, Italy
| | - Federica Spatola
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini - Castellanza, Varese, Italy
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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Gallicchio R, Giordano A, Milella M, Storto R, Pellegrino T, Nardelli A, Nappi A, Tarricone L, Storto G. Ga-68-Edotreotide Positron Emission Tomography/Computed Tomography Somatostatin Receptors Tumor Volume Predicts Outcome in Patients With Primary Gastroenteropancreatic Neuroendocrine Tumors. Cancer Control 2023; 30:10732748231152328. [PMID: 36714951 PMCID: PMC9940184 DOI: 10.1177/10732748231152328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We retrospectively aimed to assess the prognostic significance of somatostatin receptor (SSTR) standardized uptake value (SUVmaxsstr), SSTR representative tumor volume (RTVsstr) and total lesion SSTR expression (TLsstr) obtained by [68Ga]Ga-edotreotide PET/CT ([68Ga]Ga-SSTR PET/CT) in patients with primary gastroenteropancreatic neuroendocrine tumors (GEP-NET) before surgery. MATERIAL AND METHODS We analyzed patients who underwent [68Ga]Ga-SSTR PET/CT 3-6 weeks before surgery from February 2020 to April 2022. The mean SUVmaxsstr value, the RTVsstr (cm3; 42% threshold) and the TLsstr (g) were registered. Thereafter the patients were followed up 10.3 months (range 3-27). The PET/CT results were compared to the event free survival (EFS). RESULTS Forty-two patients (61 ± 13 years) have been enrolled. At multivariate analysis only RTVsstr values were predictive. The Kaplan-Meier survival analysis for RTVsstr showed a significant better EFS in patients presenting lower values as compared to those having greater (P = .003, log-rank test). SUVmaxsstr was not suitable for predicting EFS, TLsstr mildly. CONCLUSION RTVsstr represents a valuable volumetric parameter able to predict the outcome in GEP-NET patients who underwent surgery. The magnitude of the SSTR representative tumor burden holds a predominant value for determining the response to therapy in GEP-NET patients before surgery, rather than the maximal SSTR representation at single voxel.
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Affiliation(s)
- Rosj Gallicchio
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Alessia Giordano
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Mariarita Milella
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Rebecca Storto
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Teresa Pellegrino
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Anna Nardelli
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Antonio Nappi
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Luigia Tarricone
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy
| | - Giovanni Storto
- Nuclear Medicine, Referral Cancer Center of Basilicata, IRCCS CROB, Rionero in Vulture, Italy,Giovanni Storto, Referral Cancer Center of Basilicata, IRCCS CROB, Via P. Pio 1, Rionero in Vulture 85028, Italy.
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14
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Tacelli M, Bina N, Crinò SF, Facciorusso A, Celsa C, Vanni AS, Fantin A, Antonini F, Falconi M, Monica F, Capurso G, Arcidiacono PG, Barresi L. Reliability of grading preoperative pancreatic neuroendocrine tumors on EUS specimens: a systematic review with meta-analysis of aggregate and individual data. Gastrointest Endosc 2022; 96:898-908.e23. [PMID: 35863518 DOI: 10.1016/j.gie.2022.07.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Therapy and prognosis of pancreatic neuroendocrine tumors (PanNETs) are strictly related to the Ki-67 index, which defines tumor grading. The criterion standard for the assessment of grading of PanNETs is EUS-guided FNA (EUS-FBAFNA) or EUS-guided fine-needle biopsy sampling (EUS-FNB). Because data on diagnostic accuracy of EUS-FNA and EUS-FNB are heterogeneous, we aimed to analyze the variability in concordance between EUS grading and surgical grading. METHODS The MEDLINE, SCOPUS, and EMBASE databases were searched until November 2021 to identify studies reporting the concordance rate between EUS grading and surgical grading. The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled events were calculated using a random-effects model and expressed in terms of pooled prevalence rates. A multivariate meta-regression was performed to find possible sources of heterogeneity. Where available, individual data were analyzed. RESULTS Twenty-six studies with 864 patients undergone EUS-FNA or EUS-FNB and surgical resection for PanNETs were included. The pooled estimate rate for the overall concordance of EUS grading and surgical grading was 80.3% (95% confidence interval, 75.6-85.1). Undergrading (EUS grading < surgical grading) was significantly more frequent with respect to overgrading (14.7% vs 3.5%, P < .001). Individual data analysis showed that among nonconcordant patients, the median Ki-67 difference was 3% (interquartile range, 2-6.15). The type of World Health Organization classification adopted and the median lesion diameter were significantly associated with heterogeneity at meta-regression. CONCLUSIONS EUS is an accurate technique in defining grading in patients with PanNETs, but a margin of error still exists, which should be the focus of future studies to minimize the risk of over- and/or undertreatment.
