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Irisawa, Atsushi, Takuto Hikichi, Manoop S. Bhutani, and Hiromasa Ohira. "Basic technique of FNA." Gastrointestinal Endoscopy 69, no. 2 (2009): S125—S129. http://dx.doi.org/10.1016/j.gie.2008.12.017.
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Lee, Jae Min, Hong Sik Lee, Seong ji Choi, et al. "Prospective evaluation of slow-pull with fanning technique in EUS-guided fine needle aspiration on pancreatic masses." Journal of Clinical Oncology 36, no. 4_suppl (2018): 232. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.232.
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232 Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in obtaining pancreatic mass samples. Combination of modified techniques (slow-pull technique and fanning technique) may improve the sample quality obtained by EUS-FNA. We investigated the effectiveness of a slow-pull with fanning technique in EUS-FNA for pancreatic mass. Methods: This prospective comparative study investigated EUS-FNA for pancreatic solid masses from August 2015-July 2016. The pairwise specimens were alternately obtained using two techniques: standard suction or slow-pull with fanning for target pancreatic lesions. We compared the specimen quality, blood contamination, and diagnostic yield of these techniques. Results: Forty-eight consecutive patients were enrolled (29 men; mean age, 68.1±11.9 years), and 96 pancreatic mass specimens were obtained. The slow-pull with fanning technique had significantly superior diagnostic accuracy than the suction technique (88% vs. 71%, p = 0.044). Further, blood contamination significantly reduced when the slow-pull with fanning technique was used (ratio of no or few contamination, 77% vs. 56%, p = 0.041). In the subgroup analysis, tumor size and sampling technique were related to EUS-FNA diagnostic accuracy. Conclusions: The slow-pull with needle fanning technique showed a good diagnostic yield for EUS-FNA for pancreatic mass. It can be useful in performing EUS-guided sampling for diagnosing pancreatic disease.
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Bansal, Rinkesh Kumar, and Rajesh Puri. "EUS-Guided FNA: Tips and Tricks." Journal of Digestive Endoscopy 11, no. 02 (2020): 099–105. http://dx.doi.org/10.1055/s-0040-1714046.
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AbstractThe development of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) technique has been proved to be a great armamentarium to gastroenterologists and other branches including surgery, oncology, hepatology, pulmonary medicine, and internal medicine. EUS-FNA is quite safe and allows tissue acquisition from difficult anatomical locations like retroperitoneum, pancreas, and mediastinum. The current review discusses basic techniques steps of EUS-FNA including tips and tricks. Also, false negative FNA and EUS-FNA in difficult locations are discussed. We also discussed about EUS-guided fine needle biopsy.
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Saxena, Payal, Mohamad El Zein, Tyler Stevens, et al. "Stylet slow-pull versus standard suction for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic lesions: a multicenter randomized trial." Endoscopy 50, no. 05 (2017): 497–504. http://dx.doi.org/10.1055/s-0043-122381.
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Abstract Background and study aim Standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedures involve use of no-suction or suction aspiration techniques. A new aspiration method, the stylet slow-pull technique, involves slow withdrawal of the needle stylet to create minimum negative pressure. The aim of this study was to compare the sensitivity of EUS-FNA using stylet slow-pull or suction techniques for malignant solid pancreatic lesions using a standard 22-gauge needle. Patients and methods Consecutive patients presenting for EUS-FNA of pancreatic mass lesions were randomized to the stylet slow-pull or suction techniques using a 22-gauge needle. Both techniques were standardized for each pass until an adequate specimen was obtained, as determined by rapid on-site cytology examination. Patients were crossed over to the alternative technique after four nondiagnostic passes. Results Of 147 patients screened, 121 (mean age 64 ± 13.8 years) met inclusion criteria and were randomized to the stylet slow-pull technique (n = 61) or the suction technique (n = 60). Technical success rates were 96.7 % and 98.3 % in the slow-pull and suction groups, respectively (P > 0.99). The sensitivity for malignancy of EUS-FNA was 82 % in the slow-pull group and 69 % in the suction group (P = 0.10). The first-pass diagnostic rate (42.6 % vs. 38.3 %; P = 0.71), acquisition of core tissue (60.6 % vs. 46.7 %; P = 0.14), and the median (range) number of passes to diagnosis (2 1 2 3 vs. 1 1 2; P = 0.71) were similar in the slow-pull and suction groups, respectively. Conclusions The stylet slow-pull and suction techniques both offered high and comparable diagnostic sensitivity with a mean of 2 passes required for diagnosis of solid pancreatic lesions. The endosonographer may choose either technique during FNA.
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Takasumi, Mika, Takuto Hikichi, Minami Hashimoto, et al. "A Pilot Randomized Crossover Trial of Wet Suction and Conventional Techniques of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Upper Gastrointestinal Subepithelial Lesions." Gastroenterology Research and Practice 2021 (March 22, 2021): 1–8. http://dx.doi.org/10.1155/2021/4913107.
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Background and Aim. A wet suction technique (“wet” technique) has been developed to improve the quality of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for sampling various solid lesions. However, no studies have reported on the wet technique for EUS-FNA for gastrointestinal (GI) subepithelial lesions (SELs). We conducted a pilot randomized crossover trial to explore whether the wet technique could be useful with regard to tissue adequacy of upper GI-SELs (UGI-SELs) compared to the conventional EUS-FNA technique (“dry” technique). Methods. Twenty-six patients with UGI-SELs indicated for EUS-FNA were randomly assigned to the dry-first arm using the dry technique for the first two passes or the wet-first arm using the wet technique for the first two passes using a cross-over design with a ratio of 1 : 1. The primary endpoint was the cellularity score of the EUS-FNA specimens rated on a 4-point scale (0-3). The secondary endpoints were the factors influencing cellularity in each suction technique. Results. The mean cellularity score was 1.65 ± 1.20 for the wet technique and 2.00 ± 0.98 for the dry technique ( p = 0.068 ). Logistic regression analysis showed that higher cellularity may be related to the final diagnosis of gastrointestinal stromal tumors in the dry technique and the SEL location in the upper stomach in the wet technique. Conclusion. The wet EUS-FNA technique failed to show a potential for improved cellularity of specimens compared to the dry technique for UGI-SELs.
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Wang, Yun, Rong-hua Wang, Zhen Ding, et al. "Wet- versus dry-suction techniques for endoscopic ultrasound-guided fine-needle aspiration of solid lesions: a multicenter randomized controlled trial." Endoscopy 52, no. 11 (2020): 995–1003. http://dx.doi.org/10.1055/a-1167-2214.
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Abstract Background The optimal sampling techniques for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) remain unclear and have not been standardized. The aim of this study was to compare the wet-suction and dry-suction techniques for sampling solid lesions in the pancreas, mediastinum, and abdomen. Methods This was a multicenter, crossover, randomized controlled trial with randomized order of sampling techniques. The 296 consecutive patients underwent EUS-FNA with 22G needles and were randomized in a ratio of 1:1 into two separate groups that received the dry-suction and wet-suction techniques in a different order. The primary outcome was to compare the histological diagnostic accuracy of dry suction and wet suction for malignancy. The secondary outcomes were to compare the cytological diagnostic accuracy and specimen quality. Results Among the 269 patients with pancreatic (n = 161) and non-pancreatic (n = 108) lesions analyzed, the wet-suction technique had a significantly better histological diagnostic accuracy (84.9 % [95 % confidence interval (CI) 79.9 % – 89.0 %] vs. 73.2 % [95 %CI 67.1 % – 78.7 %]; P = 0.001), higher specimen adequacy (94.8 % vs. 78.8 %; P < 0.001), and less blood contamination (P < 0.001) than the dry-suction technique. In addition, sampling non-pancreatic lesions with two passes of wet suction provided a histological diagnostic accuracy of 91.6 %. Conclusions The wet-suction technique in EUS-FNA generates better histological diagnostic accuracy and specimen quality than the dry-suction technique. Furthermore, sampling non-pancreatic lesions with two passes of EUS-FNA with wet suction may provide a definitive histological diagnosis when rapid on-site evaluation is not routinely available.
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Hehn, Sean T., Thomas M. Grogan, and Thomas P. Miller. "Utility of Fine-Needle Aspiration As a Diagnostic Technique in Lymphoma." Journal of Clinical Oncology 22, no. 15 (2004): 3046–52. http://dx.doi.org/10.1200/jco.2004.02.104.
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Purpose To evaluate, from a clinician's perspective, the sensitivity and specificity of fine-needle aspiration (FNA) as a technique for the diagnosis of lymphoma. Patients and Methods Medical records of 470 new patients seen in one lymphoma specialist's clinic from January 1998 through December 2002 were reviewed. Ninety-nine (21%) of the 470 patients underwent a total of 115 FNA procedures, which were assessed by more than 70 different pathologists in 32 different pathology departments. Subsequent excisional biopsies were performed in 67 of these patients and interpreted by a single hematopathology group without independent review. Results Of 115 FNA procedures, 93 were completed for the initial evaluation of lymphoma and 22 were done for assessment of relapsed disease. Of the 93 FNA attempts at initial diagnosis, only 27 (29%) were given a specific and complete histologic diagnosis using an accepted classification system (Working Formulation, Revised European-American Classification of Lymphoid Neoplasms, WHO). For the 22 FNAs done for recurrent disease, only nine (41%) were classified using an accepted system. Sixty-seven (72%) of the 93 FNAs performed for the evaluation of initial disease had subsequent excisional biopsies. Among these paired comparisons, only eight (12%) of 67 FNA diagnoses were correlated with the subsequent excisional biopsy diagnosis. Immunophenotyping was completed on 24 of the 67 paired FNAs. Seven of the 24 FNAs with immunophenotyping (29%) were correlated with subsequent histology on excisional biopsy. Only one (2%) of 43 FNA diagnoses, based on morphology alone, was correlated with subsequent excisional biopsy diagnosis. Conclusion Overall, FNA for lymphoma diagnosis is not helpful, not cost effective, and in addition may misguide treatment.
