Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Rastogi A, Wani S, Gupta N, Singh V, Gaddam S, Reddymasu S, Ulusarac O, Fan F, Romanas M, Dennis KL, Sharma P, Bansal A, Oropeza-Vail M, Olyaee M. A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet. Gastrointest Endosc 2011;74:58-64. [PMID: 21514932 DOI: 10.1016/j.gie.2011.02.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/16/2011] [Indexed: 12/13/2022]

For:	Rastogi A, Wani S, Gupta N, Singh V, Gaddam S, Reddymasu S, Ulusarac O, Fan F, Romanas M, Dennis KL, Sharma P, Bansal A, Oropeza-Vail M, Olyaee M. A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet. Gastrointest Endosc 2011;74:58-64. [PMID: 21514932 DOI: 10.1016/j.gie.2011.02.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/16/2011] [Indexed: 12/13/2022]

Number

Cited by Other Article(s)

Sonthalia N, Kumbar V, Tewari A, Roy A, Ghoshal UC, Goenka MK. Endoscopic ultrasound-guided fine needle biopsy using macroscopic on-site evaluation technique reduces the number passes yet maintains a high diagnostic accuracy: A randomized study. J Gastroenterol Hepatol 2024;39:2625-2630. [PMID: 39288986 DOI: 10.1111/jgh.16744] [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: 05/21/2024] [Revised: 07/18/2024] [Accepted: 08/31/2024] [Indexed: 09/19/2024]

Luo P, Ma W, Jiao D. Thyroid fine needle aspiration specimen adequacy: a noninferiority study and cost-effectiveness comparison of puncture needles. Sci Rep 2024;14:22554. [PMID: 39343786 PMCID: PMC11439899 DOI: 10.1038/s41598-024-74209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024] Open

Kanno A, Ikeda E, Ando K, Yokoyama K, Yamamoto H. The history of endoscopic ultrasound-guided fine-needle aspiration: development and progress. J Med Ultrason (2001) 2024;51:187-194. [PMID: 38244112 DOI: 10.1007/s10396-023-01400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]

Yang X, Liu ZM, Zhou X, Yang F, Ma WZ, Sun XZ, Sun SY, Ge N. Methods to increase the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions: An updated review. World J Gastrointest Endosc 2024;16:117-125. [PMID: 38577648 PMCID: PMC10989249 DOI: 10.4253/wjge.v16.i3.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/30/2023] [Accepted: 01/27/2024] [Indexed: 03/14/2024] Open

Chen D, Ren Y, Chen S, Jin Y, Xie H, Yu L, Peng K, Xia Y, Pan D, Lu J, Lu L, Wan X, Hu D, Li B. The Wet Suction Technique Enhances the Diagnostic Efficacy and Aspirate Quality of EUS-FNA for Solid Lesions: A Multicenter Retrospective Study in China. J Clin Gastroenterol 2023;57:417-422. [PMID: 35389928 DOI: 10.1097/mcg.0000000000001700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/08/2022] [Indexed: 12/10/2022]

Luo P, Mu X, Ma W, Jiao D, Zhang P. Effect of a stylet on specimen sampling in thyroid fine needle aspiration: A randomized, controlled, non-inferiority trial. Front Endocrinol (Lausanne) 2023;14:1062902. [PMID: 37033228 PMCID: PMC10076701 DOI: 10.3389/fendo.2023.1062902] [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: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open

Karstensen JG, Vilmann P. Historical perspective on needle development: From the past to the future. Best Pract Res Clin Gastroenterol 2022;60-61:101814. [PMID: 36577533 DOI: 10.1016/j.bpg.2022.101814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]

Kanno A, Miwata T, Nagai H, Ikeda E, Ando K, Kawasaki Y, Tada Y, Yokoyama K, Tamada K, Fukushima N, Kawarai Lefor A, Yamamoto H. Endoscopic ultrasound-guided pancreatic sampling for the histopathological diagnosis of autoimmune pancreatitis. Dig Endosc 2022;34:420-427. [PMID: 34233051 DOI: 10.1111/den.14076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]

Kassirian S, Mitchell MA, McCormack DG, Zeman-Pocrnich C, Dhaliwal I. Rapid On-site Evaluation (ROSE) in Capillary Pull Versus Suction Biopsy Technique With Endobronchial Ultrasound-transbronchial Needle Aspiration (EBUS-TBNA). J Bronchology Interv Pulmonol 2022;29:48-53. [PMID: 34010221 DOI: 10.1097/lbr.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]

Kanno A, Ikeda E, Ando K, Nagai H, Miwata T, Kawasaki Y, Tada Y, Yokoyama K, Numao N, Ushio J, Tamada K, Lefor AK, Yamamoto H. The Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasonography. Diagnostics (Basel) 2020;10:diagnostics10121005. [PMID: 33255660 PMCID: PMC7760882 DOI: 10.3390/diagnostics10121005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open

Affiliation(s)

Atsushi Kanno Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.) Correspondence: ; Tel.: +81-285-58-7348; Fax: 81-285-44-8297
Eriko Ikeda Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Kozue Ando Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Hiroki Nagai Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Tetsuro Miwata Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Yuki Kawasaki Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Yamato Tada Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Kensuke Yokoyama Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Norikatsu Numao Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Jun Ushio Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Kiichi Tamada Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)
Alan Kawarai Lefor Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Japan;
Hironori Yamamoto Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke 329-0498, Japan; (E.I.); (K.A.); (H.N.); (T.M.); (Y.K.); (Y.T.); (K.Y.); (N.N.); (J.U.); (K.T.); (H.Y.)

