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Cytomorphologic Features of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Celiac Ganglia
Abstracts on tissue microarray sections. The targeted probes prepared by Advanced Cell Diagnostics covered the albumin sequence from nucleotides 2 to 490. The scoring system for RNAscope was based on these criteria: 0 (0 or 1 dot/tumor cell), 1+ (2-3 dots/tumor cell), 2+ (4-10 dots/tumor cell), 3+ (>10 dots/tumor cell), and 4+ (>10 dots/tumor cell with clusters of signal). The staining intensity and distribution of VHL were recorded. Results: The results showed that 10 of 13 (77%) ICC cases were diffusely and strongly positive for VHL by IHC; in contrast, only 5 of 13 (38.5%) ICC cases were positive for albumin by RNAscope. All HCC cases were positive for albumin by RNAscope and only 2 focally positive for VHL. Conclusion: The preliminary data suggest that dectection of VHL expressino of IHC is more sensitive than detection of albumin mRNA expression in confirming the diagnosis of ICC. The low diagnostic sensitivity of albumin mRNA detection is most likely due to focal expression of albumin in the limited samples. Additional study in a large case series is warranted to validate this preliminary result.
S11 were confirmed to be either CG or CLN; 142 cases could not be confirmed, due to obscuring tumor cells or necrosis. When these equivocal cases were excluded, EUS accuracy of identifying CLN and CG, ganglia only, and lymph nodes only was 80.0%, 91.7%, and 98.6%, respectively. Conclusions: CG and CLN have distinct cytomorphologic and EUS features. Identifying ganglion cells during on-site evaluation and within the pathology report may direct patient management and provide important prognostic information to clinicians.
PST22 Cytomorphologic Features of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Celiac Ganglia Heidi Lehrke, DO, Michael Henry, MD, Michael Levy, MD, Ferga Gleeson, MD. Mayo Clinic, Rochester, MN Introduction: Endoscopic ultrasound (EUS) guided fine needle aspirations (FNAs) of celiac ganglia (CG) are uncommon and are generally interpreted as either positive or negative, without noting the presence of ganglion cells in the pathology report. This distinction may initially appear arbitrary; however, studies have shown that EUS-guided celiac neurolysis of CG may impact the overall survival of patients with metastatic pancreatic adenocarcinoma and improve their quality of life. Considering this, we aim to describe the cytomorphologic features used to distinguish CG from celiac lymph node (CLN) sampling on Diff-Quik and Papanicolaou-stained smears. Additionally, we report the ability of EUS to differentiate between CLN and CG at our institution. Materials and Methods: We reviewed the EUS features and pathology reports of 453 patients (487 specimens) over a period of eleven years who underwent EUS FNA of CLN or CG (or both). The endoscopic impression and pathology report were compared to determine EUS accuracy. If lymphocytes or ganglion cells were not mentioned pathology report, the cases were reviewed by a pathologist to confirm the tissue site sampled. Results: Morphologic features of CLN included a prominent mixed lymphocytic population with or without metastatic tumor cells (Figure 1). Celiac ganglia aspirates lacked a lymphoid background and possessed occasional fragments of spindled nerve fibers admixed with free-floating ganglion cells (Figure 2). Of the 487 specimens reviewed, 345 (70.9%)
Figure 1
Figure 2
PST23 Endoscopic Ultrasound-guided Fine-needle Biopsy (EUS-FNB) Cytology in the Era of Core Needles: A Report of 334 Cases from a Single Academic Center Suhair Al Salihi, MD, Suvra Roy, MD, Xiaohong Wang, MD, PhD, Erik Rahimi, MD, Nirav Thosani, MD, MHA, Ilker Sen, MD, Jaiyeola Thomas-Ogunniyi, MBBS, FRCPath(UK), Songlin Zhang, MD. University of Texas Health Science Center, Houston, TX Introduction: Fine-needle biopsy (FNB) has become popular due the minimal invasive nature, and core needle biopsy often can collect more tissue than aspiration. Several different core needles are now widely available in the market for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). Here we report our experience from a single medical center. Material and Method: A retrospective analysis of EUS-FNB cases from July 2014 to February 2017 was performed. EUS aspiration or core biopsy was recorded. The EUS-FNB sensitivity, specificity, positive predictive values and negative predictive value were calculated by comparing with the corresponding surgical resection diagnosis. Results: Total 334 cases were performed during the study period. 59 cases were aspiration (17.7%) and 275 cases were core biopsy (82.3%). The biopsy sites included 163 pancreas, 30 lymph nodes, 22 stomach, 21 liver, 12 ampulla, and 86 other locations. The cytology diagnosis had unsatisfactory 7/ 334 (2.1%), atypical 27/334 (8.1%), suspicious for carcinoma 7/334 (2.1%), positive for malignancy 162/334 (48.5%), and negative 131/334 (39.2%). 75 cases had the corresponding follow-up surgical resections. The EUS-FNB biopsy had sensitivity 96.4% (53/55), specificity 100% (20/20), positive predictive value 100% (53/53), and negative predictive value 90.9% (20/22). Conclusions: EUS-FNB cytology in the core needle era has low unsatisfactory rate (2.1%), low atypical and suspicious rate (10.2%), and good diagnostic rate (87.7%), and cytology has high sensitivity (96.4%), excellent specificity and positive predictive value (100%), and good negative predictive value (90.9%). The core tissue was useful for lymphoma subclassification, grading pancreatic neuroendocrine tumor,
S11 were confirmed to be either CG or CLN; 142 cases could not be confirmed, due to obscuring tumor cells or necrosis. When these equivocal cases were excluded, EUS accuracy of identifying CLN and CG, ganglia only, and lymph nodes only was 80.0%, 91.7%, and 98.6%, respectively. Conclusions: CG and CLN have distinct cytomorphologic and EUS features. Identifying ganglion cells during on-site evaluation and within the pathology report may direct patient management and provide important prognostic information to clinicians.
