Clinical Endoscopy

Original Articles

Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ: Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito; Clin Endosc 2023;56(3):353-366. Published online November 16, 2022; DOI: https://doi.org/10.5946/ce.2022.021

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Background
/Aims: This study aimed to clarify the efficacy and safety of pancreatic duct lavage cytology combined with a cell-block method (PLC-CB) for possible pancreatic ductal adenocarcinomas (PDACs).
Methods
This study included 41 patients with suspected PDACs who underwent PLC-CB mainly because they were unfit for undergoing endoscopic ultrasonography-guided fine needle aspiration. A 6-Fr double lumen catheter was mainly used to perform PLC-CB. Final diagnoses were obtained from the findings of resected specimens or clinical outcomes during surveillance after PLC-CB.
Results
Histocytological evaluations using PLC-CB were performed in 87.8% (36/41) of the patients. For 31 of the 36 patients, final diagnoses (invasive PDAC, 12; pancreatic carcinoma in situ, 5; benignancy, 14) were made, and the remaining five patients were excluded due to lack of surveillance periods after PLC-CB. For 31 patients, the sensitivity, specificity, and accuracy of PLC-CB for detecting malignancy were 94.1%, 100%, and 96.8%, respectively. In addition, they were 87.5%, 100%, and 94.1%, respectively, in 17 patients without pancreatic masses detectable using endoscopic ultrasonography. Four patients developed postprocedural pancreatitis, which improved with conservative therapy.
Conclusions
PLC-CB has an excellent ability to detect malignancies in patients with possible PDACs, including pancreatic carcinoma in situ.

Citations

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Early diagnosis of pancreatic cancer via pancreatic juice cytology with a cell-block method in a patient with altered anatomy
Yasuo Otsuka, Kosuke Minaga, Akane Hara, Kentaro Yamao, Mamoru Takenaka, Takaaki Chikugo, Masatoshi Kudo
Endoscopy International Open.2024; 12(06): E764. CrossRef
Role of endoscopic retrograde cholangiopancreatography in early diagnosis of pancreatic cancer
Yasutaka ISHII, Masahiro SERIKAWA, Shinya NAKAMURA, Juri IKEMOTO, Shiro OKA
Suizo.2024; 39(4): 247. CrossRef
Cell block created from pancreatic duct lavage is another jigsaw puzzle to diagnose early pancreatic ductal adenocarcinoma
Rungsun Rerknimitr
Clinical Endoscopy.2023; 56(3): 313. CrossRef

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Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer: Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Yuki Fujii, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Masaya Oikawa, Takaho Okada, Kei Ito; Clin Endosc 2019;52(6):588-597. Published online November 20, 2019; DOI: https://doi.org/10.5946/ce.2019.018

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Background
/Aims: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer.
Methods
Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years.
Results
Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively.
Conclusions
The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection.

