|
1
|
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
Abstract
Tissue acquisition using EUS has considerably evolved since the first EUS-FNA was reported 25 years ago. Its introduction was an important breakthrough in the endoscopic field. EUS-FNA has now become a part of the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of the organs in its proximity, including lung diseases. This review aims to present the history of EUS-FNA development and to provide a perspective on the recent developments in procedural techniques and needle technologies that have significantly extended the role of EUS and its clinical applications. There is a bright future ahead for EUS-FNA in the years to come as extensive research is conducted in this field and various technologies are continuously implemented into clinical practice.
Collapse
Affiliation(s)
- Irina Mihaela Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Gastrounit, Division of Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
|
2
|
Wyse J, Rubino M, Iglesias Garcia J, Sahai AV. Onsite evaluation of endoscopic ultrasound fine needle aspiration: the endosonographer, the cytotechnologist and the cytopathologist. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:279-283. [PMID: 28112962 DOI: 10.17235/reed.2017.4473/2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has become an essential tool in the management of multiple diseases. Its accuracy is related to different aspects of the technique, one of the most important being the experience and interaction of the endosonographer and pathologist. Certain studies over the past years have highlighted the importance of having rapid on-site evaluation (ROSE) of samples obtained at the time of EUS-FNA. We have reviewed the role of ROSE, performed by the same endosonographer, a cytotechnologist and an expert cytopathologist. The available data suggest that ROSE (either by the endosonographer, the cytotechnologist, or the cytopathologist) improves sample adequacy and diagnostic yield, with the best option to have ROSE performed by an expert cytopathologist. However, if non-ROSE accuracy is already very high, any improvement is harder to achieve.
Collapse
Affiliation(s)
- Jonathan Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Canada
| | - Maria Rubino
- Division of Gastroenterology, Jewish General Hospital, McGill University, Canada
| | | | - Anand V Sahai
- Division of Gastroenterology. CHUM, Hospital Saint Luc, Canada
| |
Collapse
|
|
3
|
Sibinga Mulder BG, Mieog JSD, Farina Sarasqueta A, Handgraaf HJM, Vasen HFA, Swijnenburg RJ, Luelmo SAC, Feshtali S, Inderson A, Vahrmeijer AL, Bonsing BA, Wezel TV, Morreau H. Diagnostic value of targeted next-generation sequencing in patients with suspected pancreatic or periampullary cancer. J Clin Pathol 2017; 71:246-252. [DOI: 10.1136/jclinpath-2017-204607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 01/04/2023]
Abstract
AimsRadiological imaging and morphological assessment of cytology material have limitations for preoperative classification of pancreatic or periampullary lesions, often resulting in surgical resection without definitive diagnosis. Our prospective study aims to define the diagnostic value of targeted next-generation sequencing (NGS) of DNA from cytology material.MethodsPatients with a suspect pancreatic or periampullary lesion underwent standard diagnostic evaluation including preoperative morphological cytology assessment. Treatment options for suspect lesions were surgical exploration with possible resection, follow-up or palliation. The cytology samples were analysed with NGS, in which 50 genes were sequenced for the presence of pathogenic variants. The NGS results were integrated with the clinical information during multidisciplinary team meetings, and changes in the treatment plan were scored. Diagnostic accuracy of NGS analysis (malignancy vs benign disease) was calculated.ResultsNGS results of the cytology samples were confirmed in the resection specimens of the first 10 included patients. The integration of the NGS results led to a change in treatment plan in 7 out of 70 patients (from exploration to follow-up, n=4; from follow-up to exploration and resection, n=2; from palliation to resection, n=1). In four patients, the NGS results were contradictory, but did not affect the treatment plan. In the remaining 59 patients, NGS analysis supported the initial treatment plan. The diagnostic accuracy of NGS analysis was 94% (sensitivity=93%; specificity=100%).ConclusionsNGS can change the treatment plan in a significant portion of patients with suspect pancreatic or periampullary lesions. Application of NGS can optimise treatment selection and diminish unnecessary surgeries.