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Xie C, Bohy K, Abdallah MA, Patel B, Nelson ME, Bleeker J, Askeland R, Abdullah A, Aloreidi K, Kiani R, Atiq M. Finding a needle in a haystack: Endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic masses in the setting of chronic pancreatitis. Ann Gastroenterol 2020;33:418-425. [PMID: 32624664 PMCID: PMC7315714 DOI: 10.20524/aog.2020.0484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/05/2020] [Indexed: 12/22/2022] Open

Castellani D, Germani U, Bassotti G, Manta R. EUS Standard Devices. ENDOTHERAPY IN BILIOPANCREATIC DISEASES: ERCP MEETS EUS 2020:47-63. [DOI: 10.1007/978-3-030-42569-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]

Indications and Techniques of Fine-Needle Aspiration of the Pancreas. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-3-030-22433-2_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Asokkumar R, Yung Ka C, Loh T, Kah Ling L, Gek San T, Ying H, Tan D, Khor C, Lim T, Soetikno R. Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a randomized study. Endosc Int Open 2019;7:E955-E963. [PMID: 31367675 PMCID: PMC6656554 DOI: 10.1055/a-0903-2565] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/18/2019] [Indexed: 12/11/2022] Open

Abstract

Background and study aims Recently, a new Franseen design endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle was developed with the goal of providing more tissue for histology. We compared the tissue adequacy rate and nucleic acid yield of 22G EUS-FNB vs. 22G endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), in solid gastrointestinal and extra-intestinal lesions. Patients and methods We conducted a randomized crossover study and recruited 36 patients. We performed three passes for pancreatic lesions and two passes for other lesions, using each needle. We blinded the pathologist to needle assignment. We assessed the diagnostic tissue adequacy rate and compared the total tissue area, diagnostic tissue area, and desmoplastic stroma (DS) area in cases of carcinoma. We also examined the nucleic acid yield of the two needles in pancreatic lesions. Results The lesions included 20 pancreatic masses (55 %), six gastric subepithelial lesions (17 %), five lymph nodes (14 %) and five other abdominal masses (14 %). Mean ± SD lesion size was 3.8 ± 2.0 cm. The final diagnosis was malignant in 27 lesions (75 %) and benign in nine lesions (25 %). We found EUS-FNB procured significantly more median total tissue area (5.2 mm ² vs. 1.9 mm ² , P < 0.001), diagnostic tissue area (2.2 mm ² vs. 0.9 mm ² , P = 0.029), and DS area (2 mm ² vs. 0.1 mm ² , P = 0.001) in lesions diagnosed as carcinoma (n = 23), as compared to EUS-FNA. In pancreatic lesions, EUS-FNB obtained significantly more nucleic acid than EUS-FNA (median; 4,085 ng vs. 2912 ng, P = 0.02). There was no difference in the cellblock or rapid on-site cytological evaluation (ROSE) diagnostic yield between the needles. Conclusion The 22G EUS-FNB provides more histological core tissue and adequate nucleic acid yield compared to 22G EUS-FNA. In this study, the diagnostic performance was similar between the needles.

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Pih GY, Kim DH. Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors. Clin Endosc 2019;52:314-320. [PMID: 31370379 PMCID: PMC6680013 DOI: 10.5946/ce.2019.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022] Open

Mitselos IV, Karoumpalis I, Theopistos VI, Tzilves D, Christodoulou DK. Endoscopic ultrasonography in pancreatic diseases: advances in tissue acquisition. Endosc Int Open 2019;7:E922-E930. [PMID: 31304238 PMCID: PMC6624111 DOI: 10.1055/a-0915-9594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open

Lee KY, Cho HD, Hwangbo Y, Yang JK, Han SJ, Choi HJ, Lee YN, Cha SW, Moon JH, Cho YD, Park SH, Lee TH. Efficacy of 3 fine-needle biopsy techniques for suspected pancreatic malignancies in the absence of an on-site cytopathologist. Gastrointest Endosc 2019;89:825-831.e1. [PMID: 30403966 DOI: 10.1016/j.gie.2018.10.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/24/2018] [Indexed: 02/08/2023]

Rana A, Rana SS. Endoscopic Ultrasound-Guided Tissue Acquisition: Techniques and Challenges. J Cytol 2019;36:1-7. [PMID: 30745731 PMCID: PMC6343389 DOI: 10.4103/joc.joc_146_18] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open

The Use of a Stylet in Endoscopic Ultrasound With Fine-Needle Aspiration: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2019. [PMID: 28644309 DOI: 10.1097/mcg.0000000000000867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]

Abstract

BACKGROUND

Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is the most efficacious way to collect specimens from a solid lesion adjacent to the gastrointestinal tract and is performed with an internal stylet during puncture. However, its reinsertion into the needle is time-consuming. Controversy surrounds whether quality of cytology specimen improves with stylet use. We performed a meta-analysis comparing the use of stylet versus no stylet with EUS-FNA of gastrointestinal-related masses.