Citations

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Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors
Tatsunori Satoh, Junichi Kaneko, Eiji Nakatani, Hirotoshi Ishiwatari, Junya Sato, Akihiko Ohata, Reiko Yamada, Tetsuro Miwata, Kazuma Ishikawa, Fumitaka Niiya, Yosuke Kobayashi, Yasushi Hamaya, Jun Ito, Kazuhito Kawata, Azumi Suzuki, Yasunari Sakamoto, Yu
Pancreatology.2025; 25(1): 125. CrossRef
Efficient Assessment of Tumor Vascular Shutdown by Photodynamic Therapy on Orthotopic Pancreatic Cancer Using High-Speed Wide-Field Waterproof Galvanometer Scanner Photoacoustic Microscopy
Jaeyul Lee, Sangyeob Han, Til Bahadur Thapa Magar, Pallavi Gurung, Junsoo Lee, Daewoon Seong, Sungjo Park, Yong-Wan Kim, Mansik Jeon, Jeehyun Kim
International Journal of Molecular Sciences.2024; 25(6): 3457. CrossRef
Role of endoscopic retrograde cholangiopancreatography in early diagnosis of pancreatic cancer
Yasutaka ISHII, Masahiro SERIKAWA, Shinya NAKAMURA, Juri IKEMOTO, Shiro OKA
Suizo.2024; 39(4): 247. CrossRef
Difference of Risk of Pancreatic Cancer in New-Onset Diabetes and Long-standing Diabetes: A Population-based Cohort Study
Hee Seung Lee, Wonjeong Chae, Min Je Sung, Jiyoung Keum, Jung Hyun Jo, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Si Young Song, Eun-Cheol Park, Chung Mo Nam, Sung-In Jang, Seungmin Bang
The Journal of Clinical Endocrinology & Metabolism.2023; 108(6): 1338. CrossRef
Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ
Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito
Clinical Endoscopy.2023; 56(3): 353. CrossRef
Main pancreatic duct stenosis without detecting tumor
Katsuhiko SATO, Minoru SHIGEKAWA, Teppei YOSHIOKA, Shuhei YAMAMOTO, Takayuki MATSUMAE, Kazuhiro KOZUMI, Yu SATO, Jyunya OKABE, Takahiro KODAMA, Hayato HIKITA, Tomohide TATSUMI, Tetsuo TAKEHARA
Suizo.2023; 38(2): 147. CrossRef
Diagnostic Ability and Safety of Repeated Pancreatic Juice Cytology Using an Endoscopic Nasopancreatic Drainage Catheter for Pancreatic Ductal Adenocarcinoma: A Multicenter Prospective Study
Shinya Nakamura, Yasutaka Ishii, Masahiro Serikawa, Keiji Hanada, Noriaki Eguchi, Tamito Sasaki, Yoshifumi Fujimoto, Atsushi Yamaguchi, Shinichiro Sugiyama, Bunjiro Noma, Michihiro Kamigaki, Tomoyuki Minami, Akihito Okazaki, Masanobu Yukutake, Teruo Mouri
Diagnostics.2023; 13(16): 2696. CrossRef
Endoscopic approach in the diagnosis of high‐grade pancreatic intraepithelial neoplasia
Keiji Hanada, Akihiro Shimizu, Keisuke Kurihara, Morito Ikeda, Takuya Yamamoto, Yasuhiro Okuda, Susumu Tazuma
Digestive Endoscopy.2022; 34(5): 927. CrossRef
Current Screening Strategies for Pancreatic Cancer
Petr Vanek, Ondrej Urban, Vincent Zoundjiekpon, Premysl Falt
Biomedicines.2022; 10(9): 2056. CrossRef
Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma
Ryota Sagami, Kentaro Yamao, Jun Nakahodo, Ryuki Minami, Masakatsu Tsurusaki, Kazunari Murakami, Yuji Amano
Cancers.2021; 13(5): 945. CrossRef
New-Onset or Exacerbation of Diabetes Mellitus Is a Clue to the Early Diagnosis of Pancreatic Cancer
Tetsuya Takikawa, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Shin Miura, Naoki Yoshida, Seiji Hongo, Yu Tanaka, Ryotaro Matsumoto, Takanori Sano, Mio Ikeda, Masahiro Iseki, Michiaki Unno, Atsushi Masamune
The Tohoku Journal of Experimental Medicine.2020; 252(4): 353. CrossRef
Can Localized Stenosis of the Main Pancreatic Duct be a Predictive Factor for Early Detection of Pancreatic Cancer?
Mamoru Takenaka, Kentaro Yamao, Masatoshi Kudo
Clinical Endoscopy.2019; 52(6): 523. CrossRef

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A “Back Light System” for Identification of Sites for Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Solid Pancreatic Masses: A Prospective, Randomized Study with a Crossover Design: Ryo Harada, Hironari Kato, Soichiro Fushimi, Hirofumi Inoue, Daisuke Uchida, Yutaka Akimoto, Takeshi Tomoda, Kazuyuki Matsumoto, Yasuhiro Noma, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada; Clin Endosc 2019;52(4):334-339. Published online May 16, 2019; DOI: https://doi.org/10.5946/ce.2019.004

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Background
/Aims: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses.
Methods
This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information.
Results
A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively).
Conclusions
The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.

Citations

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Tissue processing of endoscopic ultrasound-guided fine-needle aspiration specimens from solid pancreatic lesions
Kenji Notohara, Kaori Nakamura
Journal of Medical Ultrasonics.2024; 51(2): 261. CrossRef
Macroscopic qualitative evaluation of solid pancreatic lesion specimens from endoscopic ultrasound-guided fine needle aspiration/biopsies
Kaori Nakamura, Kenji Notohara, Ryoji Nishizaki, Etsuji Ishida, Midori Sato, Akemi Kodera, Junya Itakura, Motowo Mizuno
Pancreatology.2023; 23(8): 1028. CrossRef
Unfortunately, a “Back Light System” As a Global Positioning System Failed to Guide the Route in 25-G Fine-Needle Aspiration
Rungsun Rerknimitr, Phonthep Angsuwatcharakon
Clinical Endoscopy.2019; 52(4): 295. CrossRef

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Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology: Ji Young Park, Tae Joo Jeon; Clin Endosc 2019;52(2):168-174. Published online January 9, 2019; DOI: https://doi.org/10.5946/ce.2018.105

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Background
/Aims: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytology and indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in such cases.
Methods
We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imaging who underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients with atypical or suspicious cells on brush cytology were identified.
Results
Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampulla of Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors that independently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802– 15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909; 95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR, 4.318; 95% CI, 1.512–12.262).
Conclusions
Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patients with indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.

