Clinical Endoscopy

Original Articles

Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration: Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yusuke Kito, Takuji Tanaka, Naoki Watanabe, Senji Kasahara, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki, Yuhei Shibata, Junichi Kitagawa, Takuji Iwashita, Eiichi Tomita, Masahito Shimizu; Clin Endosc 2024;57(3):364-374. Published online September 8, 2023; DOI: https://doi.org/10.5946/ce.2023.095

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Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML).
Methods
Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles.
Results
Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group.
Conclusions
Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

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Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification
Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi
Clinical Endoscopy.2024; 57(4): 473. CrossRef

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Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology: Nonthalee Pausawasdi, Kotchakon Maipang, Tassanee Sriprayoon, Phunchai Charatcharoenwitthaya; Clin Endosc 2022;55(2):279-286. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.218-IDEN

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Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
Methods
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
Results
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
Conclusions
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

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Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy
Taha Yaseen, Abbas Ali Tasneem, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck
Euroasian journal of hepato-gastroenterology.2024; 14(1): 40. CrossRef
Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification
Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi
Clinical Endoscopy.2024; 57(4): 473. CrossRef
Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology
Wenli Wang, Chaoqun Han, Xin Ling, Xianwen Guo, Jun Liu, Rong Lin, Zhen Ding
Frontiers in Medicine.2023;[Epub] CrossRef
Detection of Lymphadenopathy as a Precursor to Autoimmune Liver Diseases Before Clinical Hepatitis Became Apparent: A Report of Two Cases
Hiroshi Okano, Hiroki Tanaka, Shimpei Matsusaki, Katsumi Mukai, Akira Nishimura, Kana Asakawa, Youichirou Baba, Tetsuya Murata
Cureus.2023;[Epub] CrossRef
Mediastinal Nodal Staging Performance of Combined Endobronchial and Esophageal Endosonography in Lung Cancer Cases: A Systematic Review and Meta-Analysis
Xiaozhen Liu, Kun Yang, Weihong Guo, Muqi Ye, Shaozhong Liu
Frontiers in Surgery.2022;[Epub] CrossRef
Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis
Hasan Maulahela, Achmad Fauzi, Kaka Renaldi, Qorina P Srisantoso, Amirah Jasmine
JGH Open.2022; 6(11): 745. CrossRef

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High Sensitivity of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Lymphadenopathy Caused by Metastatic Disease: A Prospective Comparative Study: Per Hedenström, Vasilis Chatzikyriakos, Roozbeh Shams, Catarina Lewerin, Riadh Sadik; Clin Endosc 2021;54(5):722-729. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2020.283

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Background
/Aims: The diagnostic work-up of lymphadenopathy is challenging but important to determine the correct therapy. Nevertheless, few studies have addressed the topic of endosonography (EUS)-guided tissue acquisition in lymphadenopathy. Therefore, we aimed to evaluate the accuracy and safety of EUS-guided fine-needle biopsy sampling (EUS-FNB) in intrathoracic and intraabdominal lymphadenopathy.
Methods
In a tertiary care center, patients with lymphadenopathy referred for EUS-guided sampling were included prospectively from 2014 to 2019 (NCT02360839). In all cases, EUS-FNB (22 gauge) and EUS-guided fine-needle aspiration (EUS-FNA) (25 gauge) were performed. The patients were randomized to the first needle pass with FNB or FNA. Study outcomes were the diagnostic accuracy and adverse event rate.
Results
Forty-eight patients were included (median age: 69 years [interquartile range, 59–76]; 24/48 females [50%]). The final diagnoses were metastasis (n=17), lymphoma (n=11), sarcoidosis (n=6), and inflammatory disease (n=14). The diagnostic performance of the two modalities was comparable, including a high sensitivity for metastatic nodes (EUS-FNB: 87% vs. EUSFNA: 100%, p=0.5). The sensitivity for lymphoma was borderline superior in favor of EUS-FNB (EUS-FNB: 55% vs. EUS-FNA: 9%, p=0.06). No adverse events were recorded.
Conclusions
In lymphadenopathy, both EUS-FNB and EUS-FNA are safe and highly sensitive for metastatic lymph node detection. Lymphoma diagnosis is challenging regardless of the needle used.