METHODS

Multiple databases were searched from inception until April 28, 2016. Discordant findings from independent extractions were reviewed by at least 2 investigators. Methods were executed as per the standards of the Cochrane Collaboration. Primary outcomes assessed were diagnostic adequacy of individual specimen samples, accuracy, and yield. Secondary outcomes included overall diagnostic accuracy of per-malignant lesion, cellularity, contamination, and bloodiness of the sample, and adverse events.

RESULTS

Five randomized control trials were identified comparing stylet versus no stylet use, which enrolled 504 patients, evaluated 537 lesions, and 1914 distinct specimens. There was no difference in diagnostic adequacy [risk ratio (RR)=1.00; 95% confidence interval (CI), 0.95-1.07], accuracy (RR=0.98; 95% CI, 0.90-1.06), or yield (RR=0.96; 95% CI, 0.89-1.03). No stylet use was favored in per-lesion malignant diagnosis (RR=0.85; 95% CI, 0.76-0.96). There was no difference in representative cellularity, contamination, or bloodiness of specimens obtained with or without stylet use.

CONCLUSIONS

Stylet use confers no significant advantage in diagnostic adequacy, accuracy, yield, contamination, bloodiness, or cellularity over no stylet. We reinforce that no stylet use may be used preferentially in EUS-FNA as a more convenient technique and is favored with a higher per-lesion malignant diagnosis.

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Lee JM, Lee HS, Hyun JJ, Lee JM, Yoo IK, Kim SH, Choi HS, Kim ES, Keum B, Seo YS, Jeen YT, Chun HJ, Um SH, Kim CD. Slow-Pull Using a Fanning Technique Is More Useful Than the Standard Suction Technique in EUS-Guided Fine Needle Aspiration in Pancreatic Masses. Gut Liver 2018;12:360-366. [PMID: 29409303 PMCID: PMC5945268 DOI: 10.5009/gnl17140] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/09/2017] [Accepted: 09/20/2017] [Indexed: 12/21/2022] Open

Affiliation(s)

Jae Min Lee Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Hong Sik Lee Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Jong Jin Hyun Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Jung Min Lee Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
In Kyung Yoo Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Seung Han Kim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Hyuk Soon Choi Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Eun Sun Kim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Bora Keum Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Yeon Seok Seo Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Yoon Tae Jeen Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Hoon Jai Chun Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Soon Ho Um Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Chang Duck Kim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

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Marshall C, Mounzer R, Hall M, Simon V, Centeno B, Dennis K, Dhillon J, Fan F, Khazai L, Klapman J, Komanduri S, Lin X, Lu D, Mehrotra S, Muthusamy VR, Nayar R, Paintal A, Rao J, Sams S, Shah J, Watson R, Rastogi A, Wani S. Suboptimal Agreement Among Cytopathologists in Diagnosis of Malignancy Based on Endoscopic Ultrasound Needle Aspirates of Solid Pancreatic Lesions: A Validation Study. Clin Gastroenterol Hepatol 2018;16:1114-1122.e2. [PMID: 28911946 DOI: 10.1016/j.cgh.2017.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/17/2017] [Accepted: 09/03/2017] [Indexed: 02/06/2023]

Abstract

BACKGROUND & AIMS

Despite the widespread use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to sample pancreatic lesions and the standardization of pancreaticobiliary cytopathologic nomenclature, there are few data on inter-observer agreement among cytopathologists evaluating pancreatic cytologic specimens obtained by EUS-FNA. We developed a scoring system to assess agreement among cytopathologists in overall diagnosis and quantitative and qualitative parameters, and evaluated factors associated with agreement.

METHODS

We performed a prospective study to validate results from our pilot study that demonstrated moderate to substantial inter-observer agreement among cytopathologists for the final cytologic diagnosis. In the first phase, 3 cytopathologists refined criteria for assessment of quantity and quality measures. During phase 2, EUS-FNA specimens of solid pancreatic lesions from 46 patients were evaluated by 11 cytopathologists at 5 tertiary care centers using a standardized scoring tool. Individual quantitative and qualitative measures were scored and an overall cytologic diagnosis was determined. Clinical and EUS parameters were assessed as predictors of unanimous agreement. Inter-observer agreement (IOA) was calculated using multi-rater kappa (κ) statistics and a logistic regression model was created to identify factors associated with unanimous agreement.

RESULTS

The IOA for final diagnoses, based on cytologic analysis, was moderate (κ = 0.56; 95% CI, 0.43-0.70). Kappa values did not increase when categories of suspicious for malignancy, malignant, and neoplasm were combined. IOA was slight to moderate for individual quantitative (κ = 0.007; 95% CI, -0.03 to -0.04) and qualitative parameters (κ = 0.5; 95% CI, 0.47-0.53). Jaundice was the only factor associated with agreement among all cytopathologists on multivariate analysis (odds ratio for unanimous agreement, 5.3; 95% CI, 1.1-26.89).

CONCLUSIONS

There is a suboptimal level of agreement among cytopathologists in the diagnosis of malignancy based on analysis of EUS-FNA specimens obtained from solid pancreatic masses. Strategies are needed to refine the cytologic criteria for diagnosis of malignancy and enhance tissue acquisition techniques to improve diagnostic reproducibility among cytopathologists.