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Creemers, Koen, Olaf van der Heiden, Jan Los, et al. "Endoscopic Ultrasound Fine Needle Aspiration in the Diagnosis of Lymphoma." Journal of Oncology 2011 (2011): 1–4. http://dx.doi.org/10.1155/2011/785425.
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In recent years, endoscopic ultrasound techniques with Fine Needle Aspiration (FNA) have become an increasingly used diagnostic aid in the differentiation of mediastinal lymphadenopathy. Endobronchial ultrasound (EBUS) and endoesophageal ultrasound (EUS) are now available for clinicians to reach mediastinal and paramediastinal masses using a minimally invasive approach. These techniques are an established component for diagnosing and staging lung cancer and their benefit in the diagnosis of lymphoma's has been highlighted in a number of case studies. However, the lack of tissue architecture obtained by cytological FNA specimens decreases the diagnostic accuracy for benign causes of thoracic lymphadenopathies, lymphomas, and histopathological subtyping of lung cancer. Accordingly, our study group have adapted the FNA sampling technique, resulting in tissue fragments that can be used for histopathological examinations. As an illustration, we report a case of follicular non-Hodgkin lymphoma, diagnosed on tissue fragments obtained by adjusted EUS FNA. We believe that this relatively simple adjustment to routine FNA sampling can help to overcome the diagnostic limitations inherent in cytology obtained by routine FNA.
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Ford, Lloyd, Barry M. Rasgon, Raymond L. Hilsinger, et al. "Comparison of Thinprep versus Conventional Smear Cytopreparatory Techniques for Fine-Needle Aspiration Specimens of Head and Neck Masses." Otolaryngology–Head and Neck Surgery 126, no. 5 (2002): 554–61. http://dx.doi.org/10.1067/mhn.2002.124704.
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OBJECTIVES: Diagnostic accuracy of the ThinPrep process (Cytyc, Boxborough, MA) was compared with that of conventional (smear) cytopreparation for fine-needle aspiration (FNA) of head and neck masses. METHODS: In a prospective, randomized, single-blinded study, 209 patients served as their own controls and underwent 236 FNAs using ThinPrep and conventional (smear) cytopreparatory techniques. RESULTS: ThinPrep produced less air-drying artifact and less mechanical distortion than the conventional method. The conventional technique was diagnostic in 63% of samples; the ThinPrep technique was diagnostic in 55% of samples. When all results were combined, pathologists subjectively preferred the conventional technique but accepted use of ThinPrep as the only cytopreparatory technique for most head and neck masses. CONCLUSIONS: For adequately experienced cytopathologists, ThinPrep is acceptable for FNA of salivary masses, neck cysts, metastatic lymph nodes, and thyroid lesions. Conventional smear technique should be used for FNA of nonmetastatic lymphoid lesions. Use of ThinPrep can complement use of the conventional (smear) cytopreparatory technique when aspirate is nondiagnostic or bloody, when the patient has a blood-borne infectious disease, when the clinician is inexperienced, or when aspirate has entered the syringe.
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Attam, Rajeev, Mustafa a. Arain, Stephen J. Bloechl, et al. "97 Wet Suction FNA Technique: a Novel Technique for EUS-FNA. Results of a Prospective, Randomized and Blinded Study." Gastrointestinal Endoscopy 79, no. 5 (2014): AB110. http://dx.doi.org/10.1016/j.gie.2014.02.033.
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Mokhatri, Maral, Golsa Shekarkhar, and Zahra Sarraf. "Fine-Needle Aspiration Biopsies of Ovarian Masses: A Reliable Technique." Acta Cytologica 60, no. 5 (2016): 465–74. http://dx.doi.org/10.1159/000449362.
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Objective: In gynecology, fine-needle aspiration (FNA) has an overall accuracy of 94.5% in differentiation between benign and malignant tumors. The purpose of this study was to determine reliable cytological criteria for categorizing ovarian masses into benign and malignant categories, their subtypes, and also to evaluate FNA accuracy in the diagnosis of ovarian tumors in relation to histopathological findings. Study Design: A prospective study was performed on all patients with a preoperative diagnosis of ovarian tumor who were referred to our hospital between August 2013 and August 2015. During surgery, FNA was performed using an 18-gauge needle by a pathologist. Aspirated material was spread on clean glass slides and stained with Papanicolaou and Wright-Giemsa stains. The cytological findings and results were compared with the histological diagnosis. Results: Of the 81 cases in this study, there was a discrepancy between the cytological and histological diagnosis in 9 cases. The overall cytological diagnostic accuracy in our study was 88.9% with a sensitivity and specificity of 78.1 and 95.5%, respectively. Conclusion: FNA of an ovarian mass is a minimally invasive procedure with acceptable diagnostic accuracy, especially when differentiating between benign and malignant lesions, and can be considered as a useful diagnostic modality for choosing an appropriate management course.
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Vazquez-Sequeiros, Enrique, Michael J. Levy, Manuel Van Domselaar, et al. "Diagnostic Yield and Safety of Endoscopic Ultrasound Guided Fine Needle Aspiration of Central Mediastinal Lung Masses." Diagnostic and Therapeutic Endoscopy 2013 (May 30, 2013): 1–6. http://dx.doi.org/10.1155/2013/150492.
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Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.
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DiMaio, Christopher J. "Practice patterns in FNA technique: A survey analysis." World Journal of Gastrointestinal Endoscopy 6, no. 10 (2014): 499. http://dx.doi.org/10.4253/wjge.v6.i10.499.
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Dalal, S., and D. Jhala. "Adequacy And Rate Of Atypical Cytology On Fine Needle Aspiration Technique Using Suction (FNA-S) – A Quality Assurance Study At CMCVAMC." American Journal of Clinical Pathology 154, Supplement_1 (2020): S162. http://dx.doi.org/10.1093/ajcp/aqaa161.353.
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Abstract Introduction/Objective Thyroid cancer is one of the most common prevailing conditions. Both genetic and environmental risk factors play a role in causation of thyroid cancers, with agent orange being the most documented risk factor in Veteran patient population. Based on the ultrasonographic appearance, thyroid nodules can be further investigated by minimally invasive fine needle cytology. This can be done by either of two available techniques, Fine needle aspiration with suction (FNA-S) and Fine needle capillary cytology without using suction (FNC), depending upon the preference of practicing endocrinologist. We aim to compare both cytology techniques for comparing the diagnostic yield and rate of atypia of undetermined significance (AUS) or Follicular lesion of undetermined significance (FLUS), requiring repeat FNA in approximately three months. Methods Retrospective study was conducted by searching the cases performed by an endocrinologist at Corporal Michael J Crescenz VA Medical Center between the period of January 1, 2015 and July 2, 2015. 30 nodules from 11 patients were tested by Fine needle capillary cytology technique (FNC). Yield for the diagnosis with rates of atypical (AUS) cytology were compared. On second set of the 29 patients with 38 nodules, both techniques - FNA-S versus FNC were carried out. Adequacy and rate of AUS/FLUS were calculated. Results Out of 30 total nodules performed by fine needle aspiration (FNA-S), all cases yielded diagnostic material. Of them, 14 (46.6%) were diagnosed as AUS and 16 (53.33%) were benign. On the follow-up/re-aspiration by FNC technique, all these 14 nodules were diagnosed benign. On second set of patients on whom both techniques (FNA-S and FNC) were used alternatively, 13 of 38 nodules (34.21%) were diagnosed as AUS/FLUS, 23 (60.52%) were benign/nodular goiter and 2 were non-diagnostic/inadequate (5.2%). Conclusion FNA-S (with suction) yields adequate diagnostic material, however, also has greater number of atypical cytology results requiring repeat patient visit which may increase morbidity with a burden on total health care cost. FNC (without suction) has low rates of AUS/FLUS, is diagnostically superior with excellent smear quality, less blood clots, time savings, and less inconvenience of patients/physician. FNC (without suction) is a modality of choice for an effective screening of thyroid nodules in veterans.
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Nguyen, N. Q., K. Lim, and A. Ruszkiewicz. "Preparation technique for cytologic study of EUS-guided FNA samples when onsite cytopathologist is absent: Cell block, smear, or both?" Journal of Clinical Oncology 29, no. 4_suppl (2011): 176. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.176.
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176 Background: Smearing EUS-guided fine-needle aspiration (FNA) samples, with or without cell block, is most commonly performed for cytologic study in centers without onsite cytology. The diagnostic yield of such technique is often low (35%-50%) and may be related to loss of diagnostic material during the smearing process. Cell block technique captures not only aspirated cells but also small tissue fragments, improving diagnostic yield and enabling additional ancillary studies. This study aimed to compare the diagnostic yield of cell block alone against conventional smear (±cell block) technique in the EUS-guided FNA evaluation of pancreatic solid mass without onsite cytological assessment. Methods: Data on the diagnostic yield of cell block alone technique performed over the last 12 months were prospectively collected and were compared to the yield of conventional smear ± cell block technique. A positive diagnostic yield was defined by the presence of adenocarcinoma and/or FNA findings consistent with the final surgical diagnosis. Results: Data were available for 96 patients, of which 66 had cell block alone and 30 had smear +/-cell block preparation. The diagnostic yield of cell block alone was significantly higher that that of smear +/- cell block (53/66 vs 13/30; P=0.003). The addition of cell block after smearing did not improve the diagnostic yield (smear: 42% vs. both: 45%, p=0.88). Of patients who had smear +/-cell block, the diagnostic yield was significantly higher when the smearing was performed by cytopathologist as compared to that by nurse (10/16 vs. 3/14, p=0.02). There was a direct relationship between the rate of diagnostic yield and the number of FNA passes performed. The yield was highest when 4 or more FNA passes was performed (85%) as compared to that of 3 passes (63%, p=0.049) and 2 or less passes (38%, p<0.0001). Conclusions: In the absence of onsite cytology services, the diagnostic yield from cell block alone was high (80%) and was superior to smear technique whether cell block was added to the evaluation of smears. In order to obtain adequate tissue material to maximise the diagnostic yield EUS-guided FNA of pancreatic mass, at least 4 FNA passes should be performed. No significant financial relationships to disclose.
