Role of EUS-FNA for gallbladder mass lesions with biliary obstruction: a large single-center experience (original) (raw)
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Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases
Cytopathology, 2006
Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases Objective: Endoscopic retrograde cholangiopancreaticography (ERCP)-guided brushing has been the standard of practice for surveillance and detection of carcinoma in the biliary tree. Few studies have evaluated the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in diagnosing clinically suspected cholangiocarcinoma. The role of this method in diagnosing clinically suspected gallbladder malignancies has not been extensively evaluated in the USA. This study investigates the role of EUS-FNA in the diagnosis of clinically suspected biliary tree and gallbladder malignancies in a large patient series. Methods: EUS-FNAs were obtained from 46 bile duct and seven gallbladder lesions. On-site rapid interpretation was provided using air-dried Diff Quik stained smears. In addition, alcohol fixed Papanicoloau stained smears and Thin Prep preparations (Cytye Corp., Marlborough, MA, USA) were evaluated before providing a final cytological diagnosis. Tissue biopsies and/or clinical follow-up were used as the standards to determine operating characteristics for EUS-FNA. Results: The mean ages for bile duct and gallbladder lesions were 66 years (range: 37-84 years), and 69 years (range 49-86 years), respectively. All cases diagnosed as suspicious/malignant on preliminary evaluation were confirmed on final cytological interpretation (27/27). The operating characteristics show that EUS-FNA is highly specific (100%) with sensitivity rates of 87% and 80% from clinically suspected malignancies of biliary tract and gallbladder, respectively. Sampling error in three cases and associated acute inflammation in two cases resulted in false-negative diagnoses. Conclusions: EUS-FNA of biliary tree and gallbladder carcinoma is highly specific and should be considered for evaluation of clinically suspicious lesions. Marked inflammation may result in false-negative diagnoses.
Diagnostic Cytopathology, 1998
OBJECTIVE: To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses. STUDY DESIGN: We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases. RESULTS: After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease. CONCLUSION: US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.
Digestive Diseases and Sciences, 2014
Background No previous studies have compared cytology obtained under endoscopic transpapillary gallbladder drainage (ETGD) and EUS-guided fine needle aspiration (EUS-FNA) for thick-walled gallbladders. Aim The present study investigated the diagnostic yield of bile cytology under ETGD and EUS-FNA for gallbladder tumors. Methods A total of 69 patients were diagnosed as having gallbladder wall thickening. Among these patients, 28 patients were diagnosed by clinical follow-up, solely by imaging such as computed tomography or by histological examination of surgical specimens. The remaining 41 patients underwent ETGD and/or EUS-FNA. In these 41 patients, the clinical data collected included gender, age, diameter of gallbladder wall, site of gallbladder wall thickening, final diagnosis, adverse events, and diagnostic yield of ETGD and EUS-FNA. Results Cyto-histological diagnosis with EUS-FNA was higher than that with ETGD, with a sensitivity of 100 versus 71 %, specificity of 100 versus 94 %, and accuracy of 100 versus 88 %, respectively, in the two groups. In addition, the sampling adequacy of EUS-FNA was 100 %. Adverse events were seen in five patients in the ETGD group (mild pancreatitis), although no adverse events were seen in the EUS-FNA group (P = 0.08). Conclusion Our results suggest that EUS-FNA can be safely performed for the diagnosis of gallbladder lesions. Further, this procedure may be the diagnostic method of choice over cytology of bile juice obtained via ETGD to obtain histological evidence of gallbladder cancer.