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Affiliation(s)

Carrie Marshall Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Rawad Mounzer Digestive Institute, Banner - University Medical Center, Phoenix, Arizona
Matt Hall Children's Hospital Association, Overland Park, Kansas
Violette Simon Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Barbara Centeno Department of Pathology, Moffitt Cancer Center, Tampa, Florida
Katie Dennis Department of Pathology, University of Kansas School of Medicine, Kansas City, Kansas
Jasreman Dhillon Department of Pathology, Moffitt Cancer Center, Tampa, Florida
Fang Fan Department of Pathology, University of Kansas School of Medicine, Kansas City, Kansas
Laila Khazai Department of Pathology, Moffitt Cancer Center, Tampa, Florida
Jason Klapman Gastrointestinal Tumor Program, Moffitt Cancer Center, Tampa, Florida
Srinadh Komanduri Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
Xiaoqi Lin Department of Pathology, Northwestern University, Chicago, Illinois
David Lu Department of Pathology, University of California Los Angeles, Los Angeles, California
Sanjana Mehrotra Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
V Raman Muthusamy Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
Ritu Nayar Department of Pathology, Northwestern University, Chicago, Illinois
Ajit Paintal Department of Pathology, Northwestern University, Chicago, Illinois
Jianyu Rao Department of Pathology, University of California Los Angeles, Los Angeles, California
Sharon Sams Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Janak Shah Division of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana
Rabindra Watson Vatche and Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
Amit Rastogi Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas
Sachin Wani Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

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Rapid on-site evaluation during endoscopic ultrasound-guided fine-needle aspiration of lymph nodes does not increase diagnostic yield: A randomized, multicenter trial. Am J Gastroenterol 2018;113:677-685. [PMID: 29681624 DOI: 10.1038/s41395-018-0025-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022]

Abstract

OBJECTIVES

Studies on the impact of rapid on-site evaluation (ROSE) during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of lymph nodes are retrospective and have shown conflicting results. We aimed to compare the diagnostic yield of EUS-FNA of lymph nodes with ROSE (ROSE+) and without ROSE (ROSE-).

METHODS

This was a multicenter, randomized controlled trial. Consecutive patients who were scheduled to undergo EUS-FNA of mediastinal or abdominal lymph nodes were randomized to ROSE+ or ROSE-. In the ROSE+ group, the number of passes was dictated by the on-site cytotechnician. In the ROSE- group, five passes were performed without interference from the cytotechnician. All samples were reviewed by a single-expert cytopathologist, blinded to group allocation. Primary endpoint was diagnostic yield with and without ROSE.

RESULTS

After inclusion of 90 patients, interim analysis showed futility of study continuation since diagnostic yield of ROSE+ and ROSE- were comparable. A total of 91 patients were randomized to ROSE+ (N = 45) or ROSE- (N = 46). Diagnostic yield of ROSE+ and ROSE- and diagnostic accuracy were comparable: 93.3% vs. 95.7% (P = 0.68) and 97.6% vs. 93.2% (P = 0.62), respectively. Two major complications (one per group) occurred (p = 0.99). ROSE- patients more often reported self-limiting post-procedural pain (p < 0.001). Median procedure time for ROSE+ (20 min) and ROSE- (23 min) was comparable (P = 0.06). Median time to review slides in the ROSE- group (12:47 min) was longer than with ROSE+ (7:52 min) (P < 0.001). Mean costs of ROSE- and ROSE+ were comparable: €938.29 (±172.70) vs. €945.98 (±223.38) (P = 0.91), respectively.

CONCLUSIONS

Diagnostic yield and accuracy of EUS-FNA of mediastinal and abdominal lymph nodes with and without ROSE are comparable. Time needed to review slides was shorter and post-procedural pain was less often reported in the ROSE+ group. Based on the primary outcome, the implementation of ROSE during EUS-FNA of mediastinal and abdominal lymph nodes cannot be advised. (Dutch Trial Register: NTR4876).

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Cazacu IM, Luzuriaga Chavez AA, Saftoiu A, Vilmann P, Bhutani MS. A quarter century of EUS-FNA: Progress, milestones, and future directions. Endosc Ultrasound 2018;7:141-160. [PMID: 29941723 PMCID: PMC6032705 DOI: 10.4103/eus.eus_19_18] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open

Yang MJ, Hwang JC, Yoo BM, Kim JH, Lee D, Lim H, Kim YB. A prospective randomized trial of EUS-guided tissue acquisition using a 25-gauge core biopsy needle with and without a stylet. Surg Endosc 2018;32:3777-3782. [DOI: 10.1007/s00464-018-6166-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/21/2018] [Indexed: 02/07/2023]

Diehl DL, Mok SRS, Khara HS, Johal AS, Kirchner HL, Lin F. Heparin priming of EUS-FNA needles does not adversely affect tissue cytology or immunohistochemical staining. Endosc Int Open 2018;6:E356-E362. [PMID: 29527558 PMCID: PMC5842078 DOI: 10.1055/s-0043-121880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/31/2017] [Indexed: 12/27/2022] Open

Carrara S, Auriemma F, Varadarajulu S. Advances in endoscopic ultrasound-guided tissue acquisition. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]

Haghighi M, Packey C, Gonda TA. Endoscopic Ultrasonography with Fine-needle Aspiration: New Techniques for Interpretation of Endoscopic Ultrasonography Cytology and Histology Specimens. Gastrointest Endosc Clin N Am 2017;27:601-614. [PMID: 28918801 DOI: 10.1016/j.giec.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Bansal RK, Choudhary NS, Puri R, Patle SK, Bhagat S, Nasa M, Bhasin A, Sarin H, Guleria M, Sud R. Comparison of endoscopic ultrasound-guided fine-needle aspiration by capillary action, suction, and no suction methods: a randomized blinded study. Endosc Int Open 2017;5:E980-E984. [PMID: 28983505 PMCID: PMC5628048 DOI: 10.1055/s-0043-116383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/23/2017] [Indexed: 12/29/2022] Open

