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Background: Endoscopic ultrasound-guided liver biopsy (EUS-LB) using a 19-gauge (19-G) EUS needle is becoming increasingly popular. We evaluated the efficacy and safety of a 22-G EUS fine needle biopsy (FNB) needle for performing EUS-LB.Methods: Patients referred for evaluation of elevated liver enzymes and without obstructive disease requiring endoscopic retrograde cholangiopancreatography (ERCP) were included. Using a 22-G FNB needle, two passes were made from the left lobe and one from the right. The main outcome measure was adequacy of the specimen for histology interpretation, and the secondary outcome was the safety of EUS-guided liver biopsy with a 22-G FNB needle. Patients were followed for post-procedure complications for 30 days.Results: 40 patients (median age 61 years; 26 women) underwent EUS-LB. Analyzing by needle passes, the median longest core fragment was 12 mm (1st quartile - 3rd quartile 10 mm - 16.25 mm, interquartile range [IQR] 6.25 mm) from the left lobe and 11 mm (10 mm - 15.75 mm, IQR 5.75 mm) from the right lobe. The median cumulative core length per patient was 55 mm (44.5 mm - 68 mm, IQR 23.5 mm). The median cumulative number of complete portal triads (CPTs) per patient was 42 (28.5 - 53, IQR 24.5). The specimen was considered adequate in all 40 patients (100 %). Self-limiting abdominal pain was reported in 6 patients (15 %).Conclusions: EUS-LB using a 22-G FNB needle is a safe and viable alternative to the use of larger gauge needles, yielding adequate tissue for evaluation of parenchymal disease in 100 % of the patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Fine‐needle aspiration (FNA) cytology has been the preferred technique for procuring tissue at endoscopic ultrasound (EUS) procedures for the past 25 years. To overcome some of the limitations of FNA cytology, fine‐needle biopsy (FNB) has been recently developed to yield histological tissue. Main objective was to compare the diagnostic yield of FNB compared to FNA for both onsite and offsite specimen assessment. Methods: A retrospective study was conducted at a single tertiary referral center to evaluate the outcomes of FNA and FNB over a 4‐year period. EUS‐guided tissue sampling was carried out using 22‐ or 25‐G FNA needles from 2014 to 2015, and 22‐G FNB needle was used from 2016 to 2017. Results: Of 3020 patients undergoing EUS‐guided sampling of solid mass lesions (pancreatic masses 71.3%, other lesions 28.7%), FNA was carried out in 68.9% and FNB in 31.1%. Median number of passes required for diagnostic adequacy on rapid onsite evaluation was significantly lower for FNB compared to FNA (1 [IQR: 1–2] vs 2 [IQR 1–3], P < 0.001). Diagnostic yield on cell block was also significantly superior with FNB compared to FNA (92.3 vs 71.1%, P < 0.001). The superior performance of FNB over FNA was observed for both pancreatic (P < 0.001) and non‐pancreatic lesions (P < 0.001). Conclusion: Given these promising findings, in the future, EUS‐guided FNB will likely be the preferred technique for sampling of solid mass lesions. [ABSTRACT FROM AUTHOR]

Background and Study Aims: To overcome the limitations associated with cytology, a uniquely designed needle (ProCore) was introduced in an effort to obtain a core of tissue under endoscopic ultrasound (EUS) guidance. However, studies comparing the sample quality between ProCore and standard-design fine-needle aspiration (FNA) needles have yielded varying results. A systematic review and meta-analysis was therefore conducted to compare the performance of the ProCore and standard FNA needles when performing EUS-guided tissue acquisition.Patients and Methods: MEDLINE and EMBASE were searched to identify all published manuscripts that compared the ProCore needle with standard FNA needles. Noncomparative and technical feasibility studies were excluded. The main outcome measures were diagnostic adequacy, diagnostic accuracy, acquisition of histological core tissue, and mean number of passes required to achieve a diagnosis when sampling solid lesions.Results: Nine studies (total 576 patients) met the inclusion criteria. There was no significant difference in diagnostic adequacy (75.2 % vs. 89.0 %, odds ratio [OR] 0.39, P = 0.23), diagnostic accuracy (85.8 % vs. 86.2 %, OR 0.88, P = 0.53) or rate of histological core specimen acquisition (77.7 % vs. 76.5 %, OR 0.94, P = 0.85) between the ProCore and standard FNA needles, respectively. The mean number of passes required for diagnosis, however, was significantly lower when using the ProCore needle (standardized mean difference - 1.2, P < 0.001).Conclusions: Current data do not demonstrate a significant difference between the ProCore and standard FNA needles for sample adequacy, diagnostic accuracy or acquisition of a core specimen. However, the ProCore needle establishes the diagnosis with fewer passes. [ABSTRACT FROM AUTHOR]

