BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and brushing cytology are used worldwide to diagnose pancreatic and biliary malignant tumors. Liquid-based cytology (LBC) has been developed and it is currently used to overcome the limitations of conventional smears (CS). In this study, the authors aimed to compare the diagnostic value of the CellPrepPlus (CP; Biodyne) LBC method with CS in samples obtained using EUS-FNA and brushing cytology. METHODS: This study prospectively enrolled 75 patients with pancreatic or biliary lesions from June 2012 to October 2013. For cytological analyses, including inadequate specimens, benign and atypical were further classified into benign, and suspicious and malignant were subcategorized as malignant. Sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative predictive values (NPV) were evaluated. RESULTS: In the EUS-FNA based cytological analysis of pancreatic specimens, CP had a sensitivity of 60.7%; specificity, 100%; accuracy, 77.1%; PPV, 100%; and NPV, 64.5%. CS had a sensitivity of 85.7%; specificity, 100%; accuracy, 91.7%; PPV, 100%; and NPV, 83.3%. In the brushing cytology based analysis of biliary specimens, CP had sensitivity of 53.1%; specificity, 100%; accuracy, 54.5%; PPV, 100%; and NPV, 6.3%. CS had a sensitivity of 78.1%; specificity, 100%; accuracy, 78.8%; PPV, 100%; and NPV, 12.5%. CONCLUSIONS: Our study found that CP had a lower sensitivity because of low cellularity compared with CS. Therefore, CP (LBC) has a lower diagnostic accuracy for pancreatic EUS-FNA based and biliary brush cytology based analyses compared with CS.
Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Methods ; Prospective Studies ; Sensitivity and Specificity

Rapid on-site evaluation(ROSE),an auxiliary sampling quality evaluation technology,can be used to evaluate the adequacy and diagnostic category of samples,judge the histological type of lung cancer,and optimize the gene type of lung cancer.Applying ROSE to endobronchial ultrasound-guided transbronchial needle aspiration of suspected lung cancer can improve the puncture success rate and diagnostic rate and reduce complications and puncture attempts.Rose performed via remote cytopathology technology or by trained respiratory specialists may become the future trends.
Bronchoscopy ; Cytodiagnosis/methods* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Lung Neoplasms/pathology*

BACKGROUND: Most of the patients with lung and (or) mediastinal occupying lesions are considered to be primary lung cancer clinically, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly useful operation to obtain the tissue sample and get definitive diagnosis of pathological tissues. In the EBUS-TBNA process, cytological rapid on-site evaluation (C-ROSE) is a useful technology. The purpose of our study is to discuss the value of C-ROSE in the diagnosis of lung cancer by EBUS-TBNA sampling. METHODS: Retrospective analysis of 141 cases clinical data who were performed with EBUS-TBNA and suspected diagnosis primary lung cancer, which were found have mediastinal and (or) lung lesions (including the enlargement of the lymph nodes/mass) by computed tomography (CT). Among these patients, 81 patients were in the C-ROSE group and 60 patients were in the No C-ROSE group. The message of puncture and complication of EBUS-TBNA with or without C-ROSE were compared. At the same time, we analysis the sensitivity and specificity, positive predictive value, negative predictive value of C-ROSE combined with EBUS-TBNA in that of the diagnosis of lung cancer. RESULTS: We found no statistical difference of the needle passes between C-ROSE group and No C-ROSE group. But in C-ROSE group, specimen qualified rate and diagnostic yields were signicantly higher than No C-ROSE group (98.77% vs 90.00%, 88.89% vs 75.00%, P<0.05), the incidence of complications in the C-ROSE group was signicantly lower than that in the No C-ROSE group (1.23% vs 11.67%, P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of C-ROSE combined with EBUS-TBNA in the diagnosis of lung cancer are 92.21%, 100.00%, 100.00% and 40.00%. CONCLUSIONS EBUS-TBNA combined with C-ROSE can improve the specimen qualified rate and diagnostic rate, also can reduce the complications thus worthy of further promotion.
Endoscopic Ultrasound-Guided Fine Needle Aspiration ; methods ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Time Factors