Citations

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High Diagnostic Yield of Endoscopic Retrograde Cholangiopancreatography Brush Cytology for Indeterminate Strictures
Abdulsemed M Nur, Misbah Salim, Scott Boerner, Suqing Li, Cindy C Y Law, Leanne Edwards, Kaitlin Ryan, Paul D James
Journal of the Canadian Association of Gastroenterology.2022; 5(5): 234. CrossRef
Digital Image Analysis has an Additive Beneficial Role to Conventional Cytology in Diagnosing the Nature of Biliary Ducts Stricture
Ahmed Helmy, Heba Mohamed Saad Eldien, Gehan Sayed Seifeldein, Ahmed Mohammed Abu-Elfatth, Adnan Ahmed Mohammed
Journal of Clinical and Experimental Hepatology.2021; 11(2): 209. CrossRef
Predicting Malignancy of Biliary Stricture with a Nomogram in Patients with a Non-Malignant Endoscopic Tissue Diagnosis: A Retrospective Study
Yizhen Zhang, Qingwei Jiang, Qiang Wang, Yunlu Feng, Dongsheng Wu, Tao Guo, Shengyu Zhang, Xi Chen, Yingyun Yang, Wen Shi, Xi Wu, Aiming Yang
Cancer Management and Research.2021; Volume 13: 7735. CrossRef
Tips and tricks for the diagnosis and management of biliary stenosis-state of the art review
Giovanna Del Vecchio Blanco, Michelangela Mossa, Edoardo Troncone, Renato Argirò, Andrea Anderloni, Alessandro Repici, Omero Alessandro Paoluzi, Giovanni Monteleone
World Journal of Gastrointestinal Endoscopy.2021; 13(10): 473. CrossRef
How Can We Differentiate Malignant Biliary Strictures from Clinically Indeterminate Biliary Strictures?
Eui Joo Kim, Jae Hee Cho
Clinical Endoscopy.2019; 52(2): 95. CrossRef

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Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumors: Takashi Tamura, Yasunobu Yamashita, Kazuki Ueda, Yuki Kawaji, Masahiro Itonaga, Shin-ichi Murata, Kaori Yamamoto, Takeichi Yoshida, Hiroki Maeda, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, Jun Kato; Clin Endosc 2017;50(4):372-378. Published online January 20, 2017; DOI: https://doi.org/10.5946/ce.2016.083

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Background
/Aims: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone.
Methods
Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison.
Results
The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06).
Conclusions
ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.