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Coté, Gregory A., Christine E. Hovis, Cara Kohlmeier, et al. "Training in EUS-Guided Fine Needle Aspiration: Safety and Diagnostic Yield of Attending Supervised, Trainee-Directed FNA from the Onset of Training." Diagnostic and Therapeutic Endoscopy 2011 (November 24, 2011): 1–5. http://dx.doi.org/10.1155/2011/378540.
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Background. The optimal time to initiate hands-on training in endoscopic ultrasound fine needle aspiration (EUS-FNA) is unclear. We studied the feasibility of initiating EUS-FNA training concurrent with EUS training. Methods. Three supervised trainees were instructed on EUS-FNA technique and allowed hands-on exposure from the onset of training. The trainee and attending each performed passes in no particular order. During trainee FNA, the attending provided verbal instruction as needed but no hands-on assistance. A blinded cytopathologist assessed the adequacy (cellularity) and diagnostic yield of individual passes. Primary outcomes compared cellularity and diagnostic yield of attending versus fellow FNA passes. Results. We analyzed 305 FNA sites, including pancreas (51.2%), mediastinal/upper abdominal lymph node (LN) (28.5%) and others (20.3%). The average proportion of fellow passes with AC was similar to attending FNA—pancreas: 70.3 versus 68.8%; LN: 79.0 versus 81.7%; others 65.5 versus 68.7%; P > 0.05); these did not change significantly during the training period. Among cases with confirmed malignancy (n = 179), the sensitivity of EUS-FNA was 78.8% (68.4% fellow-only versus 69.6% attending only). There were no EUS-FNA complications. Conclusions. When initiated at the onset of EUS training, attending-supervised, trainee-directed FNA is safe and has comparable performance characteristics to attending FNA.
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Guo, Hui-qin, Zhi-hui Zhang, Huan Zhao, Li-juan Niu, Qing Chang, and Qin-Jing Pan. "Factors Influencing the Reliability of Thyroid Fine-Needle Aspiration: Analysis of Thyroid Nodule Size, Guidance Mode for Aspiration and Preparation Method." Acta Cytologica 59, no. 2 (2015): 169–74. http://dx.doi.org/10.1159/000381412.
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Objective: We aimed to clarify the influence of ThinPrep preparation, nodule size and guidance mode on the accuracy of thyroid fine-needle aspiration (FNA). Methods: A total of 1,240 thyroid FNAs were reviewed and 489 cases with histological correlations were enrolled in this study. Results: Of the 489 total cases examined, 101 were processed with both ThinPrep and conventional preparation and 388 entirely with ThinPrep. The overall nondiagnostic rate, sensitivity and accuracy of FNA were 2.0, 91.0 and 89.4%, respectively. The cases with a preoperative ultrasound (n = 469) were grouped according to nodule size. The nondiagnostic rate, sensitivity and accuracy of FNA did not differ significantly with nodule size (p1 = 0.339, p2 = 0.179, p3 = 0.119). A total of 101 resections were performed with palpation-guided FNA and 388 were performed with ultrasound-guided FNA. The nondiagnostic rates, sensitivity and accuracy of FNA were similar in these two groups. Conclusions: The ThinPrep technique is a valid method for thyroid FNA and is effective for thyroid nodules ≥0.5 cm. The reliability of FNA results is not reduced with larger nodules. The use of palpation-guided FNA for palpable solid nodules is also effective.
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Walsh, Leonard, Lindsay Mitchell, Ansh Johri, Nicholas Matone, Mary Frecker, and Matthew Moyer. "When high viscosity of pancreatic cysts precludes effective EUS-FNA: a benchtop comparison of negative pressure devices." Endoscopy International Open 07, no. 04 (2019): E594—E599. http://dx.doi.org/10.1055/a-0842-6332.
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Abstract Background and study aims Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs) is an important diagnostic tool; however, it is often unsuccessful due to high viscosity of cystic fluid. In an effort to improve FNA, we objectively compared eight vacuum device configurations to determine the most effective method for aspirating viscous fluid collections. We also tested a high-frequency oscillation (HFO) technique that could be employed in FNA. Materials and methods Maximum gauge pressures of four vacuum devices were measured: two standard EUS-FNA syringes, a 50-cc Alliance II device, and a nonmedical hand vacuum pump. To aspirate a viscous stock solution, 19-gauge and 22-gauge needles were used and flow rates were calculated. HFO was also applied to the needle during aspiration to determine effect on aspiration rate. Results Aspiration devices generated maximum gauge pressures ranging from –21.5 to –27.5 inHg. The 19-gauge FNA needle aspirated viscous fluid 11.3 × faster on average than a 22-gauge needle. HFO increased average flow rates by 29.7 % in 19G and 124.6 % in 22G configurations. Conclusion EUS-FNA of viscous fluid can be optimized by using the lowest possible gauge needle and connecting a vacuum device capable of generating and sustaining near perfect vacuum. This can be accomplished by maximizing syringe volume. In addition, connector-tubing length between the syringe and needle should be minimized, and tubing wall should be sufficiently strong to resist collapse under vacuum. Other novel techniques to increase fluid yield include a hand vacuum pump and application of HFO to FNA.
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May, B., A. Rossiter, and P. Heyworth. "Core Biopsy and FNA: A Comparison of Diagnostic Yield in Lymph Nodes of Different Ultrasound Determined Malignant Potential." Journal of Global Oncology 4, Supplement 2 (2018): 37s. http://dx.doi.org/10.1200/jgo.18.66100.
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Background: The tissue diagnosis of lymphoma and metastases is commonly obtained from affected lymph nodes. The lymph nodes chosen for biopsy are often the consequence of their appearance on ultrasound, which determines their risk of malignancy. Two frequently used percutaneous sampling techniques are core biopsy and fine needle aspiration (FNA). While core biopsy obtains a larger tissue sample and provides a degree of architectural information, FNA is considered less invasive and has the advantage of immediate confirmation of adequacy by the attending cytologist. Anecdotally, core biopsy is more commonly used when a lymph node is suspected of harboring neoplasia, however a feature of malignancy is hypercellularity, which theoretically should increase the diagnostic yield of FNA. Aim: The aim of this project was to compare the diagnostic capability of FNA and core biopsy in lymph nodes of different malignant potential, as defined by ultrasound, and determine if the radiologic appearance can guide clinicians in their choice of sampling technique. The project also reviewed the role of clinical experience in both the choice of sampling technique and diagnostic yield. Methods: Retrospective study of percutaneous lymph node biopsies performed at a large tertiary hospital between July 2016 and March 2018. The associated ultrasounds were reviewed and the lymph nodes were classified as high or low risk of malignancy by their sonographic appearance. The end point for analysis was the capacity for FNA or core biopsy to provide a definitive diagnosis. The diagnostic yield was then separately assessed for lymph nodes of high and low malignant potential. The effect of clinical experience on diagnostic yield was also examined, by comparing the outcomes of radiology consultants and radiology trainees. Results: 296 lymph node biopsies were reviewed and statistical analysis was performed using logistic regression analysis. Core biopsy, in comparison with FNA, was used twice as often in lymph nodes of high malignant potential, supporting the aforementioned anecdotal evidence. Core biopsy demonstrated superior diagnostic yield in comparison with FNA, providing a diagnostic sample 45% ( P = 0.313) more often in low-risk lymph nodes and 209% ( P = < 0.05) more often in high-risk lymph nodes. Consultant radiologists used FNA 81% more often than core biopsy in lymph nodes of high malignant potential, while radiology trainees used core biopsy 104% more often than FNA in the same group. In high-risk lymph nodes, trainees were 117% ( P = 0.105) more likely to obtain a diagnostic sample than consultants. Conclusion: Core biopsy is superior to FNA in the tissue sampling of lymph nodes regardless of ultrasound determined risk of malignancy. Biopsies obtained by radiology trainees provided a diagnosis twice as often as those obtained by radiology consultants. This appeared to be the consequence of consultant preference for FNA over core biopsy.
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Sobhrakhshankhah, Elham, Masoudreza Sohrabi, Hamid Reza Norouzi, et al. "Tissue Sampling through Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Endoscopic Retrograde Cholangiopancreatographic Brushing Cytology Technique in Suspicious Malignant Biliary Stricture." Middle East Journal of Digestive Diseases 13, no. 4 (2021): 294–301. http://dx.doi.org/10.34172/mejdd.2021.238.
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BACKGROUND Differentiation of benign and malignant biliary strictures plays a pivotal role in managing biliary strictures. Brush cytology via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are two diagnostic methods. In the present study, we aimed to compare the accuracy of the results of EUS-FNA and ERCP-based sampling of biliary strictures. METHODS In a prospective study, between January 2019 and March 2020, patients with indeterminate biliary strictures who had no history of hepatobiliary surgery, opium usage, cancer of pancratobiliary system, and acute liver disease were selected. They underwent EUS and ERCP in the same session. They were followed up for 6 months, and the sensitivity, specificity, positive and negative predictive values, and accuracy of these imaging modalities were compared. RESULTS A total of 60 patients were enrolled. 28 lesions were located in the distal and 32 lesions in the proximal parts of the biliary tree. 55 malignant and 5 benign lesions were diagnosed. The sensitivity and accuracy of EUS-FNA and ERCP tissue sampling were 78.2% and 80.0% versus 50.9% and 55.0%, respectively (p = 0.024). The combination of both methods improved the sensitivity and accuracy to 85.5% and 86.7%, respectively. Regarding the location, EUS-FNA is superior to ERCP-brush cytology in diagnosing proximal lesions with sensitivity and specificity of 73.3% and 75.0% vs. 50.0% and 53.1%, respectively (p = 0.04). CONCLUSION EUS-FNA is superior to ERCP brushing in the diagnosis of indeterminate biliary strictures, particularly in distal lesions. Combining ERCP brushing and EUS-FNA improves the diagnosis accuracy.