Collapse
|
|
4
|
Ieni A, Barresi V, Todaro P, Caruso RA, Tuccari G. Cell-block procedure in endoscopic ultrasound-guided-fine-needle-aspiration of gastrointestinal solid neoplastic lesions. World J Gastrointest Endosc 2015; 7:1014-1022. [PMID: 26322154 PMCID: PMC4549658 DOI: 10.4253/wjge.v7.i11.1014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 02/05/2023] Open
Abstract
In the present review we have analyzed the clinical applications of endoscopic ultrasound-guided-fine-needle-aspiration (EUS-FNA) and the methodological aspects obtained by cell-block procedure (CBP) in the diagnostic approach to the gastrointestinal neoplastic pathology. CBP showed numerous advantages in comparison to the cytologic routine smears; in particular, better preservation of cell architecture, achievement of routine haematoxylin-eosin staining equivalent to histological slides and possibility to perform immunohistochemistry or molecular analyses represented the most evident reasons to choose this method. Moreover, by this approach, the differential diagnosis of solid gastrointestinal neoplasias may be more easily achieved and the background of contaminant non-neoplastic gastrointestinal avoided. Finally, biological samples collected by EUS-FNA CBP-assisted should be investigated in order to identify and quantify further potential molecular markers.
Collapse
|
|
5
|
Czarnecka K, Yasufuku K. The role of endobronchial ultrasound/esophageal ultrasound for evaluation of the mediastinum in lung cancer. Expert Rev Respir Med 2015; 8:763-76. [PMID: 25395019 DOI: 10.1586/17476348.2014.985210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The introduction: of ultrasound-based, minimally invasive techniques (Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) and Esophageal Ultrasound guided Fine Needle Aspiration) has revolutionized care of patients with lung cancer needing mediastinal lymph node sampling. When combined, the techniques offer safe and accurate assessment of mediastinum, with accuracy surpassing that of the pervious gold standard - cervical mediastinoscopy. EBUS-TBNA can be used for mediastinal restaging in both, patients with suspected recurrence following treatment for primary lung cancer and followingneoadjuvant therapy in preparation for definitive surgical intervention. Both EBUS-TBNA and esophageal ultrasound guided fine needle aspiration techniques have been shown to provide sufficient material for molecular and DNA testing, extending their role beyond initial evaluation of the mediastinum to help direct and personalize medical treatment and predict response to therapy. In the future, assessing sonographic features of lymph nodesmay become useful in predicting nodal metastasis, further increasing the sensitivity of these techniques for detection of metastatic disease.
Collapse
Affiliation(s)
- Kasia Czarnecka
- Division of Respirology and Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | |
Collapse
|
|
6
|
Morotti A, Gned D, Di Martino L, Cristaldi G, Alì A, Nicoli P, Veltri A, Guerrasio A. The challenging diagnosis of pancreatic masses: not all tumors are cancers. Case Rep Med 2015; 2015:832463. [PMID: 25945095 PMCID: PMC4402166 DOI: 10.1155/2015/832463] [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: 11/24/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022] Open
Abstract
In the elderly patients, where biopsy-induced complications could outweigh the benefit, the identification of pancreatic masses is generally referred to as a synonymous of pancreatic cancer and patients are dismissed with no further options than palliative and supportive care. Notwithstanding, not all pancreatic tumors are cancers and therefore alternative diagnoses need to be investigated, especially when patients are unfit for invasive diagnostic procedures. Here, we report a case of an aged patient that was admitted to an internal medicine division for a previously diagnosed pancreatic cancer. The reassessment of the diagnosis has allowed identifying the pancreatic mass as a manifestation of focal pancreatitis in the context of an IgG4-related disease. Accordingly, patient was treated with steroids with rapid clinical improvement. This clinical case suggests that autoimmune diseases should always be considered in the differential diagnosis of pancreatic masses of the elderly.