Citations

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Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
Gastrointestinal Endoscopy.2024; 99(6): 895. CrossRef
Gastric glomus tumor on EUS-FNA-based cytology: clinicopathologic and immunohistochemical features of 4 cases, including 1 case with associated MIR143HG-NOTCH2 fusion gene
Sameer Chhetri Aryal, Sanam Husain, Ziying Zhang, Lisi Yuan
Journal of the American Society of Cytopathology.2023; 12(4): 296. CrossRef
EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?
Thomas Vasilakis, Dimitrios Ziogas, Georgios Tziatzios, Paraskevas Gkolfakis, Eleni Koukoulioti, Christina Kapizioni, Konstantinos Triantafyllou, Antonio Facciorusso, Ioannis S. Papanikolaou
Diagnostics.2023; 13(13): 2176. CrossRef
A prospective randomized noninferiority trial comparing conventional smears and SurePathTM liquid-based cytology in endoscopic ultrasound-guided sampling of esophageal, gastric, and duodenal lesions
Jae Chang Jun, Sang Hyub Lee, Han Myung Lee, Sang Gyun Kim, Hyunsoo Chung, Joo Seong Kim, Namyoung Park, Jin Ho Choi, Yoonjin Kwak, Soo-Jeong Cho
Medicine.2023; 102(29): e34321. CrossRef
The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
Masanari Sekine, Takeharu Asano, Hirosato Mashima
Diagnostics.2022; 12(4): 810. CrossRef
A Pilot Study of Image-associative Teaching Versus Traditional Didactic Teaching for Novice Endosonographers Learning Cytopathology Effectively
Yi Chu, Wenyu LI, Min Luo, HongYi Zhu, Yi Sun, Xiaolin She, Jirong Huo, Yuqian Zhou
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(4): 324. CrossRef
Diagnostic yield of EUS-TA for gastric submucosal epithelial lesions using rapid specimen evaluation under stereomicroscopy
Tetsuhiko Hirai, Junro Ishizaki, Hiroshi Imaizumi, Myontyori Kim, Yoichi Saegusa, Akinori Tamaki, Masafumi Watanabe, Hironori Masutani, Kosuke Okuwaki, Mitsuhiro Kida, Chika Kusano
Progress of Digestive Endoscopy.2022; 100(1): 63. CrossRef
Ki‐67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification
Xi Wang, Rita Abi‐Raad, Haiming Tang, Guoping Cai
Cancer Cytopathology.2022; 130(12): 974. CrossRef
Recent Progress and Challenges in the Diagnosis and Treatment of Gastrointestinal Stromal Tumors
Toshirou Nishida, Shigetaka Yoshinaga, Tsuyoshi Takahashi, Yoichi Naito
Cancers.2021; 13(13): 3158. CrossRef
Optimal number of needle punctures in endoscopic ultrasound-guided fine-needle biopsy for gastric subepithelial lesions without rapid on-site evaluation
Masato Suzuki, Yusuke Sekino, Kunihiro Hosono, Kenichi Kawana, Hajime Nagase, Kensuke Kubota, Atsushi Nakajima
Journal of Medical Ultrasonics.2021; 48(4): 623. CrossRef
Methodological and Technical Aspects of EUS-Guided Fine Needle Aspiration of the Upper Digestive Tract Lesions
E. A. Godzhello, N. A. Bulganina, M. V. Khrustaleva
Experimental and Clinical Gastroenterology.2020; 174(4): 107. CrossRef
Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1
Jean-Marc Dumonceau, Myriam Delhaye, Nicolas Charette, Annarita Farina
Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef
Mucosal incision‐assisted biopsy versus endoscopic ultrasound‐guided fine‐needle aspiration with a rapid on‐site evaluation for gastric subepithelial lesions: A randomized cross‐over study
Takashi Osoegawa, Yosuke Minoda, Eikichi Ihara, Keishi Komori, Akira Aso, Ayako Goto, Soichi Itaba, Haruei Ogino, Kazuhiko Nakamura, Naohiko Harada, Kosuke Makihara, Shinichi Tsuruta, Hidetaka Yamamoto, Yoshihiro Ogawa
Digestive Endoscopy.2019; 31(4): 413. CrossRef
Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors
Gyu Young Pih, Do Hoon Kim
Clinical Endoscopy.2019; 52(4): 314. CrossRef
Rapid On-Site Evaluation of Fine-Needle Aspiration by Non-Cytopathologists: A Systematic Review and Meta-Analysis of Diagnostic Accuracy Studies for Adequacy Assessment
Lauren Pearson, Rachel E. Factor, Sandra K. White, Brandon S. Walker, Lester J. Layfield, Robert L. Schmidt
Acta Cytologica.2018; 62(4): 244. CrossRef
Is a Cytopathologist Always Needed during Endoscopic Ultrasonography-Guided Tissue Acquisition?
Moon Won Lee, Gwang Ha Kim
Clinical Endoscopy.2017; 50(4): 311. CrossRef
Endoscopic Evaluation and Management of Gastric Stromal Tumors
Kambiz Kadkhodayan, Ehsan Rafiq, Robert H. Hawes
Current Treatment Options in Gastroenterology.2017; 15(4): 691. CrossRef

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Endoscopic Ultrasound-Guided Fine-Needle Aspiration of the Adrenal Glands: Analysis of 21 Patients: Rajesh Puri, Ragesh Babu Thandassery, Narendra S. Choudhary, Hardik Kotecha, Smruti Ranjan Misra, Suraj Bhagat, Manish Paliwal, Kaushal Madan, Neeraj Saraf, Haimanti Sarin, Mridula Guleria, Randhir Sud; Clin Endosc 2015;48(2):165-170. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.165

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Background/Aims

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible.

Methods

Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years.

Results

Of the 21 patients (mean age, 56±12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4×1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred.

Conclusions

EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities.

