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... Targeting subcapsular lesions with no liver in front of them should be avoided, given the increased risk of hemorrhage. The central part of the tumor should also be avoided because it may be necrotic (31). While suction increases the quantity of the sample, it makes the specimen bloodier and diminishes the quality of the aspirate, thus, there is no consensus concerning whether it should be used or not (32). ...
Background/aim:
Endoscopic ultrasound (EUS)-guided liver tumor biopsy has some advantages over the percutaneous and surgical route and, in many cases, should be preferred. The aim of this study was to evaluate the role of EUS-fine needle aspiration (FNA) in the diagnosis of liver tumors with an emphasis on its diagnostic accuracy and histological quality of the acquired specimen.
Patients and methods:
We followed 30 consecutive patients who underwent liver tumor biopsy using EUS guidance. Tissue was acquired using a 22-gauge FNA needle.
Results:
In 97% of patients, the results of EUS-FNA were adequate for diagnosis. In one case, the pathologist recommended a repeat biopsy. The acquired specimen was a core fragment in 81% of cases while in 19% of cases the specimen was fragmented and subsequently used as a cell block. No complications were reported.
Conclusion:
EUS-FNA is characterized by a high success rate on the acquisition of good-quality tissue specimens, a low rate of complications, and decreased patient discomfort. This procedure should be especially considered in the case of liver lesions that are inaccessible via the percutaneous route or when concurrent biopsies are required for accurate diagnosis.
... Although MRI is considered superior in the evaluation of pancreatic cystic lesions, a distinct advantage of EUS (especially with improved image resolution) is the ability to sample pancreatic cyst fluid for both cytology and tumor markers including carcinoembryonic antigen (CEA) and DNA mutational analysis. [55][56][57][58][59] Under current guidelines, EUS is increasingly reserved for pancreatic cysts with high-risk stigmata or worrisome features where it may impact on Open access diagnostic workup as well as stratifying patients for either surveillance or surgical resection. 16 60 staging of pancreatic cancers EUS is a useful modality for the staging of pancreatic cancers in patients with suspected malignancy and assisting in determining surgically resectable lesions. ...
Pancreatic cancer is one of the leading causes of cancer-related mortality in western countries. Early diagnosis of pancreatic cancers plays a key role in the management by identification of patients who are surgical candidates. The advancement in the radiological imaging and interventional endoscopy (including endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography and endoscopic enteral stenting techniques) has a significant impact in the diagnostic evaluation, staging and treatment of pancreatic cancer. The multidisciplinary involvement of radiology, gastroenterology, medical oncology and surgical oncology is central to the management of patients with pancreatic cancers. This review aims to highlight the diagnostic and therapeutic role of EUS in the management of patients with pancreatic malignancy, especially pancreatic ductal adenocarcinoma.
Nonneoplastic disorders involving the liver and extrahepatic biliary tract are not uncommonly encountered in practice. Besides solid lesions such as hepatocytes hyperplasia, regeneration or cirrhosis, liver cysts are also commonly encountered in the cytology. Certain infectious entities such as echinococcal cysts or amebic abscess should be kept in mind, especially with relevant clinical history. The major benign lesions include stricture, changes post stenting or primary sclerosis cholangitis. To be familiar with the cytomorphologic features of these benign or nonneoplastic lesions help differentiation from the malignant counterpart.
Endoscopic ultrasound examination may provide complementary information to cross-sectional imaging in lesions of the liver, portal vein, and surrounding lymph nodes. With fine needle aspiration, endoscopic ultrasound examination is a powerful tool for the diagnosis of focal liver lesions and has usefulness in the evaluation of indeterminate liver lesions. Endoscopic ultrasound examination may influence hepatocellular cancer staging and Endoscopic ultrasound examination with fine needle aspiration of locoregional nodes and portal vein thromboses changes management. Contrast-enhanced endoscopic ultrasound examination and endoscopic ultrasound examination elastography are likely to expand the usefulness of endoscopic ultrasound examination in evaluating liver malignancy with technologic improvements.