Ever since the first endoscopic ultrasound-guided fine needle aspiration (FNA) was done in 1992, the procedure has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors and periluminal lesions. With the growing evidence of neoadjuvant therapy and research into intratumoral therapy, the need to obtain tissue diagnosis for tumors is quite apparent. This review provides an overall perspective to the endosonographer on various issues that are a key for best practices in FNA, in addition to being an update for practicing experienced endosonographers. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound ( EUS) is an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. While fine-needle aspiration ( FNA) has been routinely carried out for establishing tissue diagnosis, the emerging concept of tailoring chemotherapeutic agents based on molecular markers has increased the demand for core tissue procurement by means of EUS-guided fine-needle biopsy ( EUS-FNB). In addition, FNB may offset the limitations of FNA wherein the diagnostic sensitivity is incumbent on the availability of an onsite cytopathologist. Given the increasing number of procedures being done, developing a unit-specific algorithmic approach for needle selection isimportant to improve the procedural efficiency and utilization of resources. Finally, the best outcomes can be attained only by practicing evidence-based techniques, procuring adequate quantity of sample for ancillary studies and processing the specimens appropriately. [ABSTRACT FROM AUTHOR]

Over the past 2 decades, endoscopic ultrasound–guided fine-needle aspiration has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. The technique is useful for biopsy of mucosal and submucosal lesions in which prior endoscopic biopsies have been nondiagnostic; to sample peri-intestinal structures such as lymph nodes; and to sample masses in the pancreas, liver, adrenal glands, gallbladder, and bile duct. Also, with the advent of neoadjuvant therapies for diseases such as pancreatic cancer, most patients require a tissue diagnosis before initiating treatment. This review provides a perspective on technical issues that are key for best practices in endoscopic ultrasound-guided fine-needle aspiration. [ABSTRACT FROM AUTHOR]

Examines the technique and experience of endoscopic ultrasound (EUS)-guided needle aspiration cytology. History of EUS-guided fine needle aspiration (FNA); Principles in performing the FNA; Factors that affect the resectability of esophageal cancer.

This study prospectively evaluated the role of transesophageal endoscopic endosonography-guided fine needle aspiration (EUS-FNA) in consecutive patients with suspected but yet undiagnosed lung cancer where bronchoscopic methods failed. Patients were included in the study if lung cancer was suspected with a demonstrated lung lesion and mediastinal adenopathy on CT, and if the bronchoscopy and biopsy, cytology, and transbronchial biopsies failed to establish the diagnosis. Patients were excluded from the study if they had a previous history of malignancy, metastatic mediastinal deposits from an extrathoracic primary, esophageal stenosis, or a bleeding tendency (coagulopathy or thrombocytopenia). No prophylactic antibiotics were given. All examinations were performed with the curved linear array echoendoscope on an outpatient basis under i.v. sedation. All patients were subsequently discharged in 2 h. No complications, especially pneumothorax, were reported. Thirty-five patients with suspected lung cancer and mediastinal adenopathy met inclusion criteria and were en-rolled in this study. When more than one lymph node was imaged by EUS, FNA of the more suspicious lesion was performed. The location of the mediastinal lymph nodes were described according to the American Thoracic Society mediastinal staging map for lymphadenopathy. One to two needle passes were performed to obtain adequate tissue. Interestingly, no cytopathologist was available for immediate assessment of the smear's adequacy because the endosonographer was trained to perform it. A true positive malignant cytology result was obtained in 25/35 patients and a true benign cytology was obtained in 9/35 patients. One patient had a potentially false-negative result. Therefore, the overall sensitivity of EUS-FNA was 96.2% (95% CI = 77-100); specificity, 100% (95% CI = 67-100); positive predictive value, 100% (95% CI = 80.4-100); negative predictive value, 90% (95% CI = 59-100); and the diagnostic accuracy of EUS-FNA, 97% (95% CI = 80.5-100). It is important to note that lymph node echofeatures and size did not accurately predict malignant involvement, and there was a tremendous overlap between malignant and benign lymph nodes. In seven patients, the lymph nodes detected were less than 1 cm. Four of these yielded malignant cells, and the other three were judged to be benign. The final diagnoses in the 35 patients were as follows: small cell lung cancer (n = 10), adenocarcinoma (n = 11), squamous cell cancer (n = 3), non-Hodgkin's lymphoma (n = 1), reactive inflammatory lymph nodes (n = 5), sarcoidosis (n = 2), and anthracosis (n = 2). The authors concluded that EUS-FNA is highly useful in the diagnosis of mediastinal adenopathy, especially in the presence of small lymph nodes. They advocated the use of EUS-FNA to be the investigation of choice in these patients before embarking on to more expansive and invasive techniques. This is especially true in the presence of comorbidity or obvious metastatic disease where surgery is unlikely to be a curative option. [ABSTRACT FROM AUTHOR]