Citations

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A case of adrenal metastasis of hepatocellular carcinoma diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration
Tsuyoshi Ueda, Shinji Oe, Akitoshi Yoneda, Yudai Koya, Satoru Nebuya, Koichiro Miyagawa, Yuichi Honma, Michihiko Shibata, Shohei Shimajiri, Masaru Harada
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Chinmay Vishwanath Hegde, Anudeep Katrevula, Balasaheb Wanve, Nageshwar Reddy Duvvur
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Adrenal gland fine needle aspiration: a multi-institutional analysis of 139 cases
Kimberly S. Point du Jour, Yazeed Alwelaie, Arlixer Coleman, Talaat Tadros, Ritu Aneja, Michelle D. Reid
Journal of the American Society of Cytopathology.2021; 10(2): 168. CrossRef
Diagnostic utility of cytology smears and cell block in adrenal lesions
Sriranjan Mukherjee, Moumita Sengupta, Ram Narayan Das, Uttara Chatterjee, Banhisikha Kanjilal, Keya Basu, Anish Kar, Akash Mondal, Satinath Mukhopadhyay
Diagnostic Cytopathology.2020; 48(11): 1003. CrossRef
EUS‐FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions
Muhammad Saqib, Maheen Maruf, Sehar Bashir, Shafqat Mehmood, Noreen Akhter, Muhammed Aasim Yusuf, Asif Loya
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Fine‐needle aspiration of adrenal lesions: A 20‐year single institution experience with comparison of percutaneous and endoscopic ultrasound guided approaches
Aaron G. Novotny, Jordan P. Reynolds, Akeesha A. Shah, Amit Bhatt, Prabhleen Chahal, Erick M. Remer, Tyler Stevens, Stephen Gmitro, Charles D. Sturgis
Diagnostic Cytopathology.2019; 47(10): 986. CrossRef
Adrenal biopsy: performance and use
Catherine D. Zhang, Danae A. Delivanis, Patrick W. Eiken, Thomas D. Atwell, Irina Bancos
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Endoscopic ultrasound-guided fine-needle aspiration of enlarged adrenals in patients with pyrexia of unknown origin: A single-center experience of 52 cases
Rinkesh K. Bansal, Narendra S. Choudhary, Saurabh K. Patle, Amit Agarwal, Gagandeep Kaur, Haimanti Sarin, Rajesh Puri
Indian Journal of Gastroenterology.2018; 37(2): 108. CrossRef
Transesophageal approach to lung, adrenal biopsy and fiducial placement using endoscopic ultrasonography (EUS): An interventional pulmonology experience. Initial experience of the UCSF-FRETOC (fresno tracheobronchial & oesophageal center) study group
Faye M. Pais, Raj A. Shah, Jose J. Vempilly, Sneha Gullapalli, Daya Upadhyay, Michael Peterson, Moishe Liberman, Pravachan Hegde
Respiratory Medicine.2018; 141: 52. CrossRef
First Reported Case of Endoscopic Ultrasound-Guided Core Biopsy Yielding Diagnosis of Primary Adrenal Leiomyosarcoma
Shaunak R. Mulani, Patrick Stoner, Alexander Schlachterman, Hans K. Ghayee, Li Lu, Anand Gupte
Case Reports in Gastrointestinal Medicine.2018; 2018: 1. CrossRef
Lipomatous tumours in adrenal gland: WHO updates and clinical implications
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A Twenty-First-Century Perspective of Disseminated Histoplasmosis in India: Literature Review and Retrospective Analysis of Published and Unpublished Cases at a Tertiary Care Hospital in North India
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Mycopathologia.2017; 182(11-12): 1077. CrossRef
DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis
Irina Bancos, Shrikant Tamhane, Muhammad Shah, Danae A Delivanis, Fares Alahdab, Wiebke Arlt, Martin Fassnacht, M Hassan Murad
European Journal of Endocrinology.2016; 175(2): R65. CrossRef
Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors
Martin Fassnacht, Wiebke Arlt, Irina Bancos, Henning Dralle, John Newell-Price, Anju Sahdev, Antoine Tabarin, Massimo Terzolo, Stylianos Tsagarakis, Olaf M Dekkers
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Role of endoscopic ultrasound in non-small cell lung cancer
Sumit Bhatia, Rajesh Puri
International Journal of Gastrointestinal Intervention.2016; 5(3): 187. CrossRef
Is Endoscopic Ultrasonography-Guided Fine Needle Aspiration Trailblazing in Tissue Sampling of Adrenal Masses?
Tae Hyeon Kim
Clinical Endoscopy.2015; 48(2): 94. CrossRef

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Review

Fine-Needle Biopsy: Should This Be the First Choice in Endoscopic Ultrasound-Guided Tissue Acquisition?: Eun Young Kim; Clin Endosc 2014;47(5):425-428. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.425

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS)-guided tissue acquisition is an indispensable technique for the diagnosis of many diseases of the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) is known for its high accuracy and low complication rate. However, the outcome of EUS-FNA highly depends on several factors such as the location and characteristics of the lesion, endosonographer's experience, technique of sampling and sample preparation, type and size of the needle used, and presence of a cytopathologist for rapid on-site examination. EUS-guided fine-needle biopsy is useful to obtain core tissue samples with relatively fewer passes. Aspiration of core tissue with preserved architecture is beneficial for the diagnosis of certain diseases and the performance of ancillary testing such as tumor molecular profiling. Issues related to needle size, type, and their acquired samples for cytologic and histologic evaluation are discussed here.