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Affiliation(s)
- Matteo Tacelli
- Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Niccolò Bina
- Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
| | - Ciro Celsa
- Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
| | - Andrea Sbrozzi Vanni
- Gastroenterology and Diagnostic and Operative Digestive Endoscopy, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Filippo Antonini
- Gastroenterology and Digestive Endoscopy Unit, Augusto Murri Hospital, Polytechnic University of Marche, Fermo, Italy
| | - Massimo Falconi
- Vita-Salute San Raffaele University, Milan, Italy; Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, "Cattinara" Academic Hospital, Trieste, Italy
| | - Gabriele Capurso
- Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy
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15
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Jia WY, Gui Y, Chen XQ, Zhang XQ, Zhang JH, Dai MH, Guo JC, Chang XY, Tan L, Bai CM, Cheng YJ, Li JC, Lv K, Jiang YX. Evaluation of the diagnostic performance of the EFSUMB CEUS Pancreatic Applications guidelines (2017 version): a retrospective single-center analysis of 455 solid pancreatic masses. Eur Radiol 2022; 32:8485-8496. [PMID: 35699767 DOI: 10.1007/s00330-022-08879-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the diagnostic performance of EFSUMB CEUS Pancreatic Applications guidelines (version 2017) before and after the addition of iso-enhancement and very fast/fast washout as supplementary diagnostic criteria for PDAC. METHODS In this retrospective study, patients diagnosed with solid pancreatic lesions from January 2017 to December 2020 were evaluated. Pancreatic ductal adenocarcinoma (PDAC) is reported to show hypo-enhancement in all phases according to the EFSUMB guidelines. First, based on this definition, all lesions were categorized as PDAC and non-PDAC. Then, iso-enhancement and very fast/fast washout were added as supplementary diagnostic criteria, and all lesions were recategorized. The diagnostic performance was assessed in terms of the accuracy (ACC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV). The reference standard consisted of histologic evaluation or composite imaging and clinical follow-up findings. RESULTS A total of 455 nodules in 450 patients (median age, 58.37 years; 250 men) were included. The diagnostic performance using the EFSUMB CEUS guidelines for PDAC had an ACC of 69.5%, SEN of 65.4%, SPE of 84%, PPV of 93.5%, NPV of 40.6%, and ROC of 0.747. After recategorization according to the supplementary diagnostic criteria, the diagnostic performance for PDAC had an ACC of 95.8%, SEN of 99.2%, SPE of 84%, PPV of 95.7%, NPV of 96.6%, and ROC of 0.916. CONCLUSION The EFSUMB guidelines and recommendations for pancreatic lesions can effectively identify PDAC via hypo-enhancement on CEUS. However, the diagnostic performance may be further improved by the reclassification of PDAC lesions after adding iso-enhancement and very fast/fast washout mode. KEY POINTS • In the EFSUMB guidelines, the only diagnostic criterion for PDAC is hypo-enhancement, to which iso-enhancement and very fast/fast washout mode were added in our research. • Using hypo-enhancement/iso-enhancement with very fast/fast washout patterns as the diagnostic criteria for PDAC for solid pancreatic masses on CEUS has high diagnostic accuracy. • The blood supply pattern of PDAC can provide important information, and CEUS has unique advantages in this respect due to its real-time dynamic attenuation ability.
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Affiliation(s)
- Wan-Ying Jia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yang Gui
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xue-Qi Chen
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiao-Qian Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jia-Hui Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Meng-Hua Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jun-Chao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiao-Yan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Li Tan
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Chun-Mei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yue-Juan Cheng
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jian-Chu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ke Lv
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yu-Xin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Facciorusso A, Crinò SF, Gkolfakis P, Ramai D, Lisotti A, Papanikolaou IS, Mangiavillano B, Tarantino I, Anderloni A, Fabbri C, Triantafyllou K, Fusaroli P. Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis. Gastroenterol Rep (Oxf) 2022; 10:goac062. [PMID: 36340808 PMCID: PMC9632631 DOI: 10.1093/gastro/goac062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided tissue acquisition represents the choice of methods for suspected lymph nodes (LNs) located next to the gastrointestinal tract. This study aimed to compare the pooled diagnostic performance of EUS-guided fine-needle biopsy (EUS-FNB) and fine-needle aspiration (EUS-FNA) for LNs sampling. METHODS We searched PubMed/MedLine and Embase databases through August 2021. Primary outcome was diagnostic accuracy; secondary outcomes were sensitivity, specificity, sample adequacy, optimal histological core procurement, number of passes, and adverse events. We performed a pairwise meta-analysis using a random-effects model. The results are presented as odds ratio (OR) or mean difference along with 95% confidence interval (CI). RESULTS We identified nine studies (1,276 patients) in this meta-analysis. Among these patients, 66.4% were male; the median age was 67 years. Diagnostic accuracy was not significantly different between the two approaches (OR, 1.31; 95% CI, 0.81-2.10; P = 0.270). The accuracy of EUS-FNB was significantly higher when being performed with newer end-cutting needles (OR, 1.87; 95% CI, 1.17-3.00; P = 0.009) and in abdominal LNs (OR, 2.48; 95% CI, 1.52-4.05; P < 0.001) than that of EUS-FNA. No difference in terms of sample adequacy was observed between the two approaches (OR, 1.40; 95% CI, 0.46-4.26; P = 0.550); however, histological core procurement and diagnostic sensitivity with EUS-FNB were significantly higher than those with EUS-FNA (OR, 6.15; 95% CI, 1.51-25.07; P = 0.010 and OR, 1.87; 95% CI, 1.27-2.74, P = 0.001). The number of needle passes needed was significantly lower in the EUS-FNB group than in the EUS-FNA group (mean difference, -0.54; 95% CI, -0.97 to -0.12; P = 0.010). CONCLUSIONS EUS-FNA and EUS-FNB perform similarly in LN sampling; however, FNB performed with end-cutting needles outperformed FNA in terms of diagnostic accuracy.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens, Greece
| | | | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milano, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens, Greece
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
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Development and validation of a combined nomogram model based on deep learning contrast-enhanced ultrasound and clinical factors to predict preoperative aggressiveness in pancreatic neuroendocrine neoplasms. Eur Radiol 2022; 32:7965-7975. [PMID: 35389050 DOI: 10.1007/s00330-022-08703-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to develop and validate a combined nomogram model based on deep learning (DL) contrast-enhanced ultrasound (CEUS) and clinical factors to preoperatively predict the aggressiveness of pancreatic neuroendocrine neoplasms (PNENs). METHODS In this retrospective study, consecutive patients with histologically proven PNENs underwent CEUS examination at the initial work-up between January 2010 and October 2020. Patients were randomly allocated to the training and test sets. Typical sonographic and enhanced images of PNENs were selected to fine-tune the SE-ResNeXt-50 network. A combined nomogram model was developed by incorporating the DL predictive probability with clinical factors using multivariate logistic regression analysis. The utility of the proposed model was evaluated using receiver operator characteristic, calibration, and decision curve analysis. RESULTS A total of 104 patients were evaluated, including 80 (mean age ± standard deviation, 47 years ± 12; 56 males) in the training set and 24 (50 years ± 12; 14 males) in the test set. The DL model displayed effective image recognition with an AUC of 0.81 (95%CI: 0.62-1.00) in the test set. The combined nomogram model that incorporated independent clinical risk factors, such as tumor size, arterial enhancement level, and DL predictive probability, showed strong discrimination, with an AUC of 0.85 (95%CI: 0.69-1.00) in the test set with good calibration. Decision curve analysis verified the clinical usefulness of the combined nomogram. CONCLUSIONS The combined nomogram model could serve as a preoperative, noninvasive, and precise evaluation tool to differentiate aggressive and non-aggressive PNENs. KEY POINTS • Tumor size (odds ratio [OR], 1.58; p = 0.02), arterial enhancement level (OR, 0.04; p = 0.008), and deep learning predictive probability (OR, 288.46; p < 0.001) independently predicted aggressiveness of pancreatic neuroendocrine neoplasms preoperatively. • The combined model predicted aggressiveness better than the clinical model (AUC: 0.97 vs. 0.87, p = 0.009), achieving AUC values of 0.97 and 0.85 in the training set and the test set, respectively.