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Abdel-Aziz, Yousef, Tariq Hammad, Mohamad Nawras, Hayder Abdulwahid, and Ali Nawras. "Metastatic Renal Cell Cancer to Thyroid Diagnosed by Endoscopic Ultrasound Guided Fine Needle Aspiration Technique." Case Reports in Gastrointestinal Medicine 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/6725297.
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Medical literature about the role of endoscopic ultrasound (EUS) in identifying thyroid lesions is limited. We present a case of secondary thyroid cancer from renal cell carcinoma (RCC) metastasis, diagnosed by thyroid EUS-fine needle aspiration (FNA) approach that was done for staging of esophageal adenocarcinoma, in a patient with 11-year history of complete right nephrectomy for RCC. An 81-year-old female patient underwent EUS for the evaluation of a newly discovered distal esophageal cancer. A hypoechoic, round, and well-demarcated mass that measured 26.9 mm × 21.9 mm was noticed in the right lobe thyroid gland. Therefore FNA was performed. The cytological results were consistent with metastatic RCC. In conclusion, EUS-FNA of thyroid nodule is a feasible and safe technique that can be used to evaluate any suspicious thyroid nodule. This case emphasizes the importance of carefully examining the thyroid gland during routine upper esophageal EUS examinations in the presence of history of nonthyroidal cancer.
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Kobara, Hideki, Nobuya Kobayashi, Noriko Nishiyama, Naoya Tada, Shintaro Fujihara, and Tsutomu Masaki. "Simplified Submucosal Tunneling Biopsy Using Clip-With-Line Traction and Closure for Gastric Subepithelial Lesion." Diagnostics 10, no. 9 (2020): 690. http://dx.doi.org/10.3390/diagnostics10090690.
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Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as a standard and convenient method for the sampling of subepithelial lesions (SELs). Immunohistological analysis is required to definitively distinguish mesenchymal tumors; however, EUS-FNA provides insufficient material to achieve this, especially for small SELs < 2 cm. We therefore previously reported a novel submucosal tunneling biopsy (STB) technique that utilizes endoscopic submucosal dissection (ESD) for sampling SELs. However, unresolved advanced technical issues have hindered its widespread application. Currently, a counter-traction technique is used to facilitate ESD. We here describe a technically simplified STB technique using clip-with-line traction for gastric SELs.
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Bor, Renáta, Béla Vasas, Anna Fábián, et al. "Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions." Diagnostics 13, no. 17 (2023): 2841. http://dx.doi.org/10.3390/diagnostics13172841.
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Background: The inconclusive cytological findings of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remain a major clinical challenge and often lead to treatment delays. Methods: Patients who had undergone EUS-FNA sampling for solid pancreas lesions between 2014 and 2021 were retrospectively enrolled. The “atypical” and “non-diagnostic” categories of the Papanicolaou Society of Cytopathology System were considered inconclusive and the “negative for malignancy” category of malignancy was suspected clinically. We determined the frequency and predictors of inconclusive cytological finding. Results: A total of 473 first EUS-FNA samples were included, of which 108 cases (22.83%) were inconclusive. Significant increases in the odds of inconclusive cytological findings were observed for lesions with a benign final diagnosis (OR 11.20; 95% CI 6.56–19.54, p < 0.001) as well as with the use of 25 G FNA needles (OR 2.12; 95% CI 1.09–4.01, p = 0.023) compared to 22 G needles. Furthermore, the use of a single EUS-FNA technique compared to the combined use of slow-pull and standard suction techniques (OR 1.70; 95% CI 1.06–2.70, p = 0.027) and less than three punctures per procedure led to an elevation in the risk of inconclusive cytology (OR 2.49; 95% CI 1.49–4.14, p < 0.001). Risk reduction in inconclusive cytology findings was observed in lesions between 2–4 cm (OR 0.40; 95% CI 0.23–0.68, p = 0.001) and >4 cm (OR 0.16; 95% CI 0.08–0.31, p < 0.001) compared to lesions ≤2 cm. Conclusions: The more than two punctures per EUS-FNA sampling with larger-diameter needle (19 G or 22 G) using the slow-pull and standard suction techniques in combination may decrease the probability of inconclusive cytological findings.
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Bensussan, Alena V., John Lin, Chunxiao Guo, et al. "Distinguishing Non-Small Cell Lung Cancer Subtypes in Fine Needle Aspiration Biopsies by Desorption Electrospray Ionization Mass Spectrometry Imaging." Clinical Chemistry 66, no. 11 (2020): 1424–33. http://dx.doi.org/10.1093/clinchem/hvaa207.
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Abstract BACKGROUND Distinguishing adenocarcinoma and squamous cell carcinoma subtypes of non-small cell lung cancers is critical to patient care. Preoperative minimally-invasive biopsy techniques, such as fine needle aspiration (FNA), are increasingly used for lung cancer diagnosis and subtyping. Yet, histologic distinction of lung cancer subtypes in FNA material can be challenging. Here, we evaluated the usefulness of desorption electrospray ionization mass spectrometry imaging (DESI-MSI) to diagnose and differentiate lung cancer subtypes in tissues and FNA samples. METHODS DESI-MSI was used to analyze 22 normal, 26 adenocarcinoma, and 25 squamous cell carcinoma lung tissues. Mass spectra obtained from the tissue sections were used to generate and validate statistical classifiers for lung cancer diagnosis and subtyping. Classifiers were then tested on DESI-MSI data collected from 16 clinical FNA samples prospectively collected from 8 patients undergoing interventional radiology guided FNA. RESULTS Various metabolites and lipid species were detected in the mass spectra obtained from lung tissues. The classifiers generated from tissue sections yielded 100% accuracy, 100% sensitivity, and 100% specificity for lung cancer diagnosis, and 73.5% accuracy for lung cancer subtyping for the training set of tissues, per-patient. On the validation set of tissues, 100% accuracy for lung cancer diagnosis and 94.1% accuracy for lung cancer subtyping were achieved. When tested on the FNA samples, 100% diagnostic accuracy and 87.5% accuracy on subtyping were achieved per-slide. Conclusions DESI-MSI can be useful as an ancillary technique to conventional cytopathology for diagnosis and subtyping of non-small cell lung cancers.
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Bechade, Dominique, Carine A. Bellera, Coralie Cantarel, et al. "Diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the evaluation of hypermetabolic lymphadenopathy mediastinum lower, posterior, and middle, detected by PET-CT with 18F-FDG (PET) (APOGEE Study)." Journal of Clinical Oncology 38, no. 4_suppl (2020): 798. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.798.
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798 Background: In the context of a new cancer or relapse, the high sensitivity (Se) (95-100%) of PET-CT with 18F-FDG can lead to the demonstration of hypermetabolic mediastinal adenopathies. Its lower specificity (Sp) (89%) can require histological examination. We report the results of a prospective, single-center study evaluating the diagnostic performance of EUS-FNA in this indication. Methods: Prospective single-center study featuring patients in whom PET had revealed hypermetabolic mediastinal lymphadenopathy requiring diagnostic certainty. All EUS-FNA were performed with a 19-gauge needle (EchoTip, Cook Endoscopy). Main objective: To evaluate the diagnostic performance in terms of Se and Sp of EUS-FNA in the characterization of hypermetabolic mediastinal adenopathies in PET in the context of a new cancer or relapse. Secondary objectives: To evaluate the negative predictive value (NPV) of the EUS-FNA and to evaluate the percentage of surgical diagnostic procedures avoided. The standard technique was a thoraco-abdominopelvic CT scan at 6 months and at 12 months. Results: 52 patients were eligible and evaluable for the primary endpoint. The most common primary cancers were mammary (17.3%) and bronchial (13.5%). The lymph nodes were analyzed as malignant in 44.2% of cases, benign in 50% of cases and atypical or suspicious in 3.8% of cases. The malignant lymph nodes were metastatic for breast cancer in 21.7% of cases, bronchial cancer in 17.4% of cases, colorectal cancer in 17.4% of cases and prostate cancer in 13% of cases. The Se of the EUS-FNA was 92% (95% CI 0.74-0.99) and the Sp 100%. NPV was 87% (95% CI: 0.59-0.98). A diagnostic surgical procedure was necessary in 2% of the cases. PET and EUS-FNA often allowed the modification of the therapeutic strategy. Conclusions: When a confirmed diagnosis is required, the diagnostic accuracy of the minimally invasive procedure of EUS-FNA, is sufficiently robust to avoid a surgical diagnosis technique. The combination of PET and EUS-FNA may alter the therapeutic strategy that would have been considered after PET alone. Clinical trial information: NCT01892501.
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Adamowicz, Bartosz, Thibaut Manière, Vincent Déry, and Étienne Désilets. "Needle Fracture during Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspicious Thoracic Lymph Nodes." Case Reports in Medicine 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/2526789.
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Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is used to make a cytopathologic diagnosis of suspicious lesions located around the gastrointestinal tract. It is a safe technique with few complications. The most common complications of EUS-FNA are related to pancreatic lesions (pancreatitis, bleeding, and abdominal pain). Rare complications have been noted such as stent malfunction, air embolism, infection, neural and vascular injuries, and tumor cell seeding. There are very few studies examining equipment malfunctions. We report a case of needle fracture during the EUS-FNA of suspicious thoracic lymph nodes in a 79-year-old man investigated for unexplained weight loss.
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Vadala, Rohit, Saurabh Mittal, Aruna Nambirajan, et al. "Transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for left adrenal gland (LAG) sampling: A report of three cases with a review of the literature." Lung India 40, no. 6 (2023): 550–54. http://dx.doi.org/10.4103/lungindia.lungindia_381_22.