Collapse
Affiliation(s)
- Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano 10043, Italy
- Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Turin, Orbassano 10043, Italy
| | | | - Gaetano Cristaldi
- Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy
| | - Anna Alì
- Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy
| | - Paolo Nicoli
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano 10043, Italy
| | - Andrea Veltri
- Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Turin, Orbassano 10043, Italy
| | - Angelo Guerrasio
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano 10043, Italy
- Division of Internal Medicine, San Luigi Hospital, Orbassano 10043, Italy
| |
Collapse
|
|
7
|
Grimaldi F, Fazio N, Attanasio R, Frasoldati A, Papini E, Angelini F, Baldelli R, Berretti D, Bianchetti S, Bizzarri G, Caputo M, Castello R, Cremonini N, Crescenzi A, Davì MV, D’Elia AV, Faggiano A, Pizzolitto S, Versari A, Zini M, Rindi G, Öberg K. Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. J Endocrinol Invest 2014; 37:875-909. [PMID: 25038902 PMCID: PMC4159596 DOI: 10.1007/s40618-014-0119-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Franco Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, P.le S.M. della Misericordia, 15-33100, Udine, Italy
| | - Nicola Fazio
- Unit of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | | | - Andrea Frasoldati
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Enrico Papini
- Endocrinology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Francesco Angelini
- Oncology and Hematology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Roberto Baldelli
- Endocrinology Section, Regina Elena National Cancer Institute, Rome, Italy
| | - Debora Berretti
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Sara Bianchetti
- Oncology and Hematology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Giancarlo Bizzarri
- Diagnostic Imaging Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Marco Caputo
- Dipartimento Servizi di Diagnosi e Cura, AUSL 22 Regione Veneto, Bussolengo, VR Italy
| | - Roberto Castello
- Medicina Interna ad indirizzo Endocrinologico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nadia Cremonini
- Endocrinology Unit, Maggiore and Bellaria Hospital, Bologna, Italy
| | - Anna Crescenzi
- Pathology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Maria Vittoria Davì
- Medicina Interna D, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Angela Valentina D’Elia
- Genetic Service, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stefano Pizzolitto
- Pathology Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Annibale Versari
- Nuclear Medicine Service, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Michele Zini
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Guido Rindi
- Institute of Pathology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kjell Öberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden
| |
Collapse
|
|
8
|
Ali A, Brown V, Denley S, Jamieson NB, Morton JP, Nixon C, Graham JS, Sansom OJ, Carter CR, McKay CJ, Duthie FR, Oien KA. Expression of KOC, S100P, mesothelin and MUC1 in pancreatico-biliary adenocarcinomas: development and utility of a potential diagnostic immunohistochemistry panel. BMC Clin Pathol 2014; 14:35. [PMID: 25071419 PMCID: PMC4112611 DOI: 10.1186/1472-6890-14-35] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/16/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pancreatico-biliary adenocarcinomas (PBA) have a poor prognosis. Diagnosis is usually achieved by imaging and/or endoscopy with confirmatory cytology. Cytological interpretation can be difficult especially in the setting of chronic pancreatitis/cholangitis. Immunohistochemistry (IHC) biomarkers could act as an adjunct to cytology to improve the diagnosis. Thus, we performed a meta-analysis and selected KOC, S100P, mesothelin and MUC1 for further validation in PBA resection specimens. METHODS Tissue microarrays containing tumour and normal cores in a ratio of 3:2, from 99 surgically resected PBA patients, were used for IHC. IHC was performed on an automated platform using antibodies against KOC, S100P, mesothelin and MUC1. Tissue cores were scored for staining intensity and proportion of tissue stained using a Histoscore method (range, 0-300). Sensitivity and specificity for individual biomarkers, as well as biomarker panels, were determined with different cut-offs for positivity and compared by summary receiver operating characteristic (ROC) curve. RESULTS The expression of all four biomarkers was high in PBA versus normal ducts, with a mean Histoscore of 150 vs. 0.4 for KOC, 165 vs. 0.3 for S100P, 115 vs. 0.5 for mesothelin and 200 vs. 14 for MUC1 (p < .0001 for all comparisons). Five cut-offs were carefully chosen for sensitivity/specificity analysis. Four of these cut-offs, namely 5%, 10% or 20% positive cells and Histoscore 20 were identified using ROC curve analysis and the fifth cut-off was moderate-strong staining intensity. Using 20% positive cells as a cut-off achieved higher sensitivity/specificity values: KOC 84%/100%; S100P 83%/100%; mesothelin 88%/92%; and MUC1 89%/63%. Analysis of a panel of KOC, S100P and mesothelin achieved 100% sensitivity and 99% specificity if at least 2 biomarkers were positive for 10% cut-off; and 100% sensitivity and specificity for 20% cut-off. CONCLUSION A biomarker panel of KOC, S100P and mesothelin with at least 2 biomarkers positive was found to be an optimum panel with both 10% and 20% cut-offs in resection specimens from patients with PBA.