Citations

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Transesophageal Bronchoscopic Ultrasound-guided Cryobiopsy (EUS-B-Cryo) for mediastinal lesions in critical airway obstruction: a case series with a systematic review
Sanchit Mohan, A. J. Mahendran, Rohit Kumar, Manu Madan, Pranav Ish, Rajnish Kaushik, Nitesh Gupta
Chest Disease Reports.2024;[Epub] CrossRef
Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration
Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yusuke Kito, Takuji Tanaka, Naoki Watanabe, Senji Kasahara, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki, Yuhei Shibata, Junichi Kitagawa, Takuji Iwashita, Eiichi Tomita, Masahito Shimizu
Clinical Endoscopy.2024; 57(3): 364. CrossRef
Lymphadenopathy Tissue Sampling by EUS-Guided Fine-Needle Biopsy Contributes to Meeting the Conditions for Genomic Profiling
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Diagnostic accuracy and safety of EUS-guided end-cutting fine-needle biopsy needles for tissue sampling of abdominal and mediastinal lymphadenopathies: a prospective multicenter series
Silvia Carrara, Daoud Rahal, Kareem Khalaf, Tommy Rizkala, Glenn Koleth, Cristiana Bonifacio, Marta Andreozzi, Benedetto Mangiavillano, Francesco Auriemma, Paola Bossi, Monica Balzarotti, Antonio Facciorusso, Teresa Staiano, Elena Maldi, Marco Spadaccini,
Gastrointestinal Endoscopy.2023; 98(2): 191. CrossRef
Endoscopic Ultrasound-Guided Fine Needle Biopsy in the Diagnostic Work-Up of Deep-Seated Lymphadenopathies and Spleen Lesions: A Monocentric Experience
Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
Diagnostics.2023; 13(17): 2839. CrossRef
Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis
Antonio Facciorusso, Stefano Francesco Crinò, Paraskevas Gkolfakis, Daryl Ramai, Andrea Lisotti, Ioannis S Papanikolaou, Benedetto Mangiavillano, Ilaria Tarantino, Andrea Anderloni, Carlo Fabbri, Konstantinos Triantafyllou, Pietro Fusaroli
Gastroenterology Report.2022;[Epub] CrossRef
A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System
Elena Vigliar, Gennaro Acanfora, Antonino Iaccarino, Massimo Mascolo, Daniela Russo, Giulia Scalia, Roberta Della Pepa, Claudio Bellevicine, Marco Picardi, Giancarlo Troncone
Diagnostics.2021; 11(8): 1314. CrossRef
Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study
Antonio Facciorusso, Stefano Francesco Crinò, Nicola Muscatiello, Paraskevas Gkolfakis, Jayanta Samanta, Juliana Londoño Castillo, Christian Cotsoglou, Daryl Ramai
Cancers.2021; 13(17): 4298. CrossRef

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Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration: Yuki Fujii, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Toji Murabayashi, Fumisato Kozakai, Yutaka Noda, Hiroyuki Okada, Kei Ito; Clin Endosc 2019;52(2):152-158. Published online January 7, 2019; DOI: https://doi.org/10.5946/ce.2018.125

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Background
/Aims: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation.
Methods
Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others.
Results
The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015).
Conclusions
The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.

