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CC BY-NC-ND 3.0 · Journal of Digestive Endoscopy 2017; 08(04): 176-181
DOI: 10.4103/jde.JDE_53_17
Original Article
Journal of Digestive Endoscopy

Comparison of Diagnostic Yield of Endoscopic Ultrasound-guided Fine-needle Aspiration Cytology and Cell Block in Solid Lesions

Avinash Bhat Balekuduru
Department of Gastroenterology, M. S. Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
,
Amit Kumar Dutta
1   Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Sanjeev Kumar Nagaruru
Department of Gastroenterology, M. S. Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
,
Shamim Sheik
2   Department of Pathology, M. S. Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
,
Suneetha Parandhamaiah Kurella
2   Department of Pathology, M. S. Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
,
Satyaprakash Bonthala Subbaraj
Department of Gastroenterology, M. S. Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
› Author Affiliations
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Publication History

Publication Date:
25 September 2019 (online)

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ABSTRACT

Background and Aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a procedure of choice for the diagnostic evaluation of submucosal and periluminal lesions. Tissue sample can be obtained by EUS-FNA cytology (FNAC) or cell block (CB). The aim of the present study is to compare diagnostic yield of EUS-FNA CB and cytology in the absence of onsite pathologist following a protocol-based EUS-FNA approach in solid lesions. Patients and Methods: Participants who underwent EUS-FNA at our center for solid submucosal or periluminal lesions (pancreas, lymph node, and liver) between 2014 and 2016 were included, retrospectively. The indication for the procedure along with the clinical and other investigation details and the final etiological diagnosis were recorded on uniform structured data forms. The diagnostic yield of cytology and CB were compared using McNemar’s test. The P < 0.05 was considered statistically significant. Results: EUS-FNA for solid lesion was performed in 130 lesions in 101 patients during the study period. Their mean age was 52.5 ± 12 years and 42.5% were female. Pancreatic masses were the most common lesions (37.7%) followed by lymph nodes (36.9%). Submucosal lesions (17.7%) and liver lesions (7.7%) accounted for rest of the cases. The overall diagnostic yield for EUS-FNAC (70%) and CB (74.6%) was not significantly different (P = 0.3) and their combined yield was 85.3%. For the 23 patients with submucosal lesion, diagnostic yield of CB (82.6%) was significantly better than cytology (47.8%, P = 0.04). Conclusions: EUS-guided CB has better yield compared to cytology in gastrointestinal submucosal lesions. The combination of CB with cytology improves the overall yield of the procedure; and hence, they should be considered complimentary rather than alternatives.

