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

No abstract available.
Cystadenoma, Serous* ; Diagnosis* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration*

No abstract available.
Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Fibrinolytic Agents* ; Hemorrhage* ; Humans

No abstract available.
Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Lymphatic Diseases

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is routinely performed for establishing tissue diagnosis in patients with gastrointestinal tumors. The concept of delivering chemotherapy based on molecular markers and the ability to establish a reliable diagnosis in lieu of an onsite cytopathologist has fuelled the recent trend in procuring core tissue by means of EUS-guided fine needle biopsy. To overcome the technical limitations induced by the rigidity of the Trucut biopsy needle, a new ProCore needle with reverse bevel technology has been developed. Recent data suggests that the newly developed flexible 19 gauge needle can also procure core tissue and has easy maneuverability when navigating the transduodenal route. Irrespective of the needles being used, the best clinical outcomes can be attained only by practicing evidence-based techniques, procuring adequate quantity of sample for ancillary studies, and processing the specimens appropriately.
Biopsy ; Biopsy, Fine-Needle ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Needles

BACKGROUND/AIMS: The superiority of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) over EUS-guided fine needle aspiration (EUS-FNA) remains controversial. Given the lack of studies analyzing histologic specimens acquired from EUS-FNB or EUS-FNA, we compared the proportion of the histologic core obtained from both techniques. METHODS: A total of 58 consecutive patients with solid mass lesions were enrolled and randomly assigned to the EUS-FNA or EUS-FNB groups. The opposite needle was used after the failure of core tissue acquisition using the initial needle with up to three passes. Using computerized analyses of the scanned histologic slide, the overall area and the area of the histologic core portion in specimens obtained by the two techniques were compared. RESULTS: No significant differences were identified between the two groups with respect to demographic and clinical characteristics. Fewer needle passes were required to obtain core specimens in the FNB group (p<0.001). There were no differences in the proportion of histologic core (11.8%±19.5% vs 8.0%±11.1%, p=0.376) or in the diagnostic accuracy (80.6% vs 81.5%, p=0.935) between two groups. CONCLUSIONS: The proportion of histologic core and the diagnostic accuracy were comparable between the FNB and FNA groups. However, fewer needle passes were required to establish an accurate diagnosis in EUS-FNB.
Biopsy* ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Humans ; Needles* ; Prospective Studies*

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

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

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

Incidental pancreatic cysts are being increasingly recognized recently with incremented concern about health and frequent health check-up. Endoscopic ultrasound (EUS) has emerged as the principal modality for imaging pancreas for various pancreatic diseases including pancreatic cyst. But imaging alone cannot accurately identify the exact nature of the pancreatic cyst. EUS-guided fine needle aspiration is a useful adjunctive procedure to differentiate pancreatic cystic lesions. Cystic fluid analysis with cytologic evaluation is important to diagnose etiology of pancreatic cystic lesions, helping the clinician to more accurately assess the presence or potential for malignancy.
Biopsy, Fine-Needle ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Pancreas ; Pancreatic Cyst ; Pancreatic Diseases