New Developments in Endoscopic Ultrasound Tissue Acquisition. Gastrointest Endosc Clin N Am 2017;27:585-599. [PMID: 28918800 DOI: 10.1016/j.giec.2017.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Artifon ELA, Guedes HG, Cheng S. Maximizing the Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy. Gastroenterology 2017;153:881-885. [PMID: 28867271 DOI: 10.1053/j.gastro.2017.08.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Mohamadnejad M, Mullady D, Early DS, Collins B, Marshall C, Sams S, Yen R, Rizeq M, Romanas M, Nawaz S, Ulusarac O, Hollander T, Wilson RH, Simon VC, Kushnir V, Amateau SK, Brauer BC, Gaddam S, Azar RR, Komanduri S, Shah R, Das A, Edmundowicz S, Muthusamy VR, Rastogi A, Wani S. Increasing Number of Passes Beyond 4 Does Not Increase Sensitivity of Detection of Pancreatic Malignancy by Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Clin Gastroenterol Hepatol 2017;15:1071-1078.e2. [PMID: 28025154 DOI: 10.1016/j.cgh.2016.12.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]

Abstract

BACKGROUND & AIMS

It is not clear exactly how many passes are required to determine whether pancreatic masses are malignant using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We aimed to define the per-pass diagnostic yield of EUS-FNA for establishing the malignancy of a pancreatic mass, and identify factors associated with detection of malignancies.

METHODS

In a prospective study, 239 patients with solid pancreatic masses were randomly assigned to groups that underwent EUS-FNA, with the number of passes determined by an on-site cytopathology evaluation or set at 7 passes, at 3 tertiary referral centers. A final diagnosis of pancreatic malignancy was made based on findings from cytology, surgery, or a follow-up evaluation at least 1 year after EUS-FNA. The cumulative sensitivity of detection of malignancy by EUS-FNA was calculated after each pass; in the primary analysis, lesions categorized as malignant or suspicious were considered as positive findings.

RESULTS

Pancreatic malignancies were found in 202 patients (84.5% of the study population). EUS-FNA detected malignancies with 96% sensitivity (95% confidence interval [CI], 92%-98%); 4 passes of EUS-FNA detected malignancies with 92% sensitivity (95% CI, 87%-95%). Tumor size greater than 2 cm was the only variable associated with positive results from cytology analysis (odds ratio, 7.8; 95% CI, 1.9-31.6). In masses larger than 2 cm, 4 passes of EUS-FNA detected malignancies with 93% sensitivity (95% CI, 89%-96%) and in masses ≤2 cm, 6 passes was associated with 82% sensitivity (95% CI, 61%-93%). Sensitivity of detection did not increase with increasing number of passes.

CONCLUSIONS

In a prospective study, we found 4 passes of EUS-FNA to be sufficient to detect malignant pancreatic masses; increasing the number of passes did not increase the sensitivity of detection. Tumor size greater than 2 cm was associated with malignancy, and a greater number of passes may be required to evaluate masses 2 cm or less. ClinicalTrials.gov number, NCT01386931.

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Affiliation(s)

Mehdi Mohamadnejad University of California, Los Angeles, Los Angeles, California; Liver and Pancreatobiliary Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Science, Tehran, Iran
Daniel Mullady Washington University School of Medicine, St. Louis, Missouri
Dayna S Early Washington University School of Medicine, St. Louis, Missouri
Brian Collins Washington University School of Medicine, St. Louis, Missouri
Carrie Marshall University of Colorado Anschutz Medical Campus, Aurora, Colorado
Sharon Sams University of Colorado Anschutz Medical Campus, Aurora, Colorado
Roy Yen University of Colorado Anschutz Medical Campus, Aurora, Colorado
Mona Rizeq University of Colorado Anschutz Medical Campus, Aurora, Colorado
Maria Romanas Kansas City VA Medical Center and University of Kansas, Kansas City, Missouri
Samia Nawaz University of Colorado Anschutz Medical Campus, Aurora, Colorado
Ozlem Ulusarac Kansas City VA Medical Center and University of Kansas, Kansas City, Missouri
Thomas Hollander Washington University School of Medicine, St. Louis, Missouri
Robert H Wilson University of Colorado Anschutz Medical Campus, Aurora, Colorado
Violette C Simon University of Colorado Anschutz Medical Campus, Aurora, Colorado
Vladimir Kushnir Washington University School of Medicine, St. Louis, Missouri
Stuart K Amateau University of Colorado Anschutz Medical Campus, Aurora, Colorado
Brian C Brauer University of Colorado Anschutz Medical Campus, Aurora, Colorado
Srinivas Gaddam Washington University School of Medicine, St. Louis, Missouri
Riad R Azar Washington University School of Medicine, St. Louis, Missouri
Srinadh Komanduri Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Raj Shah University of Colorado Anschutz Medical Campus, Aurora, Colorado
Ananya Das Arizona Center for Digestive Health, Gilbert, Arizona
Steven Edmundowicz University of Colorado Anschutz Medical Campus, Aurora, Colorado
V Raman Muthusamy University of California, Los Angeles, Los Angeles, California
Amit Rastogi Kansas City VA Medical Center and University of Kansas, Kansas City, Missouri
Sachin Wani University of Colorado Anschutz Medical Campus, Aurora, Colorado.