Citations

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Role of EBUS‐TBNA/EUS‐FNA and mass spectrometry for diagnosis and typing of lymph node amyloidosis: 10‐year experience in two tertiary care academic centers
Asghar Naqvi, Michael Bonert, Christian Finley, Katarzyna Czarnecka‐Kujawa, Kazuhiro Yasufuku, Joerg Schwock, Vathany Kulasingam, Rohan John, Hyang‐Mi Ko
Cancer Cytopathology.2023; 131(11): 724. CrossRef
Endoscopic Ultrasound-Guided Fine Needle Biopsy in the Diagnostic Work-Up of Deep-Seated Lymphadenopathies and Spleen Lesions: A Monocentric Experience
Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
Diagnostics.2023; 13(17): 2839. CrossRef
Lymph node FNA cytology: Diagnostic performance and clinical implications of proposed diagnostic categories
Vladislav V. Makarenko, Michelle E. DeLelys, Robert P. Hasserjian, Amy Ly
Cancer Cytopathology.2022; 130(2): 144. CrossRef
Diagnostic accuracy and clinical impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in Positron Emission Tomography - Computed Tomography (PET-CT)-positive mediastinal lymphadenopathies in patients with thoracic or extra-thoracic mali
Dominique Béchade, Carine Bellera, Lisa Gauquelin, Isabelle Soubeyran, Pippa McKelvie-Sebileau, Marc Debled, François Chomy, Guilhem Roubaud, Marianne Fonck, Simon Pernot, Alexandre Roch, Anne-Laure Cazeau
Clinics and Research in Hepatology and Gastroenterology.2022; 46(5): 101912. CrossRef
High Diagnostic Accuracy and Safety of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Malignant Lymph Nodes: A Systematic Review and Meta-Analysis
Linbin Chen, Yin Li, Xiaoyan Gao, Shiyong Lin, Longjun He, Guangyu Luo, Jianjun Li, Chunyu Huang, Guobao Wang, Qing Yang, Hongbo Shan
Digestive Diseases and Sciences.2021; 66(8): 2763. CrossRef
Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound
Akashi Fujita, Shomei Ryozawa, Masafumi Mizuide, Yuki Tanisaka, Tomoya Ogawa, Masahiro Suzuki, Hiromune Katsuda, Yoichi Saito, Tomoaki Tashima, Kazuya Miyaguchi, Eiichi Arai, Tomonori Kawasaki, Yumi Mashimo
Journal of Clinical Medicine.2021; 10(5): 1076. CrossRef
Primary localized gastric amyloidosis: A scoping review of the literature from clinical presentations to prognosis
Xin-Yu Lin, Dan Pan, Li-Xuan Sang, Bing Chang
World Journal of Gastroenterology.2021; 27(12): 1132. CrossRef
Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy Device for Lymphadenopathy
Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Tomoya Ogawa, Ryuichiro Araki, Masahiro Suzuki, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Tomoaki Tashima, Yumi Mashimo, Masami Yasuda, Shomei Ryozawa, Konstantinos Triantafyllou
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef
How to Improve the Diagnostic Accuracy of EUS-FNA in Abdominal and Mediastinal Lymphadenopathy?
Tae Hyeon Kim
Clinical Endoscopy.2019; 52(2): 93. CrossRef

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Case Report

A Case of Eosinophilic Gastroenteritis presenting with Fever and Multiple Lymphadenopathy: Borami Kang, M.D., Woo Chul Chung, M.D., Kang-Moon Lee, M.D., Chang Nyol Paik, M.D., Ji Min Lee, M.D., Hyo Sin Jeon, M.D.^*, Kyong-Hwa Jun, M.D.^* and Hyung Min Chin, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):361-365. Published online May 25, 2011

Abstract PDF: Eosinophilic gastroenteritis is an unusual disease that is associated with various clinical gastrointestinal manifestations. and its severity depends on the area involved as well as the wall layer involved. Eosinophilic gastroenteritis often causes abdominal pain, nausea, vomiting and diarrhea. To date, there has been an extremely rare case of eosinophilic gastroenteritis with systemic symptoms, such as fever or lymphadenopathy (LAP). We experienced a case of a 68-year-old-woman with fever and abdominal pain. Abdominal computed tomography revealed diffuse wall thickening of the gastric antrum as linitis plastica. Multiple hot uptakes of lymph nodes were visualized on fludeoxyglucose-positron emission tomography. The gastric biopsy pathological report demonstrated eosinophilic infiltration without malignant cells. We could not exclude malignancy and performed an exploratory laparoscopy. A lymph node specimen showed reactive hyperplasia, and her illness was finally diagnosed as eosinophilic gastroenteritis. Herein, we report the case with a brief review.

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