PST22 Cytomorphologic Features of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Celiac Ganglia Heidi Lehrke, DO, Michael Henry, MD, Michael Levy, MD, Ferga Gleeson, MD. Mayo Clinic, Rochester, MN Introduction: Endoscopic ultrasound (EUS) guided fine needle aspirations (FNAs) of celiac ganglia (CG) are uncommon and are generally interpreted as either positive or negative, without noting the presence of ganglion cells in the pathology report. This distinction may initially appear arbitrary; however, studies have shown that EUS-guided celiac neurolysis of CG may impact the overall survival of patients with metastatic pancreatic adenocarcinoma and improve their quality of life. Considering this, we aim to describe the cytomorphologic features used to distinguish CG from celiac lymph node (CLN) sampling on Diff-Quik and Papanicolaou-stained smears. Additionally, we report the ability of EUS to differentiate between CLN and CG at our institution. Materials and Methods: We reviewed the EUS features and pathology reports of 453 patients (487 specimens) over a period of eleven years who underwent EUS FNA of CLN or CG (or both). The endoscopic impression and pathology report were compared to determine EUS accuracy. If lymphocytes or ganglion cells were not mentioned pathology report, the cases were reviewed by a pathologist to confirm the tissue site sampled. Results: Morphologic features of CLN included a prominent mixed lymphocytic population with or without metastatic tumor cells (Figure 1). Celiac ganglia aspirates lacked a lymphoid background and possessed occasional fragments of spindled nerve fibers admixed with free-floating ganglion cells (Figure 2). Of the 487 specimens reviewed, 345 (70.9%)
Figure 1
Figure 2
PST23 Endoscopic Ultrasound-guided Fine-needle Biopsy (EUS-FNB) Cytology in the Era of Core Needles: A Report of 334 Cases from a Single Academic Center Suhair Al Salihi, MD, Suvra Roy, MD, Xiaohong Wang, MD, PhD, Erik Rahimi, MD, Nirav Thosani, MD, MHA, Ilker Sen, MD, Jaiyeola Thomas-Ogunniyi, MBBS, FRCPath(UK), Songlin Zhang, MD. University of Texas Health Science Center, Houston, TX Introduction: Fine-needle biopsy (FNB) has become popular due the minimal invasive nature, and core needle biopsy often can collect more tissue than aspiration. Several different core needles are now widely available in the market for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). Here we report our experience from a single medical center. Material and Method: A retrospective analysis of EUS-FNB cases from July 2014 to February 2017 was performed. EUS aspiration or core biopsy was recorded. The EUS-FNB sensitivity, specificity, positive predictive values and negative predictive value were calculated by comparing with the corresponding surgical resection diagnosis. Results: Total 334 cases were performed during the study period. 59 cases were aspiration (17.7%) and 275 cases were core biopsy (82.3%). The biopsy sites included 163 pancreas, 30 lymph nodes, 22 stomach, 21 liver, 12 ampulla, and 86 other locations. The cytology diagnosis had unsatisfactory 7/ 334 (2.1%), atypical 27/334 (8.1%), suspicious for carcinoma 7/334 (2.1%), positive for malignancy 162/334 (48.5%), and negative 131/334 (39.2%). 75 cases had the corresponding follow-up surgical resections. The EUS-FNB biopsy had sensitivity 96.4% (53/55), specificity 100% (20/20), positive predictive value 100% (53/53), and negative predictive value 90.9% (20/22). Conclusions: EUS-FNB cytology in the core needle era has low unsatisfactory rate (2.1%), low atypical and suspicious rate (10.2%), and good diagnostic rate (87.7%), and cytology has high sensitivity (96.4%), excellent specificity and positive predictive value (100%), and good negative predictive value (90.9%). The core tissue was useful for lymphoma subclassification, grading pancreatic neuroendocrine tumor,