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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard-of-care modality for evaluating mediastinal lymph nodes and masses. The EBUS bronchoscope may also be introduced through the oesophageal route to perform sampling of accessible lesions, a technique described as transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). Because of the central oesophageal approach, EUS-B-FNA provides easy access to the left para-tracheal, subcarinal and para-oesophageal lymph nodes. In addition, the left adrenal gland (LAG) can also be imaged and sampled during the EUS-B-FNA procedure. In patients with suspected lung cancer, accurate staging is essential. Adrenal metastasis is relatively common and may often be a solitary metastatic site. We describe three cases where EUS-B-FNA was performed to safely sample the enlarged LAG in suspected lung cancer. We also review the literature on the performance characteristics of EUS-B-FNA for LAG aspiration.
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Doubi, Aseel, Nuha S. Alrayes, Abdulaziz K. Alqubaisi, and Saleh F. Al-Dhahri. "The value of repeating fine-needle aspiration for thyroid nodules." Annals of Saudi Medicine 41, no. 1 (2021): 36–42. http://dx.doi.org/10.5144/0256-4947.2021.36.
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BACKGROUND: Fine-needle aspiration (FNA) is an invaluable technique used in the evaluation of thyroid nodules. OBJECTIVES: Evaluate the concordance of results for consecutive FNA readings. DESIGN: Retrospective, descriptive. SETTINGS: Two tertiary care centers. METHODS: Demographics were collected along with every FNA result and final pathology results for all patients (aged 9-90 years old) who underwent thyroid surgery from 2010 to 2017. The Bethesda system was used for cytology. Agreement levels were calculated and compared with final pathology. SAMPLE SIZE: Of 1237 initially included, 1134 had at least one FNA performed with results available for review. RESULTS: For the 1134 patients, demographic and clinical data were collection and a comparison was made between the three FNA results; the highest agreement was between FNA 2 and 3 (53.6%); however, the kappa value was consistently low for all comparisons, indicating a poor level of agreement overall. Also, the risk of malignancy was higher in this study than in the 2017 Bethesda system for reporting thyroid cytopathology in FNA cytology categories I and II. CONCLUSION: Repeating FNA biopsies yield different results every time; hence, there is a low level of agreement. The clinical decision should therefore include other important risk factors. Prospective studies could help shed more light on this topic. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.
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Diaz-Ruiz, María Jesús, Anna Arnau, Jesus Montesinos, et al. "Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study." Breast Care 11, no. 1 (2015): 34–39. http://dx.doi.org/10.1159/000442481.
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Background: The axillary nodal status is essential to determine the stage of disease at diagnosis. Our aim was to prospectively assess the diagnostic accuracy of ultrasonography-guided fine-needle aspiration (US-FNA) for the detection of metastasis in axillary lymph nodes in patients with breast cancer (BC) and its impact on the therapeutic decision. Materials and Methods: Ultrasonography (US) was performed in 407 axillae of 396 patients who subsequently underwent surgery. US-FNA was conducted when lymph nodes were detected by US. Axillary dissection (AD) was performed when US-FNA was positive for metastasis. Patients with negative US-FNA and breast tumors of 30 mm in size were candidates for selective sentinel lymph node biopsy (SLNB). The anatomopathological results of AD or SLNB were used as reference tests. Results: Lymph nodes were detected by US in 207 (50.8%) axillae. Of these, US-FNA was performed on 180 (86.9%). 94 axillae (52.2%) were positive for carcinoma and 79 women received AD. US-FNA had 77.5% sensitivity, 100% specificity, 100% positive predictive value, 69.3% negative predictive value, and 85.1% diagnostic accuracy. US-FNA avoided SLNB in 18.1% of patients who underwent AD. Conclusions: Axillary US-FNA is an accurate technique in the staging of patients with BC. It allows reducing the number of SLNB and, when positive, offers a fast and useful tool.
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Paksoy, Nadir, and Busra Ozbek. "Cytopathologist-performed and ultrasound-guided fine needle aspiration cytology enhances diagnostic accuracy and avoids pitfalls: An overview of 20 years of personal experience with a selection of didactic cases." CytoJournal 15 (March 8, 2018): 8. http://dx.doi.org/10.4103/cytojournal.cytojournal_20_17.
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Over the last few decades, fine needle aspiration cytology (FNA) has emerged as a SAFE (Simple, Accurate, Fast, Economical) diagnostic tool based on the morphologic evaluation of cells. The first and most important step in obtaining accurate results from FNA is to procure sufficient and representative material from the lesion and to appropriately transfer this material to the laboratory. Unfortunately, the most important aspect of this task occurs beyond the control of the cytopathologist, a key reason for obtaining unsatisfactory results with FNA. There is growing interest in the field of cytology in “cytopathologist-performed ultrasound (US)-guided FNA,” which has been reported to yield accurate results. The first author has been applying FNA in his own private cytopathology practice with a radiologist and under the guidance of US for more than 20 years. This study retrospectively reviews the utility of this practice. We present a selection of didactic examples under different headings that highlight the application of FNA by a cytopathologist, accompanied by US, under the guidance of a radiologist, in the form of an “outpatient FNA clinic.” The use of this technique enhances diagnostic accuracy and prevents pitfalls. The highlights of each case are also outlined as “take-home messages.”
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Adachi, Akihisa, Yoshikazu Hirata, Hayato Kawamura, et al. "Efficacy of Mucosal Cutting Biopsy for the Histopathological Diagnosis of Gastric Submucosal Tumors." Case Reports in Gastroenterology 13, no. 1 (2019): 185–94. http://dx.doi.org/10.1159/000499442.
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Background: Gastrointestinal stromal tumors occur frequently. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed commonly for diagnosis. However, the success rate of histological diagnosis is insufficient when the submucosal tumor (SMT) is small. Recently, another technique, mucosal cutting biopsy (MCB) has been reported. The aim of this study is to evaluate the efficacy and safety of MCB. Method: Between January 2012 and August 2018, MCB and EUS-FNA were performed 16 and 31 times for diagnosing gastric SMT. The diagnostic rate, the rate of successful immunohistochemistry, and the safety were reviewed. Difficult locations for EUS-FNA were also evaluated. Results: The mean SMT sizes measured on MCB and EUS-FNA were 21.2 and 36.2 mm. The diagnostic rates of MCB and EUS-FNA were almost the same (88 vs. 81%), but successful immunohistochemistry was significantly higher in the MCB group (93 vs. 59%, p = 0.03). In the subgroup of SMTs < 20 mm, the successful histological diagnosis rate from EUS-FNA was relatively low. There were no complications. Failures of EUS-FNA were more frequent in the middle third of the stomach. Conclusions: MCB was an effective procedure for diagnosing gastric SMT, especially in the case of small SMTs located at the middle third of the stomach.
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Lad, D. L., L. K. V. Lad, N. C. Jhala, and A. Toha. "EUS-Guided FNA Biopsy of Solid Pancreatic Lesions: A Review of 111 Cases and Comparative Study of Diff-Quik/PAP/Thin Prep Staining Techniques." Journal of Global Oncology 4, Supplement 2 (2018): 216s. http://dx.doi.org/10.1200/jgo.18.87400.
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Background: Pancreatic cancer is the fourth leading cause of cancer associated deaths in the United States and ranks ninth in its incidence. EUS-guided FNA cytology has emerged as an important diagnostic tool since Vilman and Grimm (1992) made the first reports of endoscopic guided fine needle aspiration. Currently, EUS-guided FNA biopsy of the pancreas is a standard practice for the diagnosis and staging of pancreatic malignancy. Aim: The current study was carried out with the following objectives. 1. To find out the diagnostic accuracy, sensitivity, and specificity of EUS-guided FNA of the pancreatic malignancy by correlating cytologic diagnosis with histologic diagnosis and other investigations. 2. To know the diagnostic accuracy of air-dried smears using Diff-Quik Stain. 3. To compare the diagnosis obtained by Diff-Quik, conventional PAP Stain smears/cytospin preparation and Thin Prep (liquid-based media). Methods: 111 cases of EUS-guided FNA biopsy of the pancreas performed during the year January 2008 to December 2009 having solid pancreatic mass/lesion on the USG/CT and suspicious for the malignancy or malignant on clinical and radiologic investigations were reviewed in August 2011 at the Department of Pathology and Laboratory Medicine, Hospital of University of Pennsylvania. Results: There was an 83.9% correlation between Diff-Quick diagnosis and the final cytologic diagnosis. The overall diagnostic accuracy for the malignancy was 89.7%, sensitivity 90.6%, and specificity 100% of the cases where the cytologic diagnosis was correlated with histologic diagnosis and the other investigations. The positive predictive value for the malignancy was 100%. The false negative diagnosis was encountered in 10.3% cases. 51% of the cases showed intranuclear vacuoles, in the malignant cases on Diff-Quik stain. Conclusion: EUS FNA of the pancreas is a safe and reliable technique with high diagnostic accuracy, sensitivity, and specificity. The Diff-Quik stain smear is a useful technique for the rapid on-site cytologic evaluation for the detection of malignancy of the pancreas. Thin Prep was found superior to the PAP/Diff-Quik stain for the diagnosis of the malignancy. The EUS FNA samples processed by multiple staining techniques help to improve the diagnostic accuracy and sensitivity.
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Conrad, Rachel, Sung-Eun Yang, Shelley Chang, et al. "Comparison of Cytopathologist-Performed Ultrasound-Guided Fine-Needle Aspiration With Cytopathologist-Performed Palpation-Guided Fine-Needle Aspiration: A Single Institutional Experience." Archives of Pathology & Laboratory Medicine 142, no. 10 (2018): 1260–67. http://dx.doi.org/10.5858/arpa.2017-0123-oa.