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Pancreas.2020; 49(3): e21. CrossRef
Which Needle Needs to Be Chosen for Better Outcome of Endoscopic Ultrasound-Guided Tissue Acquisition?
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Successful creation of pancreatic cancer organoids by means of EUS-guided fine-needle biopsy sampling for personalized cancer treatment
Herve Tiriac, Juan Carlos Bucobo, Demetrios Tzimas, Suman Grewel, Joseph F. Lacomb, Leahana M. Rowehl, Satish Nagula, Maoxin Wu, Joseph Kim, Aaron Sasson, Shivakumar Vignesh, Laura Martello, Maria Munoz-Sagastibelza, Jonathan Somma, David A. Tuveson, Elle
Gastrointestinal Endoscopy.2018; 87(6): 1474. CrossRef
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Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review
Fanyang Kong, Jianwei Zhu, Xiangyu Kong, Tao Sun, Xuan Deng, Yiqi Du, Zhaoshen Li, Giancarlo Troncone
PLOS ONE.2016; 11(9): e0163056. CrossRef
EUS-FNA diagnosis of a rare case of esophageal teratoma
Benedetto Mangiavillano, Antonella De Ceglie, Paolo Quilici, Corrado Ruggeri
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Which Needle Is Better for Diagnosing Subepithelial Lesions?
Eun Young Kim
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Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
Clinical Endoscopy.2014; 47(5): 371. CrossRef

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Focused Review Series: What Should We Know about EUS-FNA?

How Can We Get the Best Results with Endoscopic Ultrasound-Guided Fine Needle Aspiration?: Jayapal Ramesh, Shyam Varadarajulu; Clin Endosc 2012;45(2):132-137. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.132

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has evolved to become an indispensable tool for tissue acquisition. While the overall diagnostic accuracy of EUS-FNA is greater than 90% for lung cancer staging, it is lower for pancreatic mass lesions. Several factors such as location of the tumor, disease characteristics and procedural techniques determine the outcomes of EUS-FNA. In this review we evaluate the various technical factors that are keys to attaining optimal procedural outcomes.

Citations

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A prospective randomized trial of EUS-guided tissue acquisition using a 25-gauge core biopsy needle with and without a stylet
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Risk factors associated with adverse events during endoscopic ultrasound-guided tissue sampling
Kwang Hyuck Lee, Eun Young Kim, Juhee Cho, Danbee Kang, Seungmin Bang, Hyung Kil Kim, Gwang Ha Kim, Hyun Jong Choi, Joung-Ho Han, Seong Woo Jeon, Ji Kon Ryu, Jeong Seop Moon, Tae Hee Lee, Jin Woong Cho, Tae Hyeon Kim, Young Koog Cheon, Chang-Hwan Park, Jo
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Meta-Analysis for Cyto-Pathological Outcomes in Endoscopic Ultrasonography-Guided Fine-Needle Aspiration With and Without the Stylet
Jae Hyun Kim, Se Woo Park, Mi Kang Kim, Jin Lee, Sea Hyub Kae, Hyun Joo Jang, Dong Hee Koh, Min Ho Choi
Digestive Diseases and Sciences.2016; 61(8): 2175. CrossRef
Rendimiento diagnóstico de repetir la biopsia guiada por ultrasonido endoscópico después de una primera biopsia negativa en pacientes con lesiones no pancreáticas
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Diagnosis of pancreatic lesions collected by endoscopic ultrasound-guided fine-needle aspiration using next-generation sequencing
Eri Kameta, Kazuya Sugimori, Takashi Kaneko, Tomohiro Ishii, Haruo Miwa, Takeshi Sato, Yasuaki Ishii, Soichiro Sue, Tomohiko Sasaki, Yuki Yamashita, Wataru Shibata, Naomichi Matsumoto, Shin Maeda
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Yields and Utility of Endoscopic Ultrasonography-Guided 19-Gauge Trucut Biopsy versus 22-Gauge Fine Needle Aspiration for Diagnosing Gastric Subepithelial Tumors
Hee Kyong Na, Jeong Hoon Lee, Young Soo Park, Ji Yong Ahn, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim
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Pitfalls in EUS FNA
Larissa L. Fujii, Michael J. Levy
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Diagnosis of Subepithelial Lesion: Still "Tissue Is the Issue"
Eun Young Kim
Clinical Endoscopy.2013; 46(4): 313. CrossRef
Endoscopic ultrasound-guided fine needle aspiration: From the past to the future
Madalin-Ionut Costache, Sevastita Iordache, JohnGásdal Karstensen, Adrian Saftoiu, Peter Vilmann
Endoscopic Ultrasound.2013; 2(2): 77. CrossRef