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Gupta P, Rana P, Marodia Y, Samanta J, Sharma V, Sinha SK, Singh H, Gupta V, Yadav TD, Sreenivasan R, Vaiphei K, Rajwanshi A, Kochhar R, Sandhu M. Contrast-enhanced ultrasound of solid pancreatic head lesions: a prospective study. Eur Radiol 2022; 32:6668-6677. [PMID: 35587829 DOI: 10.1007/s00330-022-08854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of solid pancreatic head lesions (SPHL). METHODS This prospective study comprised consecutive patients with SPHL who underwent CEUS evaluation of the pancreas. Findings recorded at CEUS were enhancement patterns (degree, completeness, centripetal enhancement, and percentage enhancement) and presence of central vessels. In addition, time to peak (TTP) and washout time (WT) were recorded. The final diagnosis was based on histopathology or cytology. Multivariate analysis was performed to identify parameters that were significantly associated with pancreatic ductal adenocarcinoma (PDAC). RESULTS Ninety-eight patients (median age 53.8 years, 59 males) were evaluated. The final diagnosis was PDAC (n = 64, 65.3%), inflammatory mass (n = 16, 16.3%), neuroendocrine tumor (NET, n = 14, 14.3%), and other tumors (n = 4, 4.1%). Hypoenhancement, incomplete enhancement, and centripetal enhancement were significantly more common in PDAC than non-PDAC lesions (p = 0.001, p = 0.031, and p = 0.002, respectively). Central vessels were present in a significantly greater number of non-PDAC lesions (p = 0.0001). Hypoenhancement with < 30% enhancement at CEUS had sensitivity and specificity of 80.6% and 67.7%, respectively, for PDAC. There was no significant difference in the TTP and WT between PDAC and non - PDAC lesions. However, the WT was significantly shorter in PDAC compared to NET (p = 0.011). In multivariate analysis, lack of central vessels was significantly associated with a PDAC diagnosis. CONCLUSION CEUS is a useful tool for the evaluation of SPHL. CEUS can be incorporated into the diagnostic algorithm to differentiate PDAC from non-PDAC lesions. KEY POINTS • Hypoenhancement and incomplete enhancement at CEUS were significantly more common in PDAC than in non-PDAC. • Central vessels at CEUS were significantly associated with PDAC. • There was no difference in TTP and WT between PDAC and non-PDAC lesions.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India.
| | - Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | - Yashi Marodia
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | | | - Vishal Sharma
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, PGIMER, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, PGIMER, Chandigarh, India
| | | | | | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Manavjit Sandhu
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
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Zhu FH, Wang YK, Zhou JL, Meng NL, Wang Y, Jiang B, Wang SN. The Histopathological Types and Distribution Characteristics of Gastric Mixed Tumors. Front Oncol 2022; 12:873005. [PMID: 35785186 PMCID: PMC9247174 DOI: 10.3389/fonc.2022.873005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The present study aimed to investigate the histopathological types and distribution characteristics of gastric mixed tumors. Methods Detailed histological observations, together with related immunohistochemical and genetic tests, were analyzed on 960 surgically resected samples in 6 hospitals with gastric mixed tumors from May 2017 to May 2021 in this retrospective study. Results Epithelial-derived tumors accounted for 80.10% (769/960) of the gastric mixed tumor samples studied, and tumors of different tissue origins accounting for 10.83% (104/960), mesenchymal-derived tumors accounting for 6.25% (60/960), neuroendocrine tumors accounting for 2.40% (23/960), and lymphoma accounting for 0.42% (4/960). The histological types of gastric mixed tumors identified as most commonly were epithelial originated, followed by mixed tumors of different tissue originated, then mixed neuroendocrine, lymphoma, and mesenchymal originated in sequence. The histological number of gastric mixed tumors was ≤ 3 in 83.23% (799/960) of cases and > 4 in 16.77% (161/960) of cases. The mixed histological patterns of gastric mixed tumors were divided into three types: those with tumor cells interspersed with each other, those with incomplete fibrous tissue separation, and those without fibrous tissue separation. The gene target characteristics of gastric mixed tumors were the existence of multi-gene mutation, including human epidermalgrowth factor receptor-2 (HER2) gene amplification, key result areas (K-ras) and platelet-derived growth factor receptor alpha (PDGFRA). Conclusion Gastric mixed tumors should be adequately sampled, each piece of tissue should be involved in the morphological proportional division of the tumor, and any independent histological component should be written into the pathological examination report.
