Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

Abstract

Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects.

Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact.

Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88 % (95 %CI,0.74–0.96), 100 % (95 %CI,0.59–1), and 90 % (95 %CI,0.78–0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88 %). Arterial vessel and ASA-III had a trend with incidents (both, P < 0.08). Rapid on-site evlauation was found to be an independent predictor for obtaining a conclusive sample (OR 6.2; 95 %CI, 1.06–36.73, P < 0.04).

Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.

• References

• 1 Lieberman RP, Waldman SD. Celiac plexus neurolysis with the modified transaortic approach. Radiology 1990; 175: 274-276
• 2 Gupta S, Ahrar K, Morello F. et al. Masses around the pancreatic head: CT-guided coaxial fine-needle aspiration biopsy with a posterior transcaval approach. Radiology 2002; 222: 63-69
• 3 Sofocleous CT, Schubert J, Brown KT. et al. CT-guided transvenous or transcaval needle biopsy of pancreatic and peripancreatic lesions. J Vasc Intern radiol 2004; 15: 1099-1104
• 4 von Bartheld MB, Rabe KF, Annema JT. Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes. Gastrointest Endosc 2009; 69: 345-349
• 5 Veitch AM, Vanbiervliet G, Gershlick AH. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy 2016; 48: 385-402
• 6 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 7 Vincent B, Huggins JT, Doelken P. et al. Successful real-time endobronchial ultrasound-guided transbronchial needle aspiration of a hilar lung mass obtained by traversing the pulmonary artery. J Thorac Oncol 2006; 1: 362-364
• 8 Wallace MB, Woodward TA, Raimondo M. et al. Transaortic fine-needle aspiration of centrally located lung cancer under endoscopic ultrasound guidance: The Final Frontier. Ann Thorac Surg 2007; 84: 1019-1021
• 9 Kazakov J, Hegde P, Tahiri M. et al. Endobronchial and endoscopic ultrasound-guided transvascular biopsy of mediastinal, hilar, and lung lesions. Ann Thoracic Surg 2017; 103: 951-955
• 10 Mehta RM, Biraris PR, Pattabhiraman V. et al. Defining expanded areas in EBUS sampling: EBUS guided trans- and intra-pulmonary artery needle aspiration, with review of transvascular EBUS. Clin Respir J 2018; 12: 1958-1963
• 11 Ravaglia C, Colella S, Tomassetti S. et al. Diagnostic yield and safety of EUS-FNA biopsy in sub-aortic and para-aortic lymph node stations with the trans-aortic approach: a case series and literature review. Eur Clin Respir J; 2019 Available from (Accessed 2020 March 24): 6. 1552064 https://www.tandfonline.com/doi/full/10.1080/20018525.2018.1552064?af=R
• 12 Molina JC, Chaudry F, Menezes V. et al. Transvascular Endosonographic-Guided Needle Biopsy of Intrathoracic Lesions. J Thorac Cardiovasc Surg 2019;
• 13 Bang JY, Varadarajulu S. Diagnosis of a metastatic neuroendocrine tumor of the pancreas by transaortic endoscopic ultrasound-guided fine-needle aspiration. Am Surg 2012; 78: 183-184
• 14 Galasso D, Rimba M, Attili F. et al. Transaortic endoscopic ultrasound-guided fine-needle aspiration of a positron emission tomography-positive abdominal para-aortic lymph node. Endoscopy 2015; 47: 536-537
• 15 Lee NK, Park S, Park S. et al. EUS-guided trans-aortic fine-needle aspiration for intra-abdominal plasmacytoma in a patient with multiple myeloma. Gastrointest Endosc 2015; 81: 1479-1480
• 16 Wang M, Huang S, Pei R. et al. Endoscopic ultrasonography guided transgastric trans-portal system fine needle aspiration for diagnosing pancreatic head and uncinate process malignancy. Ann Transl Med 2019; 7: 719
• 17 Garg R, Rustagi T. Endoscopic ultrasound-guided portal venous access: diagnostic and therapeutic implications. J Clin Gastroenterol 2017; 51: 677-682
• 18 Trikudanathan G, Pannala R. ASGE Technology Committee. et al. EUS-guided portal vein interventions. Gastrointest Endosc 2017; 85: 883-888
• 19 Chapman CG, Waxman I. EUS-guided portal vein sampling. Endosc Ultrasound 2018; 7: 240-245
• 20 Lococo F, De Vincentis F, Naldini A. et al. Transesophageal endoscopic ultrasound-guided transcarotid fine needle aspiration of a positron emission tomography (PET)-positive mediastinal lymph node. Endoscopy 2012; 44: 402-403
• 21 Lococo F, Attili F, Meacci E. et al. Transcaval endoscopic ultrasound-guided fine needle aspiration of a right adrenal lesion. Endoscopy 2013; 45: 201-202