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Context.— Although fine-needle aspiration (FNA) practice by pathologists is now well established, it has been primarily performed by manual palpation. In recent years, pathologists have begun to venture into ultrasound-guided FNAs (UGFNAs). Reports on experiences with this relatively new technique for pathologists have shown promising results. However to date, there have been few studies in the literature comparing pathologist-performed UGFNA with the more traditional pathologist-performed palpation-guided FNA (PGFNA). Objective.— To compare UGFNA to PGFNA by cytopathologists at an academic medical center. Design.— A retrospective study of FNAs performed by cytopathologists within the University of California, Los Angeles (UCLA) pathology departmental FNA clinic was performed. Data collected included performance technique (UGFNA versus PGFNA), lesion site and size, adequacy status (nondiagnostic rate), and number of passes per procedure. Corresponding surgical pathology/flow cytometric/cytogenetic result follow-up was compared to FNA results. Findings between UGFNA and PGFNA cases were compared. Results.— Of 1029 FNA cases during the study period, there were 449 UGFNA cases (43.6%) and 580 PGFNA cases (56.4%). Nondiagnostic rates with UGFNA and PGFNA were 6.7% (30 of 449 cases) and 20.7% (120 of 580 cases), respectively. Nondiagnostic rate was also significantly lower with UGFNA than with PGFNA for lesions within the thyroid (6.0% versus 33.3%), head and neck (6.6% versus 21.2%), and salivary gland (6.2% versus 17.1%), and across all nodule sizes. A total of 495 of 1029 FNA cases (48.1%) had follow-up. Discordance rate was significantly lower with UGFNA than with PGFNA (5.4% versus 12.8%). Conclusions.— This study shows improved performance characteristics of cytopathologist-performed UGFNA versus PGFNA.
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Cui, Yongmei, Xiangqi Huang, Jinrui Guo, et al. "Fine-needle Aspiration Washout Precipitation Specimens: An Acceptable Supplement to Genetic Mutation Detection of Thyroid Nodules." Technology in Cancer Research & Treatment 20 (January 2021): 153303382110579. http://dx.doi.org/10.1177/15330338211057982.
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Objectives: Thyroid nodules are common in adults, but only some of them are malignant. Ultrasound-guided fine-needle aspiration (FNA) is widely applied as a reliable and minimally invasive technique for evaluating thyroid nodules. However, the scarcity of FNA biopsy specimens poses a challenge to molecular diagnosis. This study aimed to evaluate the feasibility of FNA washout precipitation specimens as an effective supplement to the thyroid genetic test. Methods: A total of 115 patients with thyroid nodules were enrolled in our study. The BRAF V600E mutation status was detected in all FNA washout precipitation specimens and biopsy formalin-fixed paraffin-embedded (FFPE) specimens using an amplification refractory mutation system PCR (ARMS-PCR). All patients underwent cytological diagnoses; 79 patients also underwent surgery for histopathological analysis. Results: All the 115 samples were successfully analyzed using both FNA washout precipitation and biopsy FFPE specimens. The results showed that the BRAF V600E status detected in 96 FNA washout precipitation specimens were consistent with that in FNA biopsy FFPE specimens, including 41 BRAF V600E positive and 55 BRAF V600E negative, achieving a concordance rate of 84.4% (kappa = 0.689). Furthermore, the BRAF V600E mutation status using FNA washout precipitation specimens provided a 100.0% positive predictive value for diagnosing papillary thyroid carcinoma in patients with The Bethesda system for reporting thyroid cytopathology (TBSRTC) V. Besides, the BRAF V600E mutation status was positive in 90.9% (10/11) FNA washout precipitation specimens from patients with capsule invasion, achieving a higher overall sensitivity of 100.0%, compared with 57.1% of FNA washout precipitation specimens from patients without capsule invasion. Conclusion: These results suggested that FNA washout precipitation specimens might be a valuable supplementary sample type for detecting the BRAF V600E mutation in patients with thyroid nodules, especially with thyroid capsule invasion.
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Bayrak, Busra Yaprak, and Nadir Paksoy. "Diagnostic accuracy of fine-needle aspiration cytology for extrathyroidal head-and-neck lesions performed by a cytopathologist with the assistance of radiologist: A single-center study." Cytojournal 22 (June 2, 2025): 57. https://doi.org/10.25259/cytojournal_247_2024.
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Objective: In recent years, several publications have described the use of ultrasound-guided fine-needle aspiration (FNA) by cytopathologists to achieve better diagnostic accuracy. Some cytopathologists enroll in courses to learn and apply ultrasound (US) guidance themselves. However, no standard procedure has been established that cytopathologists can follow to perform US for FNA. Alternatively, FNA can be a useful tool when cytopathologists collaborate with radiologists. Here, we aimed to evaluate the diagnostic accuracy of FNA for non-thyroidal head-and-neck masses retrieved by a cytopathologist with US guidance provided by a radiologist. Material and Methods: The FNA results for non-thyroidal head-and-neck masses at a private clinic using the Scandinavian FNA model with radiologist‒cytopathologist collaboration were compared with the histopathology results. Results: In all, 1890 patients who underwent FNA were identified, among whom 1435 (76%) also had histopathological results. Non-cystic lesions were obtained from lymph nodes (LNs), salivary glands, and soft tissue, while the other lesions were cystic in nature. For FNA, the accuracy was 99.4%, the sensitivity was 99.6%, the specificity was 99.3%, the positive predictive value was 99.3%, and the negative predictive value was 99.6%. No FNA results were non-diagnostic. Surgical follow-up revealed that only eight of the 1435 assessments (0.5%), all performed for LN lesions, yielded false-negative or false-positive results. Conclusion: The present study is based on single-center observations. The use of FNA, when performed by a specialized cytopathologist and with US assistance from a radiologist, produces accurate results and sufficient material for analysis, especially for LNs in extrathyroidal head-and-neck lesions. This study also reveals that the technique is a low-cost and effective process. The way in which FNA is presented here indicates that this procedure would be useful and ideal for any health service.
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S., Anju, Sheeja S., Renu Thambi, and Sankar Sundaram. "A study of the diagnostic effectiveness of repeated fine needle aspiration in thyroid and breast lesions." International Journal of Research in Medical Sciences 10, no. 4 (2022): 879. http://dx.doi.org/10.18203/2320-6012.ijrms20220980.
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Background: Fine needle aspiration cytology (FNAC) is a relatively safe diagnostic tool with high sensitivity and specificity. Due to lesion inherent properties and lack of proper technique, adequate cellularity is not yielded in some instances, resulting in an inconclusive report. In such instances we have to go for repeat FNA to make a proper diagnosis. Repeat aspirations impose unnecessary workload on the lab and are distressful to the patients. The issue of repeat aspiration is largely unaddressed. Objectives were to identify the proportion of repeated fine needle aspirations in breast and thyroid lesions turning out to be diagnostic and to identify and describe the common factors leading to repeat fine needle aspiration.Methods: 190 cases of repeated FNA including both thyroid and breast lesions are included in the study. FNA done after an initial aspiration with inconclusive smear is considered as repeated FNA. History, clinical examination findings, findings in imaging studies, nature of aspirate obtained for each patient advised repeat FNA, are recorded. Proportion of repeat FNAs turning out to be diagnostic and the documented reasons for repeat were taken as the outcome measure.Results: 78% of repeat FNA in thyroid lesions and 50% of the repeat FNA in breast lesions were diagnostic. Inadequate cellularity, haemorrhagic aspirate and cystic change are the most common factors leading to repeat FNA.Conclusions: Since thyroid and breast are the most common sites where FNA is done and 64% of the total lesions are diagnostic, repeat FNA in all other sites are likely to yield a similar diagnostic outcome. Hence, repeat FNA is advisable in lesions which had initial non diagnostic result.
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Wiedmeyer, Charles, Thomas Fangman, Kent Schwartz, and Brian Payne. "Fine-needle aspiration and cytology as an antemortem method for evaluating injection-site lesions." Journal of Swine Health and Production 22, no. 5 (2014): 244–47. http://dx.doi.org/10.54846/jshap/820.
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Objectives: To apply a fine-needle aspirate (FNA) technique to evaluate grossly visible injection-site reactions by cytologic examination and determine agreement with gross and histopathological findings. Materials and methods: Two trials were conducted. In both, pigs were vaccinated with porcine circovirus type 2 vaccine at weaning and 17 days later. Seven days after the second vaccination, pigs with grossly visible injection-site lesions were selected (Trial 1, n = 40; Trial 2, n = 12). In Trial 1, pigs were manually restrained for the FNA procedure. In Trial 2, pigs were sedated and the FNA procedure was conducted using two different-sized hypodermic needles (18-gauge and 22-gauge). After the FNA procedure, pigs were euthanized and the injection-site lesions and lymph nodes dissected and submitted for histopathologic interpretation. All cytologic preparations were examined by a board-certified veterinary clinical pathologist. Results: In Trial 1, the cytologic interpretation of the samples was mild lymphocytic to mixed inflammation. Lesions were suggested to be the result of an immunologic response to the vaccine, not hemorrhage or abscess. In Trial 2, no differences were detected between preparations made with an 18-gauge or 22-gauge needle. Cytologic and histological findings agreed, reporting low to moderate numbers of lymphocytes and macrophages, with low numbers of neutrophils, foreign material, and bacteria. Implications: The FNA procedure described is a potential technique practitioners can utilize to characterize tissue-reaction lesions without the need for euthanasia or surgical biopsy.
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Tantău, Alina, Cosmina Sutac, Anamaria Pop, and Marcel Tantău. "Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion." World Journal of Radiology 16, no. 4 (2024): 72–81. http://dx.doi.org/10.4329/wjr.v16.i4.72.