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Two Cases of Adrenal Cysts Assessed by Endoscopic Ultrasound-Guided Fine Needle Aspiration for Diagnostic and Therapeutic Purposes: Hyung Hun Kim, M.D., Jung Hwan Lee, M.D., Sang Ryul Lee, M.D., Su-Yeon Lee, M.D., Young Il Park, M.D., Soo Hyung Ryu, M.D., You Sun Kim, M.D. and Jeong Seop Moon, M.D.; Korean J Gastrointest Endosc 2010;40(2):97-101. Published online February 27, 2010

Abstract PDF: Adrenal cyst is a rare disease and its incidence rate is about 0.06∼0.18%. Many cases of adrenal cysts are diagnosed incidentally. Surgical excision is generally performed to rule out malignancy when an adrenal cyst is detected. However, a reviewing the overall cases revealed that only 7% of adrenal cysts were malignant or potentially malignant. Thus, it has been suggested to observe an asymptomatic simple benign cyst after aspiration. From this point of view, it is necessary to perform a functional hormonal test and fine needle aspiration cytology for investigating the nature of adrenal cysts. Adrenal cyst drainage can be performed when surgical resection is not indicated. Computed tomography or ultrasonography guided percutaneous aspiration and drainage has been performed, but linear endoscopic ultrasound has not yet been used for this purpose. We have performed endoscopic ultrasound guided fine needle aspiration of adrenal cysts for cytologic and hormonal examination and endoscopic ultrasound guided adrenal cyst drainage, and we report here on our experiences with this technique. (Korean J Gastrointest Endosc 2010;40:97-101)

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A Case of Pancreatic Intraepithelial Neoplasia Presenting as Aucte Pancreatitis: Dong Wook Lee, M.D., Jae Kwon Jung, M.D., Dong Yeub Eun, M.D., Jung Soo Lee, M.D., Jae Kwang Lee, M.D., Sang Man Park, M.D., Hyun Soo Kim, M.D. and Mi Jin Gu, M.D.*; Korean J Gastrointest Endosc 2010;40(1):62-67. Published online January 30, 2010

Abstract PDF: Pancreatic intraepithelial neoplasia (PanIN) is a precancerous lesion. A 72-year old man was admitted to our hospital because of abdominal pain, and he had an elevated serum level of pancreatic amylase. ERCP showed a focal stricture of the main pancreatic duct without upstream dilatation in the body of the pancreas. Cytologic evaluation with an endoscopic brush at the stricture suggested the presence of adenocarcinoma. After subtotal pancreatectomy, the features of PanIN were observed in the branch pancreatic duct. ERCP with brush cytology seems to be a useful method for detecting PanIN at the precancerous stage. We report here on a case of PanIN associated with a stricture of the main pancreatic duct. (Korean J Gastrointest Endosc 2010;40:62-67)

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악성 담도협착증에서 내시경적 쇄자세포진 검사의 진단적 유용성 ( Usefulness of Endoscopic Brush Cytology from malignant Biliary Obstruction ): Korean J Gastrointest Endosc 2001;23(3):159-163. Published online November 30, 2000

Abstract PDF: Background
s/Aims: In patients with obstructive jaundice due to malignant biliary tract stricture, a tissue diagnosis is essential because the various treatment options are available. The tissue biopsy form the biliary tree is difficult because of the focal, sclerotic, small annular nature and lower celluarity. Brush cytology is and effective method for obtaining a tissue from bile duct stricture, and the diagnostic sensitivity of endoscopic brush cytology is reported as between 40% and 70% form malignant bile duct strictures. In this study, we analyzed the diagnostic value of endoscopic brush cytology in patient with extrahepatic bile duct strictures. Methods: The eight patients with extrahepatic bile duct strictures diagnosed with endoscopic retrograde cholangiopancretography underwent endoscopic brush cytology and aspiration bile cytology. Brushing were taken using a Greenen cytology brush passed with a guide wire through the stricture. Results: The final diagnoses were made by surgical pathology and clinical follow-up. The sensitivity of brush cytology (62.5%, 5/8) was significantly higher than the sensitivity of bile cytology (0%; 0/8). No procedure related complication occurred. Conclusions: Endoscopic brush cytology would be an effective and a relatively safe method for tissue diagnosis in patients with malignant biliary obstruction.