To explore the value for contrast-enhanced transrectal ultrasound (CETRUS) in the diagnosis of prostate cancer.
 Methods: Prostate biopsy from 207 cases of suspected prostate cancer were collected between January 2013 and March 2015. These patients were performed ultrasound-guided prostate biopsy in Central Hospital of Changsha. They were randomly divided into a radiography group (n=104) and a non-radiography group (n=103) according to the order of treatment. Transrectal ultrasonography (TRUS) was the first choice in the 2 groups, and CETRUS was conducted in the radiography group. Then, the transrectal biopsy was carried out in the 2 groups. The diagnostic value of CETRUS in prostate cancer was evaluated by pathological examination, a gold standard.
 Results: The sensitivity, specificity, and coincidence rates of TRUS in diagnosing prostate cancer were 65%, 60.4%, and 62.8%, respectively, while those rates of CETRUS in diagnosing prostate cancer were 89%, 78%, and 84%, respectively, with significant difference between the above 2 groups (all P<0.05).
 Conclusion: The sensitivities, specificities, and coincidence rates for CETRUS are superior to TRUS in diagnosing prostate cancer, which can provide a clinical basis for the diagnosis and differential diagnosis of prostate cancer.
Contrast Media ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; methods ; Humans ; Male ; Prostate ; diagnostic imaging ; pathology ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; Radiography, Interventional ; Sensitivity and Specificity ; Ultrasonography ; methods

Patient-derived tumor xenograft is the transfer of primary human tumors directly into an immunodeficient mouse. Patient-derived tumor xenograft plays an important role in the development and evaluation of new chemotherapeutic agents. We succeeded in generating a patient-derived tumor xenograft of a biliary tumor obtained by endoscopic ultrasound-guided fine-needle aspiration from a patient who had an inoperable extrahepatic cholangiocarcinoma. This patient-derived tumor xenograft will be a promising tool for individualized cancer therapy and can be used in developing new chemotherapeutic agents for the treatment of biliary cancer in the future.
Aged ; Animals ; Bile Duct Neoplasms/*pathology/surgery ; Cholangiocarcinoma/*pathology/surgery ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Heterografts/*pathology/surgery ; Humans ; Male ; Mice ; Mice, Nude ; Transplantation, Heterologous/*methods

Convex-probe endobronchial ultrasound-guided transbronchial needle aspiration (CP-EBUS-TBNA) has emerged as a new diagnostic modality that allows ultrasound-guided, real-time needle aspiration of mediastinal and hilar lymph nodes. Mediastinoscopy has been the reference standard for neoplastic staging in the mediastinum, but it is invasive and requires general anesthesia. Considering recent prospective studies and clinical guidelines, a needle technique such as EBUS-TBNA and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) should be performed first for the mediastinal nodal staging of non-small lung cancer. Combining EBUS-TBNA and EUS-FNA will replace more invasive methods such as mediastinoscopy. CP-EBUS-TBNA can also be used for the restaging after neoadjuvant therapy, the diagnosis of recurrent lung cancer and central lung parenchymal lesion which abuts trachea or bronchi. In the era of personalized medicine, good-quality and sufficient tissues need to be obtained for the molecular testing and treatment guidance. EBUS-TBNA has the ability to obtain satisfactory material for the detection of EGFR mutation, KRAS mutation, and EML-ALK fusion gene.
Anesthesia, General ; Bronchi ; Diagnosis* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Mediastinoscopy ; Mediastinum ; Methods ; Needles ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Trachea ; Precision Medicine

BACKGROUND: Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic method for mediastinal and hilar lymphadenopathy. This study aimed to investigate the incidence of fever following EBUS-TBNA. METHODS: A total of 684 patients who underwent EBUS-TBNA from May 2010 to July 2012 at Seoul National University Hospital were retrospectively reviewed. The patients were evaluated for fever by a physician every 6–8 hours during the first 24 hours following EBUS-TBNA. Fever was defined as an increase in axillary body temperature over 37.8℃. RESULTS: Fever after EBUS-TBNA developed in 110 of 552 patients (20%). The median onset time and duration of fever was 7 hours (range, 0.5–32 hours) after EBUS-TBNA and 7 hours (range, 1–52 hours), respectively, and the median peak body temperature was 38.3℃ (range, 37.8–39.9℃). In most patients, fever subsided within 24 hours; however, six cases (1.1%) developed fever lasting longer than 24 hours. Infectious complications developed in three cases (0.54%) (pneumonia, 2; mediastinal abscess, 1), and all three patients had diabetes mellitus. The number or location of sampled lymph nodes and necrosis of lymph node were not associated with fever after EBUS-TBNA. Multiple logistic regression analysis did not reveal any risk factors for developing fever after EBUS-TBNA. CONCLUSION: Fever is relatively common after EBUS-TBNA, but is transient in most patients. However, clinicians should be aware of the possibility of infectious complications among patients with diabetes mellitus.
Abscess ; Body Temperature ; Diabetes Mellitus ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Fever* ; Humans ; Incidence* ; Logistic Models ; Lymph Nodes ; Lymphatic Diseases ; Methods ; Necrosis ; Needles* ; Retrospective Studies ; Risk Factors ; Seoul