Collapse
Affiliation(s)
- Asif Ali
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden G61 1QH, UK
| | - Victoria Brown
- Pathology Laboratory, Forth Valley Royal Hospital, Stirling Road, Larbert FK5 4WR, UK
| | - Simon Denley
- West of Scotland Pancreatic Unit and Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - Nigel B Jamieson
- West of Scotland Pancreatic Unit and Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | | | - Colin Nixon
- Beatson Institute for Cancer Research, Glasgow G61 1BD, UK
| | - Janet S Graham
- Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, UK
| | - Owen J Sansom
- Beatson Institute for Cancer Research, Glasgow G61 1BD, UK
| | - C Ross Carter
- West of Scotland Pancreatic Unit and Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - Colin J McKay
- West of Scotland Pancreatic Unit and Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - Fraser R Duthie
- Department of Pathology, Southern General Hospital, Greater Glasgow & Clyde NHS, Glasgow G51 4TF, UK
| | - Karin A Oien
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden G61 1QH, UK
- Department of Pathology, Southern General Hospital, Greater Glasgow & Clyde NHS, Glasgow G51 4TF, UK
| |
Collapse
|
|
9
|
Costache MI, Iordache S, Karstensen JG, Săftoiu A, Vilmann P. Endoscopic ultrasound-guided fine needle aspiration: from the past to the future. Endosc Ultrasound 2014; 2:77-85. [PMID: 24949369 PMCID: PMC4062239 DOI: 10.4103/2303-9027.117691] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 02/20/2013] [Indexed: 12/17/2022] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained through aspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung, etc. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is superior to computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detection of malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist during EUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently the procedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses.
Collapse
Affiliation(s)
- Mădălin-Ionuț Costache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania
| | - Sevastița Iordache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania
| | | | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania ; Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark
| | - Peter Vilmann
- Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark
| |
Collapse
|
|
10
|
Ahmed F. Endoscopic ultrasonography: Challenges and opportunities in the developing world. World J Gastrointest Pharmacol Ther 2014; 5:55-56. [PMID: 24868485 PMCID: PMC4023324 DOI: 10.4292/wjgpt.v5.i2.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has become a vital diagnostic modality for the evaluation of mediastinal lymphadenopathy, pancreatic cysts and masses, anorectal pathology, subepithelial gastrointestinal lesions, and for the staging of many gastrointestinal and pulmonary malignancies. Establishing a EUS program in a developing country presents many challenges. Doing so in Pakistan has led to the identification of the following challenges: initial investment, ongoing costs (particularly fine needle aspiration needle costs), awareness and cytopathology. Endoscopic ultrasonography has revolutionized aspects of the practice of gastroenterology and oncology in the West. This technique is becoming increasingly available in the developing world, where it poses unique challenges to its practice. These challenges include those relating to service initiation and maintenance costs, physician awareness, and on-site cytopathology access. If these issues are anticipated and addressed in ways appropriate to local circumstances, obstacles to the institution of EUS programs can be overcome.