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Bhatia V, Varadarajulu S. Endoscopic ultrasonography-guided tissue acquisition: How to achieve excellence. Dig Endosc 2017;29:417-430. [PMID: 28140485 DOI: 10.1111/den.12823] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/25/2017] [Indexed: 02/08/2023]

Wang R, Wang J, Li Y, Duan Y, Wu X, Cheng B. Diagnostic accuracies of endoscopic ultrasound-guided fine-needle aspiration with distinct negative pressure suction techniques in solid lesions: A retrospective study. Oncol Lett 2017;13:3709-3716. [PMID: 28521473 DOI: 10.3892/ol.2017.5942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/01/2017] [Indexed: 12/14/2022] Open

Abstract

Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) is highly accurate in obtaining specific diagnoses for various diseases. The present study aimed to evaluate the diagnostic yields, accuracies and sampling adequacies, of slow-pull, 5 ml suction and 10 ml suction techniques in EUS-FNA of solid lesions. The present study was a retrospective comparative study, which was performed in tertiary academic centers, recognized for their expertise in EUS and EUS-guided FNA. The present study involved 149 patients who underwent EUS-FNA of solid masses. A total of 34 (22.8%), 37 (24.8%) and 78 (52.4%) patients underwent EUS-FNA with slow-pull, 5 ml suction and 10 ml suction techniques, respectively. The EUS-FNA cytology and histology results were compared with those from the gold standard of surgical histopathology [hematoxylin-eosin staining; immunohistochemical test of cluster of differentiation (CD) 79a, CD20 and flow cytometry test] or long-term clinical follow-up. The present retrospective comparative study demonstrated that the diagnostic yields and accuracies of EUS-FNA with slow-pull (86.1%) were significantly superior to those achieved with 5 ml suction (83.3%) or 10 ml suction (69.9%; P<0.0001; χ2 test). Consistently, 86.5% (32/37) of the samples obtained from the 5 ml suction group were adequate for histological diagnosis. By contrast, 70.6 (24/34) and 85.9% (67/78) of samples from the slow-pull and 10 ml suction groups were adequate for histological diagnosis, respectively. The samples obtained using 10 ml suction contained more blood compared with those obtained via slow-pull and 5 ml suction (P=0.0056; χ2 test). No complications were noted in any of the three groups. The samples that were obtained for histopathological diagnosis using 5 ml suction were superior to those obtained using slow-pull or 10 ml suction. Additional multi-central prospective studies in which EUS-FNA is performed with variable negative pressures are required to improve the defining of the diagnostic roles of those techniques.

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Prepared by EUS Academic group of Chinese Society of Digestive Endoscopy, Ge N, Zhang S, Jin Z, Sun S, Yang A, Wang B, Wang G, Xu G, Hao J, Zhong L, Zhong N, Li P, Zhu Q, Nian W, Li W, Zhang X, Zhou X, Yang X, Cui Y, Ding Z. Clinical use of endoscopic ultrasound-guided fine-needle aspiration: Guidelines and recommendations from Chinese Society of Digestive Endoscopy. Endosc Ultrasound 2017;6:75-82. [PMID: 28440232 PMCID: PMC5418971 DOI: 10.4103/eus.eus_20_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open

Affiliation(s)

Prepared by EUS Academic group of Chinese Society of Digestive Endoscopy
Nan Ge Department of Endoscopy, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China
Shutian Zhang Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Zhendong Jin Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
Siyu Sun Department of Endoscopy, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China
Aiming Yang Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
Bangmao Wang Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
Guiqi Wang Department of Endoscopy, Chinese Academy of Medical Sciences, Beijing, China
Guoqiang Xu Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
Jianyu Hao Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
Liang Zhong Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
Ning Zhong Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
Peng Li Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Qi Zhu Department of Endoscopy, Shanghai Jiao Tong University, Shanghai, China
Weidong Nian Department of General Surgery, Peking University Hospital, Beijing, China
Wen Li Department of Gastroenterology, Tianjin Nankai Hospital, Tianjin, China
Xiaofeng Zhang Department of Gastroenterology, The First People's Hospital of Hangzhou, Nanjing Medical University, Hangzhou, Zhejiang Province, China
Xiaoping Zhou Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu Province, China
Xiujiang Yang Department of Endoscopy, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
Yi Cui Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
Zhen Ding Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

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Hwang JH, Aslanian HR, Thosani N, Goodman A, Manfredi M, Navaneethan U, Pannala R, Parsi MA, Smith ZL, Sullivan SA, Banerjee S, Maple JT. Devices for use with EUS. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2017;2:35-45. [PMID: 29905238 PMCID: PMC5990542 DOI: 10.1016/j.vgie.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]

Storm AC, Lee LS. Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better? World J Gastroenterol 2016;22:8658-8669. [PMID: 27818584 PMCID: PMC5075543 DOI: 10.3748/wjg.v22.i39.8658] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open