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Affiliation(s)
- Fang-Heng Zhu
- Department of Pathology, Xinxiang Central Hospital, Xinxiang, China
| | - Yang-Kun Wang
- Department of Pathology, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
| | - Jun-Ling Zhou
- Shenzhen Nanshan District People’s Hospital, Shenzhen, China
| | - Nian-Long Meng
- Department of Pathology, The 989th Hospital of the Joint Logistics Support Force of The Chinese People’s Liberation Army, Luoyang, China
| | - Yue Wang
- Shenzhen Hezheng Hospital, Shenzhen, China
| | - Bo Jiang
- Department of Pathology, People’s Liberation Army Joint Logistic Support Force 990th Hospital, Zhumadian, China
| | - Su-Nan Wang
- Shenzhen Polytechnic, Shenzhen, China
- *Correspondence: Su-Nan Wang,
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Zhang X, Yang H, Xin Y, Yang Y, Lu H, Zhou X. Complete Response After Pre-Operative Transcatheter Arterial Chemoembolization for Unresectable Primary Hepatic Neuroendocrine Tumour: A Case Report and Literature Review. Front Oncol 2022; 12:893403. [PMID: 35692743 PMCID: PMC9174540 DOI: 10.3389/fonc.2022.893403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary hepatic neuroendocrine tumours (PHNET) are extremely rare. Currently, no evidence-based guidelines are available for PHNET treatment, especially for unresectable tumours. Case Presentation We present the case of a 43-year-old man who was admitted to our hospital with complaints of backache for more than 1 month. The imaging examination showed a 5.5×5.3 cm lesion in the liver and no extrahepatic lesions, which was confirmed as a grade 2 PHNET by the pathological results and exclusion of non-hepatic origins. A multidisciplinary team (MDT) consultation revealed that the lesion was an unresectable primary hepatic neuroendocrine tumour (uPHNET) but could be potentially treated by conversion surgery. The patient was initially administered four cycles of chemotherapy with temozolomide, 5-fluorouracil, and ondansetron, and was evaluated as stable disease (SD) according to the Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1). Because of the limited clinical benefit of chemotherapy, the patient subsequently underwent transcatheter arterial chemoembolisation (TACE) treatment, which reduced the tumour size and converted uPHNET to resectable tumours. A complete response (CR) was achieved after surgery, and the patient has been disease-free. Conclusions This case was reported by a patient with uPHNET who benefited from the pre-operative TACE, providing a potentially effective management strategy for refractory tumours.
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Affiliation(s)
- Xinyuan Zhang
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiru Yang
- Department of Pathology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujing Xin
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yang
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haizhen Lu
- Department of Pathology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Zhou
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Impact of tumor size and location on endoscopic ultrasound-guided sampling of pancreatic neuroendocrine tumors: A recursive partitioning analysis. Pancreatology 2022; 22:644-650. [PMID: 35589512 DOI: 10.1016/j.pan.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Current guidelines provide weak recommendations to treat small (<2 cm) non-functional pancreatic neuroendocrine tumors with low Ki-67 proliferation index either by resection or clinical follow-up. However, there is a lack of consensus regarding the minimal size of pNET, which allows EUS-guided biopsy with high enough diagnostic accuracy for stratification. METHODS We conducted a retrospective, bicentric analysis of patients who had undergone EUS-guided pNET sampling in two tertiary care Endoscopy Units in Germany and Poland. Using a recursive partitioning of the tree-aided model, we aimed to stratify the probability of successful EUS-guided biopsy of pNET lesions according to their size and location. RESULTS In our pNET cohort, successful histological confirmation of a pNET diagnosis was achieved in 59/69 (85.5%) cases at the initial EUS-guided biopsy. In 41 patients with a pNET size less than 18.5 mm, the EUS-guided first biopsy was successful in 90.2%. In 16 of these patients with smaller lesions, EUS-guided sampling was 100% in very small (less than 11 mm) and extremely small lesions (less than 8 mm). The biopsy success rate was 100% in tail lesions in the size range between ≥5.95 and <8.1 mm but only 33.3% independent of the investigator in pancreatic head or body, with an error rate of 11.2% CONCLUSION: Using a recursive partitioning of the tree-aided stratification model, we demonstrate for the first time that in balancing risks and benefits, very small pNETs (<1 cm) in the tail of the pancreas should be sampled under EUS-guidance.
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22
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Xu J, Yang J, Feng Y, Zhang J, Zhang Y, Chang S, Jin J, Du X. MRI Feature-Based Nomogram Model for Discrimination Between Non-Hypervascular Pancreatic Neuroendocrine Tumors and Pancreatic Ductal Adenocarcinomas. Front Oncol 2022; 12:856306. [PMID: 35664797 PMCID: PMC9160740 DOI: 10.3389/fonc.2022.856306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate whether magnetic resonance imaging (MRI) features could differentiate non-hypervascular pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal adenocarcinomas (PDACs). In this study, 131 patients with surgically and pathologically proven non-hypervascular PNETs (n = 44) or PDACs (n = 87) were enrolled. Two radiologists independently analyzed MRI imaging findings and clinical features. Relevant features in differentiating non-hypervascular PNETs from PDACs were identified via univariate and multivariate logistic regression models. The MRI feature-based nomogram was constructed based on multivariable logistic analysis and the reliability of the constructed nomogram was further validated. The results showed that tumor margin (P = 0.012; OR: 6.622; 95% CI: 1.510, 29.028), MPD dilation (P = 0.047; OR: 4.309; 95% CI: 1.019, 18.227), and signal in the portal phase (P < 0.001; OR: 53.486; 95% CI: 10.690, 267.618) were independent discriminative MRI features between non-hypervascular PNETs and PDACs. The discriminative performance of the developed nomogram was optimized compared with single imaging features. The calibration curve, C-index, and DCA validated the superior practicality and usefulness of the MRI-based nomogram. In conclusion, the radiologically discriminative model integrating various MRI features could be preoperatively and easily utilized to differentiate non-hypervascular PNETs from PDACs.
