EUS-geführte Feinnadelbiopsie (EUS-FNP): Wie gelingen gute Biopsien? Eine evidenzbasierte Analyse

Zusammenfassung

Obschon die endosonografisch geführte Feinnadelbiopsie (EUS-FNP) vor mehr als 22 Jahren in die klinische Medizin eingeführt wurde und heute aus der Routinediagnostik nicht mehr wegzudenken ist, werden weiterhin viele Detailfragen kontrovers beurteilt. Es gibt zahlreiche, unterschiedliche Punktionstechniken, mit denen versucht wird, möglichst viel Gewebe aus endosonografisch erkannten Zielläsionen zu gewinnen. Außerdem spielen Fragen wie die nach der „besten“ Punktionsnadel, der „besten“ Gewebeanalysemethode und der optimalen Ausbildungszielplanung für Endosonografiker eine wichtige Rolle. Ziel ist die weitere Verbesserung der mittlerweile fast flächendeckend angebotenen, minimalinvasiven EUS-Methode. Die vorliegende Übersicht geht einigen wichtigen Fragen nach und versucht, diese anhand der gegenwärtig erhältlichen „Evidenzlage“ zu charakterisieren und zu bewerten. Dabei wird der hohe Stellenwert der Methodik im klinischen Alltag erneut deutlich. Die Bewertung einiger methodischer und technischer Schritte bietet auch kleine Überraschungen. Mit dem Studium dieser aktuellen Bestandsaufnahme und Zukunftsaussichten lassen sich die Feinnadelpunktionsergebnisse in jeder Endoskopieeinheit dauerhaft verbessern.

Abstract

Endosonography with fine-needle aspiration biopsy (EUS-FNA) has become a widespreadly available clinical tool to diagnose numerous different lesions in humans. EUS-FNA is frequently used for tissue-based diagnoses such as lymphatic diseases (ranging from tuberculosis / sarcoidosis to malignant lymphoma) or solid tumors (such as pancreatic carcinoma, neuroendocrine tumors, sub-epithelial gastrointestinal tumors and others). Outcomes of EUS-FNA results, however, vary which is caused by several different factors ranging from experience of the endoscopist over technical factors such as use of stylet or suction for puncture through the skills of the cyto-pathologist who takes care of the specimen obtained by EUS-FNA. Though introduced since more than 20 years ago EUS-FNA has still not yet been perfectionized and several issues remain controversial among endoscopist. These issues include needle size and type (FNA versus TNB needles), use of a stylet and suction for FNA sampling, pure cytologic assessment versus cyto-histologic techniques, grading of the investigator´s and pathologist´s experience and improvement of EUS training for novices. In this report we briefly review the actual literature and summarize the available evidence on some controversely discussed issues. The results support the view that use of a stylet rarely aids to increase the amount of tissue obtained during EUS-FNA, whereas use of suction can be helpful in certain situations. Novel cutting needles may potentially improve number and size of core biopsies that can be rendered for special histologic tissue processing techniques. An in-room-cytopathologist not necessarily improves outcome of EUS-FNA results but may have a role during build-up of EUS units to become more successful. EUS-FNA education requires skilled endoscopists on both sides and can presumably be improved by objective testing of practical expertise by peer review and introducing objective sampling parameters. Novel techniques and equipment are about to evolve in the near future.

Schlüsselwörter

gastrointestinaler Stromatumor (GIST) - Rektumkarzinom - gastroenteropankreatische Tumoren - Magenkarzinom - MALT-Lymphom - Ösophaguskarzinom

Key words

gastrointestinal stromal tumour (GIST) - rectal cancer - gastro-entero-pancreatic tumours - gastric cancer - MALT lymphomas - oesophageal cancer

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