Cureus
Background and objective Patients with suspected malignant biliary strictures frequently undergo endoscopic retrograde cholangiopancreatography (ERCP)-based brush cytology and endoscopic ultrasound (EUS)-guided fineneedle aspiration (FNA) for establishing the diagnosis. The outcomes of these tests aid in the further management of the patient. A comparison of these two modalities in establishing the diagnosis is seldom reported. In light of this, we aimed to compare the diagnostic efficacy between ERCP-based brush cytology and EUS-FNA for tissue diagnosis in malignant biliary obstruction. Our study involved a retrospective audit of all patients admitted to the Vydehi Institute of Medical Sciences and Research Centre for EUS and ERCP from 2015 to 2019. Methodology A Comparative study was conducted in the Department of Medical Gastroenterology at the Vydehi Institute of Medical Sciences and Research Centre over a five-year period. A total of 77 subjects who presented during the study period with biliary obstruction based on clinical presentation with altered liver function test in an obstructive pattern and evidence of biliary obstruction in the form of stricture or pancreaticobiliary mass on cross-sectional imaging were included in the study. All the patients included in the study underwent EUS and ERCP. Results The majority of the patients in the study were in the fifth decade of life with a slight female predominance. The most common CT finding was a periampullary mass with common bile duct (CBD) stricture (59.7%). In the study, EUS-FNA was more sensitive than ERCP-based tissue sampling. The overall sensitivity was 90.63% for EUS-FNA and 65.63% for ERCP sampling. EUS-FNA was found to have diagnostic accuracy of 92.63% in comparison to 71.43% for brush cytology. Conclusions Based on our findings, EUS-FNA is superior to ERCP-based tissue sampling with excellent sensitivity and diagnostic accuracy. Performing EUS before ERCP in all patients with suspected malignant biliary obstruction would definitely improve diagnostic accuracy and thereby help in the management of such cases.
Ultrasound-Guided Fine Needle Aspiration Cytology of Malignant Gallbladder Masses
Acta Cytologica, 1997
Background: The appropriate clinical management of various hepatic lesions depends on accurate diagnosis. Fine needle aspiration and cell block have gained popularity because they are convenient, minimally invasive, quick and have good performance profiles. Objective: To investigate the cytomorphological features of distinctive non-neoplastic and neoplastic lesions of the liver and to evaluate the sensitivity, specificity and diagnostic accuracy of ultrasound-guided (USG) fine needle aspiration cytology (FNAC) and cell block in the diagnosis of liver diseases at Khartoum Teaching Hospital. Method: A cross-sectional study was conducted at Khartoum Teaching Hospital, Sudan during the period of November 2008 to October 2011. One hundred and five cytological materials were collected from patients with focal liver lesions who referred after initial clinical and radiological assessment for ultrasound!guided fine needle aspiration cytology (USG-FNAC). Results: The age of the patients ranged from 5-60 years and 64 (61%) of these patients were males. Out of 105 investigated samples 76 (72.4%) and 41(39.0%) were malignant by cytology and cell block respectively. Out of these 105 samples, 71 were investigated by both cytology and cell blocks and were included in the final analyses of the FNAC in comparison to cell block. The sensitivity, specificity, positive predictive value and negative predictive value of the cytology were 100% (93.0 ! 100%), 63.3% (45.2 ! 79.0%), 78.8% (66.2 ! 88.3%) and 0 (0 ! 14.6%), respectively. Conclusion: Thus, USG-FNAC is a sensitive but not specific method in differentiating the benign and malignant focal liver lesions. Differentiation between primary liver malignant lesions and metastatic lesion needs adjunct techniques
Endoscopy International Open
Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has emerged as an important method for obtaining a preoperative tissue diagnosis for suspected cholangiocarcinoma. However, doubts remain about test sensitivity. This study assessed the value and limitations of EUS-FNA in clinical practice. Patients and methods Patients undergoing EUS-FNA for biliary strictures/masses at a UK tertiary referral center from 2005 to 2014 were prospectively enrolled. Data on EUS-FNA findings, histology, and endoscopy and patient outcomes were collected to evaluate test performance and identify factors predictive of an inaccurate diagnostic result. Results Ninety-seven patients underwent a total of 112 EUS-FNA procedures. Overall test sensitivity for an initial EUS-FNA for suspected cholangiocarcinoma was 75 % (95 % CI 64 %–84 %), with specificity 100 % (95 % CI 85 %–100 %) and negative predictive value 0.62 (95 % CI 0.47–0.75). Hilar lesions, the presence of a biliar...