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Affiliation(s)
- Jiake Xu
- Department of Gastroenterology, Kunshan Second People’s Hospital, Kunshan, China
| | - Jie Yang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ye Feng
- Department of Gastroenterology, Kunshan Second People’s Hospital, Kunshan, China
| | - Jie Zhang
- Department of Gastroenterology, Kunshan Second People’s Hospital, Kunshan, China
| | - Yuqiao Zhang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Sha Chang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingqiang Jin
- Department of Radiology, Kunshan Second People’s Hospital, Kunshan, China
- *Correspondence: Xia Du, ; Jingqiang Jin,
| | - Xia Du
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- *Correspondence: Xia Du, ; Jingqiang Jin,
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Appelstrand A, Bergstedt F, Elf AK, Fagman H, Hedenström P. Endoscopic ultrasound-guided side-fenestrated needle biopsy sampling is sensitive for pancreatic neuroendocrine tumors but inadequate for tumor grading: a prospective study. Sci Rep 2022; 12:5971. [PMID: 35396490 PMCID: PMC8993931 DOI: 10.1038/s41598-022-09923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Accurate pretreatment grading of pancreatic neuroendocrine tumors (PanNETs) is important to guide patient management. We aimed to evaluate endoscopic ultrasound-guided fine needle biopsy sampling (EUS-FNB) for the preoperative diagnosis and grading of PanNETs. In a tertiary-center setting, patients with suspected PanNETs were prospectively subjected to 22-gauge, reverse-bevel EUS-FNB. The EUS-FNB samples (Ki-67EUS) and corresponding surgical specimens (Ki-67SURG) were analyzed with Ki-67 indexing and thereafter tumor grading, (GRADEEUS) and (GRADESURG) respectively. In total 52 PanNET-patients [median age: 66 years; females: 25/52; surgical resection 22/52 (42%)] were included. EUS-FNB was diagnostic in 44/52 (85%). In 42 available FNB-slides, the median neoplastic cell count was 1034 (IQR: 504-3667) with 32/42 (76%), 22/42 (52%), and 14/42 (33%) cases exceeding 500, 1000, and 2000 neoplastic cells respectively. Ki-67SURG was significantly higher compared to Ki-67EUS with a moderate correlation comparing Ki-67EUS and Ki-67SURG (Pearson r = 0.60, r2 = 0.36, p = 0.011). The GRADEEUS had a weak level of agreement (κ = 0.08) compared with GRADESURG. Only 2/12 (17%) G2-tumors were correctly graded in EUS-FNB-samples. EUS-guided fine needle biopsy sampling is sensitive for preoperative diagnosis of PanNET but biopsy quality is relatively poor. Therefore, the approach seems suboptimal for pretreatment grading of PanNET.
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Affiliation(s)
- Alexander Appelstrand
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Bergstedt
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna-Karin Elf
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Fagman
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Sahlgrenska Center for Cancer Research, Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Per Hedenström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. .,Division of Medical Gastroenterology, Department of Internal Medicine, Sahlgrenska University Hospital, Medicinmottagningen, Sahlgrenska Sjukhuset, Blå Stråket 3, 413 35, Gothenburg, Sweden.
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Wei G, Luo Q, Fang J, Li X, Shi Y, Li Y, Sun L. The Sex Features of Patients With Solid Pseudopapillary Neoplasms of the Pancreas: A Retrospective Study. Front Oncol 2022; 12:844182. [PMID: 35252013 PMCID: PMC8894654 DOI: 10.3389/fonc.2022.844182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Solid pseudopapillary neoplasms of the pancreas (SPNs) in male patients are more frequently reported. The aim of the study was to evaluate the sex features of SPN and the risk factors that predict tumor recurrence. Methods From 2013 to 2019, patients who were pathologically confirmed to have SPNs were retrospectively reviewed. The baseline study parameters were compared between males and females. A logistic regression model was established to identify the independent risk factors for tumor recurrence. Results In total, 221 patients were included in this study. Of them, 53 patients (24.0%) were males. Male patients were older than female patients (39.1 vs 31.6 years, P=0.001), and the tumor size in male patients was smaller than that in female patients (50.38 vs 39.65 mm, P=0.038). The preoperative imaging diagnostic accuracy was significantly higher in females than in males (70.5% vs 54%, P=0.02). SPNs in male patients tended to be misdiagnosed with other malignant tumors (37.7% vs 10.7%, P<0.0001), with a more solid component observed in images (66.8% vs 24.7%, P<0.0001). For immunohistochemical staining, the expression of beta catenin was significantly lower in male patients (P=0.002), and the expression of vimentin was the opposite (P=0.01). The overall survival rate and disease-free survival were not different. Based on multivariate analysis, older age [hazard ratio (HR)= 1.094, 95% confidence interval (CI): 1.005-1.190] and KI 67 index grade III (HR=12.029, 95% CI: 2.399-60.311) were independent risk factors for tumor recurrence. Conclusion The clinical and imaging features of SPN in males were not in full accord with those in females; however, the differences did not influence prognosis.
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Affiliation(s)
- Guangmin Wei
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Qiong Luo
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jiankai Fang
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaolou Li
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yanhong Shi
- Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yuqiong Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Yuqiong Li, ; Liqi Sun,
| | - Liqi Sun
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
- Department of Gastroenterology, 72 Group Army Hospital, Huzhou University, Huzhou, China
- *Correspondence: Yuqiong Li, ; Liqi Sun,
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Lin YN, Chen MY, Tsai CY, Chou WC, Hsu JT, Yeh CN, Yeh TS, Liu KH. Prediction of Gastric Gastrointestinal Stromal Tumors before Operation: A Retrospective Analysis of Gastric Subepithelial Tumors. J Pers Med 2022; 12:297. [PMID: 35207784 PMCID: PMC8879060 DOI: 10.3390/jpm12020297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 01/27/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas are the most common gastric subepithelial tumors (GSETs) with similar endoscopic findings. Preoperative prediction of GSETs is difficult. This study analyzed and predicted GSET diagnosis through a retrospective review of 395 patients who underwent surgical resection of GISTs, leiomyomas, and schwannomas measuring 2-10 cm. GSETs were divided by size (group 2-5, >2 and ≤5 cm; group 5-10, >5 and ≤10 cm) for analysis. Demographics, clinical symptoms, and images were analyzed. A recursive partitioning analysis (RPA) was used to identify optimal classifications for specific GSET diagnoses. GIST patients were relatively older than other patients. Both groups had higher proportions of UGI bleeding, lower hemoglobin (Hb) levels, and a higher ratio of necrosis on their computed tomography (CT) scans. The RPA tree showed that (a) age ≤ 55, Hb ≥ 10.7, and CT necrosis; (b) age ≤ 55 and Hb < 10.7; (c) age >55 and Hb < 12.9; and (d) age >55 and CT hetero-/homogeneity can predict high GIST risk in group 2-5. Positive or negative CT necrosis, with age >55, can predict high GIST risk in group 5-10. GIST patients were older and presented with low Hb levels and tumor necrosis. In RPA, the accuracy reached 85% and 89% in groups 2-5 and 5-10, respectively.