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간외 담관암에서 경유듀 조직생검과 담즙세포진 병합검사의 유용성 ( Combined Endoscopic Transpapillary Biopsy and Exfoliative Cytology for the Diagnosis of Bile Duct Cancer ): Korean J Gastrointest Endosc 1999;19(4):588-596. Published online November 30, 1998

Abstract PDF: Background
/Aims: In the management of patients with extrahepatic bile duct carcinoma, histologic diagnosis is crucial to determine therapeutic modalities, to predict their outcomes, and to avoid an unnecessary operation. Though various methods were developed, none of them yielded satisfactory results. A combination of those methods was reported to yield superior sensitivity and specificity to a single method. To evaluate the diagnostic efficacy, endoscopic transpapillary biopsy (ETPB) and exfoliative bile aspiration cytology (BAC) was performed in 40 patients with extrahepatic bile duct carcinoma. Methods: After visualization of the biliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), ETPB (n=40) and BAC (n=28) was done in one session with or without endoscopic sphincterotomy (EST) and the results of two methods were analyzed. Results: The final diagnoses were made by surgical pathology and by clinical follow-ups of more than a year. The locations of the 40 bile duct carcinomas were in the upper area in 25, the middle in 14 and the lower in 1. ETPB was performed in all patients and BAC in 28 patients. The overall sensitivity of the ETPB was 65.0% (26/40). According to the morphology and location, the sensitivity of ETPB was 65.6% (11/32) for sclerotic, 60.0% (3/5) for papillary, and 66.7% (2/3) for the protruding type, and 68.0% (17/25) for the upper bile duct lesion, 64.3% (9/14) for the middle, and 0% (0/1) for the lower. The overall sensitivity of the BAC was 71.4% (20/28). According to the morphology and location, the sensitivity of BAC was 80.0% (16/20) for sclerotic, 20% (1/5) for papillary, and 100% (3/3) for the protruding type, and 82.4% (14/17) for the upper bile duct lesion and 54.5% (6/11) for the middle bile duct lesion. When the two tests were combined, the sensitivity rose to 96.4% (27/28). Conclusions: A combination of ETPB and BAC is useful in making a histologic diagnosis in patients with bile duct carcinoma. (Korean J Gastrointest Endosc 19: 588∼596, 1999)

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원저 : 식도 위장관 ; 대장 정결액의 세포학적인 검사에 의한 대장암의 진단 ( Original Articles : Esophagus , Stomach & Intestine ; Cytolagic Diagnosis of Colon Cancer by Colon Cleansing Solution ): Korean J Gastrointest Endosc 1996;16(6):945-951. Published online November 30, 1995

Abstract PDF: Colorectal cancer consists of 8.2 percent of all malignancy in korea, and shows more increaing tendency. Despite the advances in the detection of calorectal cancer no single screening technique has achieved both high degree of diagnostic accuracy and minimal patient morbidity. We studied 24 patients, who underwent colonoscopy, with clinical suspicious colon cancer at Presbyterian Medical Center between Jan and Sep.1995, and evaluated the diagnostic feasibility of colon lavage cytology using oral cleansing solution. (Korean J Gastrointest 16: 945~951, 1996) (continue...)

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내시경직시하 세침흡인세포진검사로 진단된 상부위장관종양 ( Endoscopic Fine Needle Aspiration Cytology in the Diagnosis of Upper Gastrointestinal Malignancies ): Korean J Gastrointest Endosc 1993;13(2):341-345. Published online November 30, 1992

Abstract PDF: The endoscopic fine needle aspiration cytology may add to the diagnostic accuracy of endoscopic biopsy and brush cytology. It is also of particular value in submucosal, infiltrative and ulceronecrotic tumors. Endoscopic fine needle aspiration cytology was done with sclerotherapy needle(23 gauge) in. the 17 patients with submucosal tumor(18 cases), extrinsic compression(2 cases), infiltrative gastric cancer(one case) and cancer of the ampulla of Vater(one case) on the upper gastrointestinal endoscopy. Endoscopic fine needle aspiration cytology established the diagnosis in 6 cases(submucosal tumor of the stomach; 2 cases, submucosal tumor of the duodenum; one case, extrinsic mass of the duodenum; one case, infiltrative cancer of the stomach; one case, and the cancer of ampulla of Vater; one case) of 17 cases. There were negative results for malignancy in 7 cases and material insufficiency in 4 cases. Five cases of the positive results with endoscopic fine needle aspiration cytology were not diagnosed with endoscopic forceps biopsies. There was no complication. We conclude that endoscopic fine needle aspiration cytology is a simple and safe technique and is of particular value in submucosal tumor, extrinsic compression of the upper gastrointestinal tract by tumor, and infiltrative gastric cancer.

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