The role of endoscopic ultrasound in the diagnosis of gallbladder diseases
Journal of medical ultrasonics (2001), 2017
Endoscopic ultrasound (EUS) has recently played an increasing role in the diagnosis of gallbladder diseases. This review aims to summarize the role of EUS in the diagnosis of gallbladder lesions. EUS provides high-resolution images that can improve the diagnosis of gallbladder polypoid lesions and microlithiasis, in addition to evaluating gallbladder thickness and staging of gallbladder carcinoma. Contrast-enhancing agents may be useful for the differential diagnosis of gallbladder lesions, but the evidence of their effectiveness is still limited and further studies are required in this area to establish its usefulness. Endoscopic ultrasound combined with fine needle aspiration has played an increasing role in providing histological diagnosis of gallbladder tumors in addition to gallbladder thickening.
Cytologic diagnosis of gallbladder lesions - A study of 150 cases
The Indian journal of surgery, 2010
Gallbladder (GB) carcinoma is among the five most common forms of gastrointestinal cancers and the diagnosis is usually made when the carcinoma is already in an advanced stage. The aim of this study was to assess the application of ultrasound (US) guided fine needle aspiration (FNA) in diagnosing GB carcinoma. The present study was carried out on 150 patients suspected to have GB carcinoma on ultrasonography. US-guided FNA from GB was done in these patients and FNA of the other organs was simultaneously done in 20 patients. Histopathology of the GB was available in 14 cases. Ultrasonography in these patients revealed mass/thickening of the wall of GB in 140 (93.3%) cases and nonspecific US findings in 10 (6.7%). Out of the 140 cases malignancy was cytologically diagnosed in 105 (75%) cases while 12 (8.5%) cases were inflammatory and 23 (16.5%) were inconclusive. Adenocarcinoma was the most common morphologic type. Metastatic tumor deposits were noted in FNA from space occupying lesi...
JMS SKIMS, 2020
Objectives: To report the diagnostic yield and safety of endoscopic ultrasound-guided fine-needle aspiration (EUS FNA) for the evaluation of proximal bile duct lesions. Materials and methods: A retrospective analysis of data of the patients, who had undergone EUS for proximal bile duct lesions was done. FNA was performed from either the bile duct mass, enlarged node, or liver lesions. Outcome measures were the diagnostic yield of EUS FNA and adverse events. Results: From April 2011 to August 2018, 147 patients with suspected proximal bile duct malignancy underwent EUS. Mass lesion was seen in 133 (90.47%) patients. FNA was performed in 125 (85.03%) patients. The final diagnosis in patients undergoing EUS FNA was malignancy in 118, benign disease in six, and one patient was lost to follow up. EUS FNA confirmed the diagnosis in 103/118 patients with malignancy (sensitivity 87.28%); was false negative in 15/118 cases with malignancy, and was truly negative in all the six patients with ...
IOSR Journals , 2019
Background and objectives: Gallbladder (GB) carcinoma is prevalent in the Gangetic plains of the Eastern Uttar Pradesh and Western Bihar regions of India. The present study was done to assess the utility of ultrasound (US) guided fine needle aspiration (FNA) in diagnosing GB carcinoma. Materials and Methods: A study was conducted over a period of one year from August 2017 to July 2018 in the Department of Pathology and Department of Radiodiagnosis in Indira Gandhi Institute of Medical Sciences, Patna. US guided fine needle aspiration was carried out, and aspirates were drawn, processed and evaluated. Results: Out of 117 aspirations, 93 (79.4%) were adequate, 15 (12.8%) were inconclusive, and 9 (7.6%) were inadequate. The most common carcinoma was adenocarcinoma in 75cases (64.1%). The overall diagnostic adequacy was 92.4%. The common causes of inconclusive cases were necrotic areas, aspiration of reactive hepatocytes adjacent to the GB mass, scant epithelial cells, inflammatory cells and mucus flakes. Histopathology of the GB was available in 24 cases. Conclusion: US guided FNA of gall bladder lesions is a simple, safe, economically prudent technique leading to quick and early diagnosis.