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Affiliation(s)
- Yu-Ning Lin
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
| | - Ming-Yan Chen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
| | - Wen-Chi Chou
- Department of Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan;
| | - Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-N.L.); (M.-Y.C.); (C.-Y.T.); (J.-T.H.); (C.-N.Y.); (T.-S.Y.)
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Takikawa T, Kikuta K, Hamada S, Kume K, Miura S, Yoshida N, Tanaka Y, Matsumoto R, Ikeda M, Kataoka F, Sasaki A, Hayashi H, Hatta W, Ogata Y, Nakagawa K, Unno M, Masamune A. A New Preoperative Scoring System for Predicting Aggressiveness of Non-Functioning Pancreatic Neuroendocrine Neoplasms. Diagnostics (Basel) 2022; 12:diagnostics12020397. [PMID: 35204488 PMCID: PMC8870938 DOI: 10.3390/diagnostics12020397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/04/2022] Open
Abstract
The management of non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs) is still controversial. This study aimed to develop a new scoring system for treatment decisions at initial diagnosis based on the identification of the predictive factors for aggressive NF-PanNENs. Seventy-seven patients who had been pathologically diagnosed with NF-PanNENs were enrolled. We retrospectively reviewed 13 variables that could be assessed preoperatively. Univariate and multivariate stepwise logistic regression analyses were performed to identify factors for the aggressiveness of NF-PanNENs, and a scoring system was developed by assigning weighted points proportional to their β regression coefficient. Tumor size > 20 mm on contrast-enhanced computed tomography, tumor non-vascularity, and Ki-67 labeling index ≥5% on endoscopic ultrasound-guided fine-needle aspiration specimens were identified as independent factors for predicting the aggressiveness of NF-PanNENs. The new scoring system, developed using the identified factors, had an excellent discrimination ability, with area under the curve of 0.92 (95% CI, 0.85–0.99), and good calibration (p = 0.72, Hosmer-Lemeshow test). Ten-year overall survival rates in low-risk (0 point), intermediate-risk (1 to 2 points), and high-risk (3 to 4 points) groups were 100%, 90.9%, and 24.3%, respectively. This new scoring system would be useful for treatment decisions and prognostic prediction at initial diagnosis.
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Affiliation(s)
- Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Shin Miura
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Naoki Yoshida
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Yu Tanaka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Ryotaro Matsumoto
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Mio Ikeda
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Fumiya Kataoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Akira Sasaki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Hidehiro Hayashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
| | - Kei Nakagawa
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan; (K.N.); (M.U.)
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan; (K.N.); (M.U.)
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (T.T.); (K.K.); (S.H.); (K.K.); (S.M.); (N.Y.); (Y.T.); (R.M.); (M.I.); (F.K.); (A.S.); (H.H.); (W.H.); (Y.O.)
- Correspondence: ; Tel.:+81-22-717-7171; Fax: +81-22-717-7177
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Wang Y, Li G, Yan K, Fan Z, Long R, Shan J, Dai Y, Wu W. Clinical value of contrast-enhanced ultrasound enhancement patterns for differentiating solid pancreatic lesions. Eur Radiol 2021; 32:2060-2069. [PMID: 34716476 DOI: 10.1007/s00330-021-08243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) enhancement patterns for differentiating solid pancreatic lesions and compare them with conventional ultrasound (US) and enhanced computed tomography (CT). METHODS A total of 210 patients with solid pancreatic lesions who had definite pathological or clinical diagnoses were enrolled. Six CEUS enhancement patterns were proposed for solid pancreatic lesions. Two US doctors blindly observed the CEUS patterns of solid pancreatic lesions and the interrater agreement was analyzed. The diagnostic value of CEUS enhancement patterns for differentiating solid pancreatic lesions was evaluated, and the diagnostic accuracy was compared with that of US and enhanced CT. RESULTS There was good concordance for six CEUS enhancement patterns of solid pancreatic lesions between the two doctors, with a kappa value of 0.767. Hypo-enhancement (Hypo-E) or centripetal enhancement (Centri-E) as the diagnostic criteria for pancreatic carcinoma had an accuracy of 87.62%; hyper-enhancement (Hyper-E) for neuroendocrine tumors had an accuracy of 92.89%; capsular enhancement with low or uneven enhancement inside the tumor (Capsular-E) for solid pseudopapillary tumors had an accuracy of 97.63%; and iso-enhancement (Iso-E) or iso-enhancement with focal hypo-enhancement (Iso-fhypo-E) for focal pancreatitis had an accuracy of 89.10%. The diagnostic accuracy of CEUS was significantly different from that of US for 210 cases of solid pancreatic lesions (p < 0.05) and was not significantly different from that of enhanced CT for 146 cases of solid pancreatic lesions (p > 0.05). CONCLUSIONS The different enhancement patterns of solid pancreatic lesions on CEUS were clinically valuable for differentiation. KEY POINTS • Six CEUS enhancement (E) patterns, including Hyper-E, Iso-E, Iso-fhypo-E, Hypo-E, Centri-E, and Capsular-E, are proposed for the characterization of solid pancreatic lesions. • Using Hypo-E or Centri-E as the diagnostic criteria for pancreatic carcinoma, Hyper-E for neuroendocrine tumors, Capsular-E for solid pseudopapillary tumors, and Iso-E or Iso-fhypo-E for focal pancreatitis on CEUS had relatively high diagnostic accuracy. • The diagnostic accuracy of CEUS was greatly increased over that of US and was not different from that of enhanced CT.