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In patients with liver tumors, the histopathology examination can assist in diagnosis, staging, prognosis, and therapeutic management strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition using fine needle aspiration (FNA) or more newly fine needle biopsy (FNB) is a well-developed technique in order to evaluate and differentiate the liver masses. The goal of the EUS-FNA or EUS-FNB is to provide an accurate sample for a histopathology examination. Therefore, malignant tumors such as hepatocarcinoma, cholangiocarcinoma and liver metastasis or benign tumors such as liver adenoma, focal hyperplastic nodular tumors and cystic lesions can be accurately diagnosed using EUS-guided tissue acquisition. EUS-FNB using 19 or 22 Ga needle provide longer samples and a higher diagnostic accuracy in patients with liver masses when compared with EUS-FNA. Few data are available on the diagnostic accuracy of EUS-FNB when compared with percutaneously, ultrasound, computer tomography or transjugulary-guided liver biopsies. This review will discuss the EUS-guided tissue acquisition options in patients with liver tumors and its efficacy and safety in providing accurate samples. The results of the last studies comparing EUS-guided liver biopsy with other conventional techniques are presented. The EUS-guided tissue acquisition using FNB can be a suitable technique in suspected liver lesions in order to provide an accurate histopathology diagnosis, especially for those who require endoscopy.
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Santhakumar, S., Karan Deshmukh, Sangita Sharma Mehta, et al. "EBUS guided trans-esophgeal cryobiopsy-two case reports." Lung India 42, no. 3 (2025): 252–55. https://doi.org/10.4103/lungindia.lungindia_531_23.
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ABSTRACT Endobronchial ultrasound (EBUS) guided mediastinal cryobiopsy is a novel technique which can be combined with EBUS -TBNA to improve the diagnostic yield. Recent studies report, this technique is safe and superior to EBUS TBNA alone in terms of acquisition of larger tissue samples and thereby a better diagnostic yield and adequacy of tissue for molecular studies. However, safety of this technique in patients do not tolerate a bronchoscopic procedure due to hypoxia or respiratory distress is not clarified yet. Alternatively, EBUS guided FNA via trans-esophageal route(EUS-B-FNA) is a proven technique with a similar diagnostic yield as EBUS TBNA with a better tolerance and a more patient comfort. We report two patients here, in whom EUS- B guided cryobiopsy was successfully done via trans-esophageal route, due to intolerance for bronchoscopic procedure and inconclusive ROSE reports.
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Zaidi, Shaesta Naseem, and Emad Raddaoui. "Utility of endobronchial ultrasound-guided-fine-needle aspiration and additional value of cell block in the diagnosis of mediastinal granulomatous lymphadenopathy." CytoJournal 12 (September 22, 2015): 20. http://dx.doi.org/10.4103/1742-6413.165947.
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Background: Endobronchial ultrasound-guided transbronchial fine-needle aspiration is a minimally invasive technique for diagnosis of mediastinal lesions. Although most studies have reported the utility of EBUS-FNA in malignancy, its use has been extended to the benign conditions as well. Objective: To evaluate the diagnostic yield and cytologic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-FNA) in cases of clinically and radiologically suspected granulomatous diseases. Patients and Method: From May 2010 to April 2015, 43 of 115 patients who underwent EBUS-FNA at one center for radiologically and clinically suspicious granulomatous lesions, and with no definite histological diagnosis, were included in this retrospective study. Results: When the histological diagnosis was taken as the gold standard, the sensitivity of EBUS-FNA was 85% and specificity was 100% with the positive predictive value of 100. The combined diagnostic sensitivity of EBUS-FNA and transbronchial lung biopsy was 100%. In 4 cases, cell block provided an exclusive morphological diagnosis of sarcoidosis which was noncontributory by EBUS-FNA. Conclusion: Our study supports the use of EBUS-FNA, by virtue of being a safe, minimally invasive, and an outpatient procedure, in the diagnosis of granulomatous mediastinal lymphadenopathy, thereby obviating more invasive testing in a significant number of patients. Also, cell block provides additional data in the diagnosis in these benign mediastinal diseases.
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Williams, D. B., A. V. Sahai, L. Aabakken, et al. "Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience." Gut 44, no. 5 (1999): 720–26. http://dx.doi.org/10.1136/gut.44.5.720.
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BACKGROUNDEndoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) is a recent innovation in the evaluation of gastrointestinal and pulmonary malignancies.AIMSTo review the experience with EUS-FNA of a large single centre.METHODS333 consecutive patients underwent EUS-FNA. Follow up data were available on 327 lesions in 317 patients, including 160 lymph nodes, 144 pancreatic lesions, 15 extraintestinal masses, and eight intramural tumours.RESULTSA primary diagnosis of malignancy was obtained by EUS-FNA in 62% of patients with clinically suspicious lesions. The overall accuracy of EUS-FNA for the diagnosis of malignancy was 86%, with sensitivity of 84% and specificity of 96%. With respect to lesion types, the sensitivity, specificity, and accuracy were 85%, 100%, and 89% for lymph nodes; 82%, 100%, and 85% for pancreatic lesions; 88%, 100%, and 90% for perirectal masses; and 50%, 25%, and 38% for intramural lesions, respectively. Compared with size and sonographic criteria, EUS-FNA in the evaluation of lymph nodes provided superior accuracy and specificity, without compromising sensitivity. Inadequate specimens were obtained from only six patients, including 3/5 with stromal tumors. Only one complication occurred.CONCLUSIONSEUS-FNA is safe and can readily obtain tissue specimens adequate for cytopathological diagnoses. Compared with size and sonographic criteria, it is a superior modality for the detection of nodal metastases. While providing accurate diagnosis of pancreatic and perirectal malignancies, results suggest the technique is less useful for intramural lesions.
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International, Journal of Medical Science and Advanced Clinical Research (IJMACR). "Cytomorphological Spectrum of Lymphnode Lesions." International Journal of Medical Science and Advanced Clinical Research (IJMACR) 8, no. 1 (2025): 228–35. https://doi.org/10.5281/zenodo.15234371.
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<strong>Introduction: </strong>Lymphadenopathy is a common clinical entity. The diagnosis of the cause underlying the enlarged lymph nodes enables the clinician to plan appropriate management for each patient [1,2]. Enlarged superficial lymph nodes are easily evaluated by FNA technique and hence FNAC forms an important diagnostic tool. While histopathological evaluation of surgically excised lymph nodes is a more specific and accurate diagnostic parameter, it is relatively more costly, time consuming and discomforting to the patient, and may not be indicated in every patient. Enlarged lymphnodes are always not neoplastic which require surgical intervention. Non neoplastic lymphnodes are easily treated by conservative means. FNAC evaluation may prevent a patient to undergo unnecessary surgery and treating patients with conservative therapy [3,4,5]. Moreover, FNAC is more cost effective, relatively noninvasive, simple procedure This study was done to identify the causes of lymphadenopathy amongst patients referred for FNAC evaluation of enlarged lymph nodes to the laboratory of our hospital. The purpose of our study was assessment of various peripheral lymphadenopathy through FNAC. The study highlights the cytomorphological spectrum of lymph node lesion.
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Kobara, Hideki, Hirohito Mori, Naoki Nishimoto, et al. "Comparison of submucosal tunneling biopsy versus EUS-guided FNA for gastric subepithelial lesions: a prospective study with crossover design." Endoscopy International Open 05, no. 08 (2017): E695—E705. http://dx.doi.org/10.1055/s-0043-112497.
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Abstract Background and study aims Endoscopic ultrasound-guided fine needle aspiration (FNA) for gastrointestinal subepithelial lesions (SELs) has limited diagnostic accuracy due to technical problems and small lesion size. We previously reported a novel submucosal tunneling biopsy (STB) technique for sampling SELs. This study aimed to evaluate the diagnostic ability and safety of STB compared to that of FNA for SELs. Patients and methods The study was a non-randomized, prospective comparative study with crossover design in patients with endoluminal gastric SELs. Forty-three patients, including 29 cases with lesions < 2 cm were enrolled. A crossover design with 2 intervention stages (Group A: FNA followed by STB for 23 SELs, Group B: STB followed by FNA for 20 SELs) was implemented. The primary outcome was the diagnostic yield (DY). Secondary outcomes were technical success rate, procedure time, complication rate, and sample quality. Results The DY of STB was significantly higher than that of FNA (100 % vs. 34.8 %; P < 0.0001) in group A, including 100 % in overall STB. The technical success rate of STB was significantly higher than that of FNA (100 % vs. 56.5 %; P = 0.0006), whereas the median procedure time of STB was significantly longer than that of FNA (37 minutes vs. 18 minutes; P < 0.0001). The median specimen area of STB samples was markedly larger than that of FNA samples (5.54 mm2 vs. 0.69 mm2; P < 0.001). No complications occurred in either method. Conclusions STB had significantly superior diagnostic ability and a more adequate sample quality than FNA for endoluminal gastric SELs, indicating the suitability of STB for small SELs. Clinical trial registration: UMIN 000006754
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Wong, Newton A. C. S., Paida Gwiti, Timothy Murigu, et al. "Cell block processing is optimal for assessing endoscopic ultrasound fine needle aspiration specimens of pancreatic mucinous cysts." Journal of Clinical Pathology 73, no. 2 (2019): 102–6. http://dx.doi.org/10.1136/jclinpath-2019-206079.
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AimsThe cell block technique for assessing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) specimens from pancreatic mucinous cystic lesions (MCLs) was systematically evaluated for the first time, including comparisons with three traditional methods of assessing such specimens.MethodsThe prospective arm comprised EUS-FNA specimens from EUS-suspected pancreatic MCLs. The retrospective arm comprised EUS-FNA specimens from pancreatic MCLs surgically resected before the study start. For each specimen, these data points were collected: macroscopic likelihood of mucin, cyst fluid carcinoembryonic antigen (CEA) level and presence of mucin in air-dried, direct smears and in cell block preparations.ResultsThe prospective and retrospective arms of the study comprised 80 and 30 EUS-FNA specimens, respectively. Seven prospective cases led to surgical resections during the study, and therefore, 37 EUS-FNA specimens were confirmed to have originated from MCLs. In the prospective arm, macroscopic mucin was suspected, cyst fluid CEA level exceeded 192 ng/mL, mucin was detected in direct smears and cell block preparations in 78%, 30%, 39% and 73% of cases, respectively. Of the 37 specimens confirmed to originate from MCLs, macroscopic mucin assessment, cyst fluid CEA level, direct smear mucin assessment and cell block mucin assessment had sensitivities for diagnosing MCL of 87%, 45%, 45% and 81%, respectively.ConclusionsCell block preparations are as likely to identify mucin from pancreatic MCLs as macroscopic assessment but are twice as likely to diagnose MCL than direct smears and fluid CEA biochemistry. The cell block technique is easy for sample collection and processing especially because these are identical for solid and cystic pancreatic lesions.