An 88-year-old woman diagnosed with recurrent pancreatitis and pancreatic cyst at a local clinic was admitted for upper abdominal pain. The pain was aggravated after a meal, and the patient had lost 3 kg over the past 6 months. MRCP examination revealed a 68 mm-sized septated pancreatic cyst compressing the main pancreatic duct. EUS-FNA to differentiate the cystic component retrieved a high viscosity fluid. A diagnosis of mucin-producing pancreatic cystic neoplasm was made. The patient refused surgical treatment, and alternative treatments, including methods to decompress the pancreatic cyst, were performed. The patient was treated with aspiration of cystic fluid, observation with diet control, and 99% ethanol lavage to ablate the pancreatic cyst. The treatment of 99% ethanol lavage provided the longest symptom-free period, ranging from 7 to 18 months without complications. The authors report that repeated ethanol lavage of a pancreatic cyst causing recurrent pancreatitis can be an effective treatment option for patients who are poor surgical candidates.
Abdominal Pain ; Aged, 80 and over ; Diagnosis ; Diet ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Ethanol* ; Female ; Humans ; Meals ; Methods ; Mucins* ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatitis* ; Therapeutic Irrigation* ; Viscosity

An 88-year-old woman diagnosed with recurrent pancreatitis and pancreatic cyst at a local clinic was admitted for upper abdominal pain. The pain was aggravated after a meal, and the patient had lost 3 kg over the past 6 months. MRCP examination revealed a 68 mm-sized septated pancreatic cyst compressing the main pancreatic duct. EUS-FNA to differentiate the cystic component retrieved a high viscosity fluid. A diagnosis of mucin-producing pancreatic cystic neoplasm was made. The patient refused surgical treatment, and alternative treatments, including methods to decompress the pancreatic cyst, were performed. The patient was treated with aspiration of cystic fluid, observation with diet control, and 99% ethanol lavage to ablate the pancreatic cyst. The treatment of 99% ethanol lavage provided the longest symptom-free period, ranging from 7 to 18 months without complications. The authors report that repeated ethanol lavage of a pancreatic cyst causing recurrent pancreatitis can be an effective treatment option for patients who are poor surgical candidates.
Abdominal Pain ; Aged, 80 and over ; Diagnosis ; Diet ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Ethanol* ; Female ; Humans ; Meals ; Methods ; Mucins* ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatitis* ; Therapeutic Irrigation* ; Viscosity

BACKGROUNDDifficulties persist in differentiating pancreatic ductal adenocarcinomas (PDAC) from pancreatic inflammatory masses (PIM). Auxiliary diagnostic techniques which enhance the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) diagnostic yield have been attempted, for example, K-ras mutation analysis. We aimed to evaluate the accuracy of K-ras mutation analysis combined with EUS-FNA for the differential diagnosis of PDAC and PIM by pooling data of existing trials.

METHODSWe systematically searched the Medline, PubMed, Web of Science, Embase, and Cochrane Central Trials databases for relevant published studies. Meta-analysis was performed. Pooling was conducted in fixed-effect model or random-effect model.

RESULTSIn total eight studies, with 696 cases of PDAC and 138 cases of PIM, met our inclusion criteria. The pooled sensitivity, specificity, positive likely ratio and negative likely ratio of K-ras mutation analysis combined with cytopathology for diagnosis of PDAC versus PIM were 90%, 95%, 13.45, and 0.13, respectively. Especially, among total 123 patients whose EUS-FNA results were inconclusive or negative, fifty-nine had K-ras mutations and were finally diagnosed with PDAC (48%, 59/123). Publication bias was not present.

CONCLUSIONSCombining K-ras mutation analysis with routine cytology moderately improves the ability of EUS-FNA to differentially diagnose between PDAC and PIM, especially for patients with suspected PDAC yet inconclusive EUS-FNA findings, and may prove to be a valuable supplemental method to EUS-FNA.

Aged ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; methods ; Female ; Genes, ras ; genetics ; Humans ; Male ; Middle Aged ; Mutation ; Pancreatic Neoplasms ; diagnosis ; genetics