Collapse
|
|
11
|
Loya A, Nadeem M, Yusuf MA. Use of ancillary techniques in improving the yield of samples obtained at endoscopic ultrasound-guided fine needle aspiration of thoracic and abdominal lymph nodes. Acta Cytol 2014; 58:192-7. [PMID: 24503737 DOI: 10.1159/000357768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/05/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Thoracic and abdominal lymph nodes may be enlarged in a variety of disorders. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established technique for sampling such nodes, but samples obtained are small, which may make definitive diagnosis difficult. We conducted a retrospective review to determine the contribution of ancillary techniques, such as special histochemistry (SHC), immunohistochemistry (IHC) and flow cytometry, in increasing the diagnostic yield of EUS-FNA carried out at our institution. STUDY DESIGN Between November 2005 and December 2012, 278 patients underwent EUS-FNA of enlarged thoracic and abdominal nodes at our institution. All specimens obtained were subjected to rapid on-site evaluation. Data were reviewed in all patients requiring ancillary techniques for definitive diagnosis. RESULTS Ancillary techniques were performed in 111 of 278 cases. IHC was performed in 24, flow cytometry in 3 and SHC staining in 84. IHC and SHC aided in reaching a definitive diagnosis in 19 of 24 and 3 cases, respectively. Flow cytometry led to a definitive diagnosis in 3 cases. A total of 80 cases were also submitted to culture for tuberculosis with 6 positive for Mycobacterium tuberculosis. CONCLUSIONS Ancillary studies in EUS-FNA of thoracic and abdominal lymph nodes can significantly improve the yield of EUS-FNA.
Collapse
Affiliation(s)
- Asif Loya
- Department of Pathology and Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | | | | |
Collapse
|
|
12
|
de Biase D, Visani M, Baccarini P, Polifemo AM, Maimone A, Fornelli A, Giuliani A, Zanini N, Fabbri C, Pession A, Tallini G. Next generation sequencing improves the accuracy of KRAS mutation analysis in endoscopic ultrasound fine needle aspiration pancreatic lesions. PLoS One 2014; 9:e87651. [PMID: 24504548 PMCID: PMC3913642 DOI: 10.1371/journal.pone.0087651] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/27/2013] [Indexed: 02/05/2023] Open
Abstract
The use of endoscopic ultrasonography has allowed for improved detection and pathologic analysis of fine needle aspirate material for pancreatic lesion diagnosis. The molecular analysis of KRAS has further improved the clinical sensitivity of preoperative analysis. For this reason, the use of highly analytical sensitive and specific molecular tests in the analysis of material from fine needle aspirate specimens has become of great importance. In the present study, 60 specimens from endoscopic ultrasonography fine needle aspirate were analyzed for KRAS exon 2 and exon 3 mutations, using three different techniques: Sanger sequencing, allele specific locked nucleic acid PCR and Next Generation sequencing (454 GS-Junior, Roche). Moreover, KRAS was also tested in wild-type samples, starting from DNA obtained from cytological smears after pathological evaluation. Sanger sequencing showed a clinical sensitivity for the detection of the KRAS mutation of 42.1%, allele specific locked nucleic acid of 52.8% and Next Generation of 73.7%. In two wild-type cases the re-sequencing starting from selected material allowed to detect a KRAS mutation, increasing the clinical sensitivity of next generation sequencing to 78.95%. The present study demonstrated that the performance of molecular analysis could be improved by using highly analytical sensitive techniques. The Next Generation Sequencing allowed to increase the clinical sensitivity of the test without decreasing the specificity of the analysis. Moreover we observed that it could be useful to repeat the analysis starting from selectable material, such as cytological smears to avoid false negative results.
Collapse
Affiliation(s)
- Dario de Biase
- Department of Medicine (DIMES) – Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
- * E-mail:
| | - Michela Visani
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - Paola Baccarini
- Department of Medicine (DIMES) – Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Anna Maria Polifemo
- Unit of Gastroenterology, Azienda Unità Sanitaria Locale di Bologna - Bellaria Hospital, Bologna, Italy
| | | | - Adele Fornelli
- Anatomic Pathology Unit, Azienda Unità Sanitaria Locale di Bologna - Maggiore Hospital, Bologna, Italy
| | - Adriana Giuliani
- Indiana University, Bloomington, Indiana, United States of America
| | - Nicola Zanini
- Unit of General Surgery, Azienda Unità Sanitaria Locale di Bologna - Maggiore Hospital, Bologna, Italy
| | - Carlo Fabbri
- Unit of Gastroenterology, Azienda Unità Sanitaria Locale di Bologna - Bellaria Hospital, Bologna, Italy
| | - Annalisa Pession
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Medicine (DIMES) – Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|