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Comparative study of 3 systems for endoscopic ultrasound guided fine needle aspiration (EUS-FNA)
*4200 COMPARATIVE STUDY OF 3 SYSTEMS FOR ENDOSCOPIC ULTRASOUND GUIDED FINE NEEDLE ASPIRATION (EUS-FNA) Jose C. Ardengh, Gustavo A. Paul®, Angel® P. Ferrari, UNIFESP - EPM, Sao Paul® Brazil Background:EUS-FNA allows cytological and/or histological diagnosis of lesions within or adjacent to the gastrointestinal tract. However, the amount of tissue obtained with a regular 21G needle is not always satisfactory. With the development of a prototype needle (Shot-Gun@) that resembles the automatic liver biopsy needle, it is probably possible to obtain more tissue, optimizing histological analysis. Objective:To compare samples obtained with EUS-FNA using 3 different needle systems: GI1~ , NA10J-l®and Shot-Gun®. Methods:Between Oct-99 and Mar-00 16 patients underwent EUS-FNA for diagnosis (5) or tumor staging (11). Mean age was 58.9 years (range 27 82), being 50% men. All patients were submitted to EUS-FNA with 3 needles. The Shot-Gun~.vas "shot" with the needle tip located inside the mass, followed by aspiration. Samples were sent for cytological and histological analyses. Results:Mean lesion size was 3.1cm (range 1.2 5.5cm). Final diagnoses were made after surgery or intra-operative biopsy: 13 pancreatic tumors (12 adenocarcinonms and 1 neuroendocrine), 2 metastases (1 liver and 1 lymph node} and 1 cholangiocarcinoma. Cytological diagnosis was possible in 6/16 (37.5%) samples obtained with the GIP~needle, 8/16 (50%) with the NA10J-l@and 7/16 (43.8%} with the Shot-Gun®(NS). Histological diagnosis was possible in 4/16 (25%) with the GIP~needle, 8/16 (50%} with the NA10J-l®and in 13/16 (81.2%} with the Shot-Gun®(p<0.01). A final diagnosis was possible in 7/16 (43.8%) using the GIPOneedle, 10/16 (62.5%) using the NA10J-l@and in 14/16 (87.5%) with the Shot-Gun®(p<0.05). In two cases the biopsies were negative due to very hard tumors. Conclusion:The Shot-Gun°needle obtained better samples for histological diagnoses than the NA10J-l®needle.
"4201 PROSPECTIVE PREVALENCE OF ENDOSCOPIC ULTRASOUND (EUS) C R I T E R I A F O R CHRONIC PANCREATITIS (CP) IN PATIENTS UNDERGOING ROUTINE U P P E R EUS. S F. Jafri, Raman Muthusamy, Michael Hernandez, Kenneth J. Chang, Phuong T Nguyen, Univ ofCA, Irvine Medical Ctr, Orange, CA Background: EUS has a high sensitivity in detecting changes suggestive of CP. However, the specificity is not clear. No prior studies report the prevalence of the various criteria for CP in patients being evaluated by EUS for non pancreatic indications. Methods: We prospectively evaluated 178 patients (109 F/69 M) from 7/99 to 10/00, undergoing upper EUS exams for various non pancreatic indications. We specifically evaluated for the presence of 7 established EUS criteria for CP: 1)hyperechoic foci (HF) 2) hyperechoic strands (HS) 3) parenchymal lobularity (PL) 4) a hyperechoic main pancreatic duct (HMPD) 5) main pancreatic duct dilation (MPDD) 6) shadowing calcifications (SC) and 7) pancreatic cysts (C). Data regarding alcohol consumption (ETOH), cigarette smoking and body mass index (BMI) was also obtained. Results: Of the 178 patients, 52% had none of the criteria of CP. In the remaining 48% with one or more criteria, the two most commonly noted were HF and HMPD. HF or HMPD was present in 45% (80/178) and both criteria were present in 22% (39/178). 20 patients (11%) had 3 or more criteria for CP. Of these, 19 patients had both HF and HMPD. HMPD was found more commonly in >40 pack per year smokers (p=.003) while HF were found more commonly in males (p=0.01). ETOH, age or BMI were not predictive of these 2 factors. Conclusions: 1) 11% of asymptomatic patients had 3 or more criteria of CP. 2) HF or HMPD are found in nearly half®fall patients undergoing routine EUS for various non pancreatic indications. These findings are significantly more common in males and heavy smokers. HF and HMPD appear non-specific and should be considered minor criteria in the diagnonsis of CP.