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Annema, Jouke T., Michel I. Versteegh, Maud Veseliç, Pieter Voigt, and Klaus F. Rabe. "Endoscopic Ultrasound–Guided Fine-Needle Aspiration in the Diagnosis and Staging of Lung Cancer and Its Impact on Surgical Staging." Journal of Clinical Oncology 23, no. 33 (2005): 8357–61. http://dx.doi.org/10.1200/jco.2005.01.1965.
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Purpose The diagnosis and staging of lung cancer critically depends on surgical procedures. Endoscopic ultrasound (EUS) –guided fine-needle aspiration (FNA) is an accurate, safe, and minimally invasive technique for the analysis of mediastinal lymph nodes (LNs) and can additionally detect tumor invasion (T4) in patients with centrally located tumors. The goal of this study was to assess to what extent EUS-FNA could prevent surgical interventions. Patients and Methods Two hundred forty two consecutive patients with suspected (n = 142) or proven (n = 100) lung cancer and enlarged (> 1 cm) mediastinal LNs at chest computed tomography were scheduled for mediastinoscopy/tomy (94%) or exploratory thoracotomy (6%). Before surgery, all patients underwent EUS-FNA. If EUS-FNA established LN metastases, tumor invasion, or small-cell lung cancer (SCLC), scheduled surgical interventions were cancelled. Surgical-pathologic verification occurred when EUS-FNA did not demonstrate advanced disease. Cancelled surgical interventions because of EUS findings was the primary end point. Results EUS-FNA prevented 70% of scheduled surgical procedures because of the demonstration of LN metastases in non–small-cell lung cancer (52%), tumor invasion (T4) (4%), tumor invasion and LN metastases (5%), SCLC (8%), or benign diagnoses (1%). Sensitivity, specificity, and accuracy for EUS in mediastinal analysis were 91%, 100% and 93%, respectively. No complications were recorded. Conclusion EUS-FNA qualifies as the initial staging procedure of choice for patients with (suspected) lung cancer and enlarged mediastinal LNs. Implementation of EUS-FNA in staging algorithms for lung cancer might reduce the number of surgical staging procedures considerably.
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Sutanto, Yusup Subagio, Nur Santi, Brian Wasita, Ana Rima, and Hendra Kurniawan. "Diagnostic efficacy cell block method of transthoracic fine needle aspiration in diagnosis of lung cancer." Universa Medicina 40, no. 2 (2021): 133–40. http://dx.doi.org/10.18051/univmed.2021.v40.133-140.
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BackgroundLung cancer is still the main cause of cancer deaths. The high lung cancer mortality rate is caused by a diagnosis factor or therapy selection. The cell block cytology technique using fine needle aspiration (FNA) samples can provide immunocytochemical material that plays an important role in the differential diagnosis of lung cancer subtypes and in determining immunotherapy administration. This study aimed to determine the sensitivity and specificity of transthoracic FNA (TTFNA) cell block cytology in comparison with bronchial washing smears and TTFNA smears in diagnosing lung cancer. MethodsThis was a cross-sectional diagnostic study involving 26 subjects. All subjects had undergone bronchial washing and CT scan-guided fine needle aspiration followed by cell block preparation. Both direct FNA smears and cell blocks are useful in the diagnostic work-up of patients. Comparative statistical analysis of TTFNA cell block versus bronchial washing smear and TTFNA smear cytology was carried out using the McNemar test. ResultsLung cancer was found in 15 patients (57.7%) using the TTFNA cell block technique. The sensitivity and specificity of the TTFNA cell block technique were 85.7% and 75%, respectively. There was no difference in the positivity value between TTFNA cell block technique of bronchial wash smear technique, and TTFNA smear on lung cancer diagnosis (p>0.05). ConclusionsTransthoracic fine-needle aspiration in combination with the cell block technique has good sensitivity and specificity. The TTFNA can be used for immunocytochemical examinations in lung cancer diagnosis and therapy. This approach is valuable for providing individualized treatment and prognostic evaluations.
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Romano-Feinholz, Samuel, Víctor Alcocer-Barradas, Alejandra Benítez-Gasca, Ernesto Martínez-de la Maza, Cristopher Valencia-Ramos, and Juan Luis Gómez-Amador. "Hybrid fluorescein-guided surgery for pituitary adenoma resection: a pilot study." Journal of Neurosurgery 132, no. 5 (2020): 1490–98. http://dx.doi.org/10.3171/2019.1.jns181512.
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OBJECTIVEThe authors conducted a pilot study on hybrid fluorescein-guided surgery for pituitary adenoma resection and herein describe the feasibility and safety of this technique.METHODSIn this pilot study, the authors included all consecutive patients presenting with pituitary adenomas, functioning and nonfunctioning. They performed a hybrid fluorescein-guided surgical technique for tumor resection. An endonasal endoscopic approach was used; after exposure of the rostrum of the sphenoid sinus, they administered a bolus of 8 mg/kg of fluorescein sodium (FNa) intravenously, and during resection, they alternated between endoscopic and microscopic techniques to guide the resection under a YELLOW 560 filter.RESULTSThe study included 15 patients, 7 men (47%) and 8 women (53%). Of the pituitary adenomas, 7 (46%) were nonfunctioning, 6 (40%) were GH secreting, 1 (7%) was prolactin secreting, and 1 (7%) was ACTH secreting. There were no FNa-related complications (anaphylactic reactions); yellowish staining of urine, skin, and mucosa was seen in all patients and resolved in a maximum time of 24 hours. After color spectrophotometric analysis, the authors identified a statistical difference in fluorescence among tumor, gland, and scar tissue (p = 0.01).CONCLUSIONSThis is the first study of its kind to describe the feasibility and safety of using FNa to guide the resection of pituitary adenomas. The authors found this technique to be safe and feasible. It may be used to obtain better surgical results, especially for hormone-producing and recurring tumors, as well as for reducing the learning curve in pituitary adenoma surgery.
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Pantidou, Agni, Anastasia Kiziridou, Theodoros Antoniadis, Christodoulos Tsilikas, and Chariclea Destouni. "Mediastinum thymoma diagnosed by FNA and thinprep technique: A case report." Diagnostic Cytopathology 34, no. 1 (2005): 37–40. http://dx.doi.org/10.1002/dc.20383.
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Kavanagh, John, Niall McVeigh, Eoghan McCarthy, Kathleen Bennett, and Peter Beddy. "Ultrasound-guided fine needle aspiration of thyroid nodules: factors affecting diagnostic outcomes and confounding variables." Acta Radiologica 58, no. 3 (2016): 301–6. http://dx.doi.org/10.1177/0284185116654331.
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Background The incidence of thyroid cancer is increasing in men and women. Fine needle aspiration (FNA) is an accepted technique to assess thyroid nodules but is associated with a high rate of non-diagnostic sampling. Purpose To assess the diagnostic performance of ultrasound-guided FNA of thyroid nodules and identify factors associated with non-diagnostic sampling. Material and Methods A retrospective review of thyroid FNAs was performed between 2006 and 2013. Patient demographics, nodule characteristics, procedural technique, cytology, and complications were recorded. Cytology was categorized THY1-5 based on the British Thyroid Association guidelines. Descriptive and multivariable analysis were conducted to identify factors associated with non-diagnostic sampling. Results A total of 724 procedures were identified with 597 (82.5%) in women, and an overall mean age of 40 years (age range, 17–87 years). Factors associated with a non-diagnostic outcome in the multivariable regression analysis included increasing lesion depth (OR, 1.05 per mm; 95% confidence interval [CI], 1.007–1.10), age (OR, 1.012 per year; 95% CI, 1.0–1.025) and number of FNA passes (1 vs. 4+; OR, 6.07; 95% CI, 2.27–16.21). The complication rate was 1.1% related to perilesional hematomas and vaso-vagal episodes. Conclusion Thyroid FNA is a safe and reliable procedure for cytological assessment of thyroid nodules. Deeper nodules and older patients are more likely to have non-diagnostic samples.
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Zhang, Chen, Melissa L. Randolph, Kelly J. Jones, Harvey M. Cramer, Liang Cheng, and Howard H. Wu. "Anaplastic Lymphoma Kinase Immunocytochemistry on Cell-Transferred Cytologic Smears of Lung Adenocarcinoma." Acta Cytologica 59, no. 2 (2015): 213–18. http://dx.doi.org/10.1159/000430083.
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Background: Anaplastic lymphoma kinase (ALK) immunohistochemical staining on formalin-fixed paraffin-embedded tissue or cell blocks (CB) has been reported as an effective alternative to fluorescence hybridization in situ (FISH) for the detection of ALK gene rearrangement. However, CB frequently lack adequate cellularity even when the direct smears are cellular. This study aims to assess the utility of ALK immunocytochemical (ICC) staining on direct smears using the cell transfer (CT) technique for the detection of ALK rearrangement. Methods: Fine-needle aspiration (FNA) cases of lung adenocarcinoma in which the ALK status had been determined by FISH on CB or a concurrent biopsy were identified. ICC staining for ALK was performed on alcohol-fixed Papanicolaou-stained direct smears using the CT technique. ALK immunoreactivity was evaluated using a modified semiquantitative scale. Results were compared with those of FISH. Results: A total of 47 FNA specimens were included. Five of 7 FISH-positive cases showed positive ALK ICC staining (71.4%), and 39 of 40 FISH-negative cases were negative on ALK ICC staining (97.5%). The overall correlation between ALK ICC and FISH was 93.6%. Conclusion: ICC performed on FNA smears using the CT technique is an alternative method for the assessment of ALK rearrangement, especially when CB lack adequate cellularity.