Kim JH, Park SW, Kim MK, Lee J, Kae SH, Jang HJ, Koh DH, Choi MH. Meta-Analysis for Cyto-Pathological Outcomes in Endoscopic Ultrasonography-Guided Fine-Needle Aspiration With and Without the Stylet. Dig Dis Sci 2016;61:2175-2184. [PMID: 27010546 DOI: 10.1007/s10620-016-4130-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/10/2016] [Indexed: 12/20/2022]

The slow-pull capillary technique increases the quality of endoscopic ultrasound fine needle biopsy samples in solid pancreatic lesions. Eur J Gastroenterol Hepatol 2016;28:911-6. [PMID: 27140228 DOI: 10.1097/meg.0000000000000638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]

Mounzer R, Yen R, Marshall C, Sams S, Mehrotra S, Said MS, Obuch JC, Brauer B, Attwell A, Fukami N, Shah R, Amateau S, Hall M, Hosford L, Wilson R, Rastogi A, Wani S. Interobserver agreement among cytopathologists in the evaluation of pancreatic endoscopic ultrasound-guided fine needle aspiration cytology specimens. Endosc Int Open 2016;4:E812-9. [PMID: 27556103 PMCID: PMC4993880 DOI: 10.1055/s-0042-108188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 04/25/2016] [Indexed: 12/18/2022] Open

Abstract

BACKGROUND AND AIMS

Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has become the standard of care in the evaluation of solid pancreatic lesions. Limited data exist on interobserver agreement (IOA) among cytopathologists in assessing solid pancreatic EUS-FNA specimens. This study aimed to evaluate IOA among cytopathologists in assessing EUS-FNA cytology specimens of solid pancreatic lesions using a novel standardized scoring system and to assess individual clinical and cytologic predictors of IOA.

METHODS

Consecutive patients who underwent EUS-FNA of solid pancreatic lesions at a tertiary care referral center were included. EUS-FNA slides were evaluated by four blinded cytopathologists using a standardized scoring system that assessed final cytologic diagnosis and quantitative (number of nucleated/diagnostic cells) and qualitative (bloodiness, inflammation/necrosis, contamination, artifact) cytologic parameters. Final clinical diagnosis was based on final cytology, surgical pathology, or 1-year clinical follow-up. IOA was calculated using multi-rater kappa (κ) statistics. Bivariate analyses were performed comparing cases with and without uniform agreement among the cytopathologists followed by logistic regression with backward elimination to model likelihood of uniform agreement.

RESULTS

Ninety-nine patients were included (49 % males, mean age 64 years, mean lesion size 26 mm). IOA for final diagnosis was moderate (κ = 0.45, 95 % confidence interval (CI) 0.4 - 0.49) with minimal improvement when combining suspicious and malignant diagnoses (κ = 0.54, 95 %CI 0.49 - 0.6). The weighted kappa value for overall diagnosis was 0.65 (95 %CI 0.54 - 0.76). IOA was slight to fair (κ = 0.04 - 0.32) for individual cytologic parameters. A final clinical diagnosis of malignancy was the most significant predictor of agreement [OR 3.99 (CI 1.52 - 10.49)].

CONCLUSIONS

Interobserver agreement among cytopathologists for pancreatic EUS-FNA specimens is moderate-substantial for the final cytologic diagnosis. The final clinical diagnosis of malignancy was the strongest predictor of agreement. These results have significant implications for patient management and need to be validated in future trials.

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Affiliation(s)

Rawad Mounzer Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Roy Yen Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Carrie Marshall Department of Pathology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Sharon Sams Department of Pathology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Sanjana Mehrotra Department of Pathology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Mohamed Sherif Said Department of Pathology, Denver Health Medical Center, Denver, CO, USA
Joshua C. Obuch Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Brian Brauer Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Augustin Attwell Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Norio Fukami Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Raj Shah Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Stuart Amateau Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Matthew Hall Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Lindsay Hosford Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Robert Wilson Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Amit Rastogi Division of Gastroenterology, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MO, USA
Sachin Wani Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA,Corresponding author Sachin Wani, MD Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterMail Stop F7351635 Aurora CourtRm 2.031AuroraCO 80045USA+1-720-848-2749

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Kamata K, Kitano M, Omoto S, Kadosaka K, Miyata T, Minaga K, Yamao K, Imai H, Kudo M. New endoscopic ultrasonography techniques for pancreaticobiliary diseases. Ultrasonography 2016;35:169-79. [PMID: 27214660 PMCID: PMC4939715 DOI: 10.14366/usg.15042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 12/20/2022] Open

Jani BS, Rzouq F, Saligram S, Lim D, Rastogi A, Bonino J, Olyaee M. Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions: A Systematic Review of Technical and Procedural Variables. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016;8:1-11. [PMID: 27011940 PMCID: PMC4784176 DOI: 10.4103/1947-2714.175185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses. Dig Dis Sci 2016;61:890-9. [PMID: 26346997 PMCID: PMC4976479 DOI: 10.1007/s10620-015-3860-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022]

Matsubayashi H, Matsui T, Yabuuchi Y, Imai K, Tanaka M, Kakushima N, Sasaki K, Ono H. Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis. World J Gastroenterol 2016;22:628-640. [PMID: 26811612 PMCID: PMC4716064 DOI: 10.3748/wjg.v22.i2.628] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/20/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open

Holt BA, Varadarajulu S. Endoscopic ultrasound: a primer for pathologists. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.mpdhp.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]

Abe Y, Kawakami H, Oba K, Hayashi T, Yasuda I, Mukai T, Isayama H, Ishiwatari H, Doi S, Nakashima M, Yamamoto N, Kuwatani M, Mitsuhashi T, Hasegawa T, Hirose Y, Yamada T, Tanaka M, Sakamoto N. Effect of a stylet on a histological specimen in EUS-guided fine-needle tissue acquisition by using 22-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2015;82:837-844.e1. [PMID: 25936452 DOI: 10.1016/j.gie.2015.03.1898] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/05/2015] [Indexed: 12/15/2022]

Abstract

BACKGROUND

EUS-guided FNA (EUS-FNA) has become the most efficacious way to obtain specimens from a solid lesion adjacent to the GI tract. Previous reports regarding the use of a stylet during EUS-FNA were all based on cytological diagnosis and have showed no significant superiority in terms of diagnostic yield.