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Affiliation(s)
- Yanjie Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Guanghan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China.
| | - Zhihui Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Rong Long
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, China
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28
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Facciorusso A, Crinò SF, Muscatiello N, Gkolfakis P, Samanta J, Londoño Castillo J, Cotsoglou C, Ramai D. Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study. Cancers (Basel) 2021; 13:4298. [PMID: 34503112 PMCID: PMC8428361 DOI: 10.3390/cancers13174298] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
There is a paucity of evidence on the comparison between endoscopic ultrasound (EUS) fine-needle biopsy (FNB) and fine-needle aspiration (FNA) for lymph node (LNs) sampling. The aim of this study was to compare these two approaches in a multicenter series of patients with abdominal tumors. Out of 502 patients undergoing EUS sampling, two groups following propensity score matching were compared: 105 undergoing EUS-FNB and 105 undergoing EUS-FNA. The primary outcome was diagnostic accuracy. Secondary outcomes were diagnostic sensitivity, specificity, sample adequacy, optimal histological core procurement, number of passes, and adverse events. Median age was 64.6 years, and most patients were male in both groups. Final diagnosis was LN metastasis (mainly from colorectal cancer) in 70.4% of patients in the EUS-FNB group and 66.6% in the EUS-FNA group (p = 0.22). Diagnostic accuracy was significantly higher in the EUS-FNB group as compared to the EUS-FNA group (87.62% versus 75.24%, p = 0.02). EUS-FNB outperformed EUS-FNA also in terms of diagnostic sensitivity (84.71% vs. 70.11%; p = 0.01), whereas specificity was 100% in both groups (p = 0.6). Sample adequacy analysis showed a non-significant trend in favor of EUS-FNB (96.1% versus 89.5%, p = 0.06) whereas the histological core procurement rate was significantly higher with EUS-FNB (94.2% versus 51.4%; p < 0.001). No procedure-related adverse events were observed. These findings show that EUS-FNB is superior to EUS-FNA in tissue sampling of abdominal LNs.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy; (A.F.); (N.M.)
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy;
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, 37134 Verona, Italy;
| | - Nicola Muscatiello
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy; (A.F.); (N.M.)
| | - Paraskevas Gkolfakis
- Hepatopancreatology and Digestive Oncology Unit, Department of Gastroenterology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India;
| | | | | | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT 84132, USA
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Automatic Segmentation of Pancreatic Tumors Using Deep Learning on a Video Image of Contrast-Enhanced Endoscopic Ultrasound. J Clin Med 2021; 10:jcm10163589. [PMID: 34441883 PMCID: PMC8397137 DOI: 10.3390/jcm10163589] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Contrast-enhanced endoscopic ultrasound (CE-EUS) is useful for the differentiation of pancreatic tumors. Using deep learning for the segmentation and classification of pancreatic tumors might further improve the diagnostic capability of CE-EUS. Aims: The aim of this study was to evaluate the capability of deep learning for the automatic segmentation of pancreatic tumors on CE-EUS video images and possible factors affecting the automatic segmentation. Methods: This retrospective study included 100 patients who underwent CE-EUS for pancreatic tumors. The CE-EUS video images were converted from the originals to 90-s segments with six frames per second. Manual segmentation of pancreatic tumors from B-mode images was performed as ground truth. Automatic segmentation was performed using U-Net with 100 epochs and was evaluated with 4-fold cross-validation. The degree of respiratory movement (RM) and tumor boundary (TB) were divided into 3-degree intervals in each patient and evaluated as possible factors affecting the segmentation. The concordance rate was calculated using the intersection over union (IoU). Results: The median IoU of all cases was 0.77. The median IoUs in TB-1 (clear around), TB-2, and TB-3 (unclear more than half) were 0.80, 0.76, and 0.69, respectively. The IoU for TB-1 was significantly higher than that of TB-3 (p < 0.01). However, there was no significant difference between the degrees of RM. Conclusions: Automatic segmentation of pancreatic tumors using U-Net on CE-EUS video images showed a decent concordance rate. The concordance rate was lowered by an unclear TB but was not affected by RM.
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Facciorusso A, Mohan BP, Crinò SF, Ofosu A, Ramai D, Lisotti A, Chandan S, Fusaroli P. Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration versus standard fine-needle aspiration in pancreatic masses: a meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:821-828. [PMID: 33481633 DOI: 10.1080/17474124.2021.1880893] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES It is still unclear whether endoscopic ultrasound (EUS) contrast-enhanced fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses. Aim of this meta-analysis was to compare the diagnostic outcomes of these two techniques. METHODS We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized controlled trials (recruiting 701 patients). We performed pairwise meta-analysis through a random effects model and expressed data as odds ratio (OR) and 95% confidence interval (CI). RESULTS Pooled diagnostic sensitivity was 84.6% (95% CI 80.7%-88.6%) with CH-EUS-FNA and 75.3% (67%-83.5%) with EUS-FNA, with evidence of a significant superiority of the former (OR 1.74, 95% CI 1.26-2.40; p < 0.001). Subgroup analysis confirmed the superiority of CH-EUS-FNA over EUS-FNA only in larger lesions. Pooled diagnostic accuracy was 88.8% (85.6%-91.9%) in CH-EUS-FNA group and 83.6% (79.4%-87.8%) in EUS-FNA group (OR 1.52, 1.01-2.31; p = 0.05). Pooled sample adequacy was 95.1% (91.1%-99.1%) with CH-EUS-FNA and 89.4% (81%-97.8%) with EUS-FNA (OR 2.40, 1.38-4.17; p = 0.02). CONCLUSION CH-EUS-FNA seems to be superior to standard EUS-FNA in patients with pancreatic masses. Further trials are needed to confirm these results.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
| | - Babu P Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daryl Ramai
- Gastroenterology and HepatologyBrooklyn Hospital Medical Center, Brooklyn, NY, USA
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Italy
| | - Saurabh Chandan
- Gastroenterology Unit, CHI Health Creighton University Medical Center, Omaha, NE USA
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Italy
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31
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Melita G, Pallio S, Tortora A, Crinò SF, Macrì A, Dionigi G. Diagnostic and Interventional Role of Endoscopic Ultrasonography for the Management of Pancreatic Neuroendocrine Neoplasms. J Clin Med 2021; 10:2638. [PMID: 34203922 PMCID: PMC8232656 DOI: 10.3390/jcm10122638] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Pancreatic neuroendocrine neoplasms (PanNENs) are relatively rare, but their incidence has increased significantly in the last decades. Precise diagnosis and prognostic stratification are crucial for proper patient management. Endoscopic ultrasound (EUS) is the modality of choice for diagnosis of solid pancreatic tumors, showing a higher tumor detection rate than other imaging modalities, especially for small size lesions. EUS also serves as a guide for preoperative sampling and other interventions. EUS-tissue acquisition is a safe and highly accurate technique for cyto/histological diagnosis of PanNENs with a well-demonstrated correlation between Ki-67 proliferation index values and tumor grading on EUS and surgical specimens according to the WHO 2017 classification. Furthermore, the possibility of a preoperative EUS-guided fine needle tattooing or fiducial markers placement may help the surgeon to locate small and deep tumors, thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery. Finally, locoregional ablative treatments using either ethanol injection or radiofrequency ablation have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected patients unfit for surgery with functioning or non-functioning PanNENs. This article review highlights the current role of EUS in PanNENs management, focusing on the present and future applications of EUS-guided interventions.