KEYWORDS

Cell block - cytology - endoscopic ultrasound - fine-needle aspiration
 

  • References

  • 1 Costache MI, Iordache S, Karstensen JG, Săftoiu A, Vilmann P. Endoscopic ultrasound-guided fine needle aspiration: From the past to the future. Endosc Ultrasound 2013; 2: 77-85
    CrossrefPubMedSearch in Google Scholar
  • 2 Vilmann P, Jacobsen GK, Henriksen FW, Hancke S.. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992; 38: 172-3
    CrossrefPubMedSearch in Google Scholar
  • 3 Othman MO, Wallace MB. The role of endoscopic ultrasonography in the diagnosis and management of pancreatic cancer. Gastroenterol Clin North Am 2012; 41: 179-88
    CrossrefPubMedSearch in Google Scholar
  • 4 Gill KR, Ghabril MS, Jamil LH, Hasan MK, McNeil RB, Woodward TA. et al. Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer. Gastrointest Endosc 2010; 72: 265-71
    CrossrefPubMedSearch in Google Scholar
  • 5 Madhoun MF, Wani SB, Rastogi A, Early D, Gaddam S, Tierney WM. et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: A meta-analysis. Endoscopy 2013; 45: 86-92
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Eloubeidi MA, Tamhane A, Varadarajulu S, Wilcox CM. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: A prospective evaluation. Gastrointest Endosc 2006; 63: 622-9
    CrossrefPubMedSearch in Google Scholar
  • 7 Polkowski M, Larghi A, Weynand B, Boustiere C, Giovannini M, Pujol B. et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European society of gastrointestinal endoscopy (ESGE) technical guideline. Endoscopy 2012; 44: 190-206
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Bang JY, Ramesh J, Trevino J, Eloubeidi MA, Varadarajulu S. Objective assessment of an algorithmic approach to EUS-guided FNA and interventions. Gastrointest Endosc 2013; 77: 739-44
    CrossrefPubMedSearch in Google Scholar
  • 9 Bang JY, Magee SH, Ramesh J, Trevino JM, Varadarajulu S. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-50
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Ieni A, Todaro P, Crino SF, Barresi V, Tuccari G. Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas: Diagnostic efficacy of cell-block immunocytochemistry. Hepatobiliary Pancreat Dis Int 2015; 14: 305-12
    CrossrefPubMedSearch in Google Scholar
  • 11 Ieni A, Barresi V, Tuccari G. Diagnostic relevance of cell block procedure in secondary tumors of the pancreas. Cytojournal 2016; 13: 19
    CrossrefPubMedSearch in Google Scholar
  • 12 Early DS, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA. et al. ASGE Standards of Practice Committee. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013; 77: 839-43
    CrossrefPubMedSearch in Google Scholar
  • 13 Hébert-Magee S, Bae S, Varadarajulu S, Ramesh J, Frost AR, Eloubeidi MA. et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: A meta-analysis. Cytopathology 2013; 24: 159-71
    CrossrefPubMedSearch in Google Scholar
  • 14 Cooray M, Nistor I, Pham J, Bair D, Arya N.. Accuracy of endoscopic ultrasound-fine needle aspiration of solid lesions over time: Experience from a new endoscopic ultrasound program at a Canadian community hospital. Endosc Ultrasound 2017; 6: 187-94
    CrossrefPubMedSearch in Google Scholar
  • 15 Eloubeidi MA, Buxbaum JL. Improving endoscopic ultrasound-guided fine needle aspiration specimens in the absence of rapid onsite evaluation: Does cytotechnologist training provide the solution?. Dig Liver Dis 2012; 44: 273-4
    CrossrefPubMedSearch in Google Scholar
  • 16 Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: Diagnostic accuracy and complication assessment. Gastroenterology 1997; 112: 1087-95
    CrossrefPubMedSearch in Google Scholar
  • 17 Ando N, Goto H, Niwa Y, Hirooka Y, Ohmiya N, Nagasaka T. et al. The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc 2002; 55: 37-43
    CrossrefPubMedSearch in Google Scholar
  • 18 Watson RR, Binmoeller KF, Hamerski CM, Shergill AK, Shaw RE, Jaffee IM. et al. Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors. Dig Dis Sci 2011; 56: 1757-62
    CrossrefPubMedSearch in Google Scholar
  • 19 Ieni A, Barresi V, Todaro P, Caruso RA, Tuccari G. Cell-block procedure in endoscopic ultrasound-guided-fine-needle-aspiration of gastrointestinal solid neoplastic lesions. World J Gastrointest Endosc 2015; 7: 1014-22
    CrossrefPubMedSearch in Google Scholar
  • 20 Papanikolaou IS, Triantafyllou K, Kourikou A, Rosch T. Endoscopic ultrasonography for gastric submucosal lesions. World J Gastrointest Endosc 2011; 3: 86-94
    PubMedSearch in Google Scholar
  • 21 Mekky MA, Yamao K, Sawaki A, Mizuno N, Hara K, Nafeh MA. et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 2010; 71: 913-9
    CrossrefPubMedSearch in Google Scholar
  • 22 Săftoiu A, Vilmann P, Guldhammer BSkov, Georgescu CV. Endoscopic ultrasound (EUS)-guided trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: A prospective study. Scand J Gastroenterol 2007; 42: 117-25
    CrossrefPubMedSearch in Google Scholar
  • 23 Gerke H, Rizk MK, Vanderheyden AD, Jensen CS. Randomized study comparing endoscopic ultrasound-guided trucut biopsy and fine needle aspiration with high suction. Cytopathology 2010; 21: 44-51
    CrossrefPubMedSearch in Google Scholar