AB168
GASTROINTESTINAL ENDOSCOPY
Prevalence
of individual criteria
4O 3O 25 ~ 20
o. lO 5 o HMPD
HF
HS
PL
MPDD
C
SC
Factors Predictive of CP 100
l
Heaw/ ETOH
W
>-40 pack year
older Ihan 60
8MI >25
male gender
*4202 EUS IS MORE ACCURATE THAN P E T F O R N STAGE IN E S O P H A G E A L CANCER: AN EARLY EXPERIENCE Christopher Jordan, Paul S. Jowell, Thomas D'Amico, David Harpole, Edward Coleman, Kevin McGrath, Duke Univ Medical Ctr, Durham, NC Background: There has been an increasing interest in the use of positron emission tomography (PET) to determine nodal and metastatic disease in patients with esophageal cancer. We therefore sought to compare EUS and PET in the ability to determine for the presence of malignant lymph nodes (LN), i.e., N stage. Methods: All patients who unde~vent PET to stage esophageal cancer were identified. This list was cross referenced with our EUS database to identify the patients who also underwent EUS staging. EUS films were reviewed by 2 experienced endosonographers to agree on N staging. EUS criteria for malignant nodes were: size _>10 mm, round or oval shape, well demarcated and hypoechoic echogenicity. Surgical pathology and cytology were used as the gold standard. Patients who received neoadjuvant therapy were included only if they had nodal disease at surgical pathology. Patients with negative nodal pathology were included if they did not receive pre-surgical therapy. Results: 27 patients were identified who underwent both EUS and PET scanning for staging purposes. Of these, 13 met inclusion criteria. PET was accurate in N staging in 6 of 13 patients (46%); EUS was accurate in 7 of 10 patients (70%). Three patients were staged "Nx" by EUS given an inability to traverse the cancer. All 3 had positive nodes at surgery; PET was positive in one of these cases. Conclusions: EUS appears to be a more accurate modality to determine N stage in esophageal cancer. A larger study is required before making definitive conclusions.
VOLUME 53, NO. 5. 2001
"4201 PROSPECTIVE PREVALENCE OF ENDOSCOPIC ULTRASOUND (EUS) C R I T E R I A F O R CHRONIC PANCREATITIS (CP) IN PATIENTS UNDERGOING ROUTINE U P P E R EUS. S F. Jafri, Raman Muthusamy, Michael Hernandez, Kenneth J. Chang, Phuong T Nguyen, Univ ofCA, Irvine Medical Ctr, Orange, CA Background: EUS has a high sensitivity in detecting changes suggestive of CP. However, the specificity is not clear. No prior studies report the prevalence of the various criteria for CP in patients being evaluated by EUS for non pancreatic indications. Methods: We prospectively evaluated 178 patients (109 F/69 M) from 7/99 to 10/00, undergoing upper EUS exams for various non pancreatic indications. We specifically evaluated for the presence of 7 established EUS criteria for CP: 1)hyperechoic foci (HF) 2) hyperechoic strands (HS) 3) parenchymal lobularity (PL) 4) a hyperechoic main pancreatic duct (HMPD) 5) main pancreatic duct dilation (MPDD) 6) shadowing calcifications (SC) and 7) pancreatic cysts (C). Data regarding alcohol consumption (ETOH), cigarette smoking and body mass index (BMI) was also obtained. Results: Of the 178 patients, 52% had none of the criteria of CP. In the remaining 48% with one or more criteria, the two most commonly noted were HF and HMPD. HF or HMPD was present in 45% (80/178) and both criteria were present in 22% (39/178). 20 patients (11%) had 3 or more criteria for CP. Of these, 19 patients had both HF and HMPD. HMPD was found more commonly in >40 pack per year smokers (p=.003) while HF were found more commonly in males (p=0.01). ETOH, age or BMI were not predictive of these 2 factors. Conclusions: 1) 11% of asymptomatic patients had 3 or more criteria of CP. 2) HF or HMPD are found in nearly half®fall patients undergoing routine EUS for various non pancreatic indications. These findings are significantly more common in males and heavy smokers. HF and HMPD appear non-specific and should be considered minor criteria in the diagnonsis of CP.
AB168
GASTROINTESTINAL ENDOSCOPY
Prevalence
of individual criteria
4O 3O 25 ~ 20
o. lO 5 o HMPD
HF
HS
PL
MPDD
C
SC
Factors Predictive of CP 100
l
Heaw/ ETOH
W
>-40 pack year
older Ihan 60
8MI >25
male gender
*4202 EUS IS MORE ACCURATE THAN P E T F O R N STAGE IN E S O P H A G E A L CANCER: AN EARLY EXPERIENCE Christopher Jordan, Paul S. Jowell, Thomas D'Amico, David Harpole, Edward Coleman, Kevin McGrath, Duke Univ Medical Ctr, Durham, NC Background: There has been an increasing interest in the use of positron emission tomography (PET) to determine nodal and metastatic disease in patients with esophageal cancer. We therefore sought to compare EUS and PET in the ability to determine for the presence of malignant lymph nodes (LN), i.e., N stage. Methods: All patients who unde~vent PET to stage esophageal cancer were identified. This list was cross referenced with our EUS database to identify the patients who also underwent EUS staging. EUS films were reviewed by 2 experienced endosonographers to agree on N staging. EUS criteria for malignant nodes were: size _>10 mm, round or oval shape, well demarcated and hypoechoic echogenicity. Surgical pathology and cytology were used as the gold standard. Patients who received neoadjuvant therapy were included only if they had nodal disease at surgical pathology. Patients with negative nodal pathology were included if they did not receive pre-surgical therapy. Results: 27 patients were identified who underwent both EUS and PET scanning for staging purposes. Of these, 13 met inclusion criteria. PET was accurate in N staging in 6 of 13 patients (46%); EUS was accurate in 7 of 10 patients (70%). Three patients were staged "Nx" by EUS given an inability to traverse the cancer. All 3 had positive nodes at surgery; PET was positive in one of these cases. Conclusions: EUS appears to be a more accurate modality to determine N stage in esophageal cancer. A larger study is required before making definitive conclusions.
VOLUME 53, NO. 5. 2001