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Affiliation(s)
- Giuseppinella Melita
- Department of Human Pathology of Adult and Pediatric Age, University of Messina, 98100 Messina, Italy; (A.M.); (G.D.)
| | - Socrate Pallio
- Department of Internal Medicine and Medical Therapy, University of Messina, 98100 Messina, Italy;
| | - Andrea Tortora
- Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Policlinico, G. Martino, 98100 Messina, Italy;
| | | | - Antonio Macrì
- Department of Human Pathology of Adult and Pediatric Age, University of Messina, 98100 Messina, Italy; (A.M.); (G.D.)
| | - Gianlorenzo Dionigi
- Department of Human Pathology of Adult and Pediatric Age, University of Messina, 98100 Messina, Italy; (A.M.); (G.D.)
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Ku L, Shahshahan MA, Hou LA, Eysselein VE, Reicher S. Improved diagnostic yield of endoscopic ultrasound-fine needle biopsy with histology specimen processing. World J Gastrointest Endosc 2020; 12:212-219. [PMID: 32879656 PMCID: PMC7443823 DOI: 10.4253/wjge.v12.i8.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/04/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has emerged as a safe, efficacious alternative to fine needle aspiration (FNA) for tissue acquisition. EUS-FNB is reported to have higher diagnostic yield while preserving specimen tissue architecture. However, data on the optimal method of EUS-FNB specimen processing is limited.
AIM To evaluate EUS-FNB with specimen processing as histology vs EUS-FNA cytology with regards to diagnostic yield and specimen adequacy.
METHODS All EUS-FNA and EUS-FNB performed at our institution from July 1, 2016, to January 31, 2018, were retrospectively analyzed. We collected data on demographics, EUS findings, pathology, clinical outcomes, and procedural complications in two periods, July 2016 through March 2017, and April 2017 through January 2018, with predominant use of FNB in the second data collection time period. FNA specimens were processed as cytology with cell block technique and reviewed by a cytopathologist; FNB specimens were fixed in formalin, processed for histopathologic analysis and immunohistochemical staining, and reviewed by an anatomic pathologist. Final diagnosis was based on surgical pathology when available, repeat biopsy or imaging, and length of clinical follow up.
RESULTS One hundred six EUS-FNA and EUS-FNB procedures were performed. FNA alone was performed in 17 patients; in 56 patients, FNB alone was done; and in 33 patients, both FNA and FNB were performed. For all indications, diagnostic yield was 47.1% (8/17) in FNA alone cases, 85.7% (48/56) in FNB alone cases, and 84.8% (28/33) in cases where both FNA and FNB were performed (P = 0.0039). Specimens were adequate for pathologic evaluation in 52.9% (9/17) of FNA alone cases, in 89.3% (50/56) of FNB alone cases, and 84.8% (28/33) in cases where FNA with FNB were performed (P = 0.0049). Tissue could not be aspirated for cytology in 10.0% (5/50) of cases where FNA was done, while in 3.4% (3/89) of FNB cases, tissue could not be obtained for histology. In patients who underwent FNA with FNB, there was a statistically significant difference in both specimen adequacy (P = 0.0455) and diagnostic yield (P = 0.0455) between the FNA and FNB specimens (processed correspondingly as cytology or histology).
CONCLUSION EUS-FNB has a higher diagnostic yield and specimen adequacy than EUS-FNA. In our experience, specimen processing as histology may have contributed to the overall increased diagnostic yield of EUS-FNB.
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Affiliation(s)
- Lawrence Ku
- Department of Medicine, Division of Gastroenterology and Hepatology, Harbor-UCLA Medical Center, Torrance, CA 90509, United States
| | - Mohammad A Shahshahan
- Department of Medicine, Division of Gastroenterology and Hepatology, Harbor-UCLA Medical Center, Torrance, CA 90509, United States
| | - Linda A Hou
- Department of Medicine, Division of Gastroenterology and Hepatology, Harbor-UCLA Medical Center, Torrance, CA 90509, United States
| | - Viktor E Eysselein
- Department of Medicine, Division of Gastroenterology and Hepatology, Harbor-UCLA Medical Center, Torrance, CA 90509, United States
| | - Sofiya Reicher
- Department of Medicine, Division of Gastroenterology and Hepatology, Harbor-UCLA Medical Center, Torrance, CA 90509, United States
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