OBJECTIVE

To clarify the noninferiority of EUS-FNA without a stylet (S-) compared with EUS-FNA with a stylet (S+) on histological assessment.

DESIGN

A prospective, single-blind, randomized, controlled crossover study.

SETTING

Five tertiary referral centers in Japan.

PATIENTS

Patients referred for EUS-FNA of a solid lesion.

INTERVENTION

EUS-FNA S+ and S- in a total of 4 alternate passes with randomization to S+ first or S- first.

MAIN OUTCOME MEASUREMENTS

The primary endpoint was the acquisition rate of an appropriate and sufficient specimen for histological assessment. The secondary endpoints were cellularity, contamination, bloodiness, diagnostic ability, and diagnostic accuracy.

RESULTS

We enrolled 107 patients (110 lesions) and analyzed 220 specimens each in the S+ and S- groups. The acquisition rate of appropriate and sufficient specimens in the S+ group was 121 of 220 (55.0%) and 122 of 220 (55.5%) in the S- group. The difference in the acquisition rate of the specimen (S- minus S+) based on the generalized estimating equation was 0.42% (95% confidence interval, -6.72% to 7.56%), which was less than 10% of the prespecified noninferiority margin of this study. With regard to cellularity, contamination, bloodiness score, diagnostic ability, and diagnostic accuracy, there were no significant differences between both groups. There were no dropouts in the study.

LIMITATIONS

A variety of target lesions, multiple pathologists, lack of an assessment of intraobserver and interobserver variability, and a single-blind study for the pathologists.

CONCLUSION

EUS-FNA S- is noninferior to EUS-FNA S+ on histological assessment. (

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000008695.).

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The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: a prospective multicenter randomized controlled trial. Am J Gastroenterol 2015;110:1429-39. [PMID: 26346868 DOI: 10.1038/ajg.2015.262] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/01/2015] [Indexed: 12/11/2022]

Abstract

OBJECTIVES

Observational data on the impact of on-site cytopathology evaluation (OCE) during endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic masses have reported conflicting results. We aimed to compare the diagnostic yield of malignancy and proportion of inadequate specimens between patients undergoing EUS-FNA of pancreatic masses with and without OCE.

METHODS

In this multicenter randomized controlled trial, consecutive patients with solid pancreatic mass underwent randomization for EUS-FNA with or without OCE. The number of FNA passes in the OCE+ arm was dictated by the on-site cytopathologist, whereas seven passes were performed in OCE- arm. EUS-FNA protocol was standardized, and slides were reviewed by cytopathologists using standardized criteria for cytologic characteristics and diagnosis.

RESULTS

A total of 241 patients (121 OCE+, 120 OCE-) were included. There was no difference between the two groups in diagnostic yield of malignancy (OCE+ 75.2% vs. OCE- 71.6%, P=0.45) and proportion of inadequate specimens (9.8 vs. 13.3%, P=0.31). Procedures in OCE+ group required fewer EUS-FNA passes (median, OCE+ 4 vs. OCE- 7, P<0.0001). There was no significant difference between the two groups with regard to overall procedure time, adverse events, number of repeat procedures, costs (based on baseline cost-minimization analysis), and accuracy (using predefined criteria for final diagnosis of malignancy). There was no difference between the two groups with respect to cytologic characteristics of cellularity, bloodiness, number of cells/slide, and contamination.

CONCLUSIONS

Results of this study demonstrated no significant difference in the diagnostic yield of malignancy, proportion of inadequate specimens, and accuracy in patients with pancreatic mass undergoing EUS-FNA with or without OCE.

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Gonçalves B, Soares JB, Bastos P. Endoscopic Ultrasound in the Diagnosis and Staging of Pancreatic Cancer. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015;22:161-171. [PMID: 28868399 PMCID: PMC5580187 DOI: 10.1016/j.jpge.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/23/2015] [Indexed: 02/08/2023]

Huang JYL, Chang KJ. Improvements and innovations in endoscopic ultrasound guided fine needle aspiration. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015;22:E37-E46. [PMID: 25762125 DOI: 10.1002/jhbp.232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/29/2015] [Indexed: 12/11/2022]

Nelsen EM, Buehler D, Soni AV, Gopal DV. Endoscopic ultrasound in the evaluation of pancreatic neoplasms-solid and cystic: A review. World J Gastrointest Endosc 2015;7:318-327. [PMID: 25901210 PMCID: PMC4400620 DOI: 10.4253/wjge.v7.i4.318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/31/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open

Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Am J Gastroenterol 2015;110:102-13. [PMID: 25448871 DOI: 10.1038/ajg.2014.387] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]