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Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) An Accurate Modality in the Diagnosis of Recurrent Lung Cancer
Abstracts
M1213 Pilot Study On the Technical Performance of a New Forward Viewing Linear Echoendoscope for FNA and Cyst Drainage. An Arcade Group Study Thomas Roesch, Ioannis S. Papanikolaou, Thierry Ponchon, Horst Neuhaus, Guido Costamagna, Paul Fockens, Jacques M. Deviere
M1215 Trans-Esophageal EUS-Guided Fine-Needle Aspiration and Core Biopsy for Undetermined Mediastinal Lesions Ho June Song, Se Jin Jang, Dong Wan Seo, Tae Sun Shim, Woo Sung Kim, Kee Don Choi, Sang Soo Lee, Gin Hyug Lee, Hwoon-Yong Jung, Sung Koo Lee, Jin-Ho Kim
Background: Endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) for tissue diagnosis and various therapies such as pancreatic cyst drainage is firmly established in gastroenterologic endoscopy. A new prototype forward EUS scope was tested which due its straight channel may overcome some of the remaining limitations of EUS-FNA such as limited needle manoeuvrability in the duodenum and restricted endoscopic control by oblique viewing optics. Methods: We collected retrospective data of all diagnostic FNA cases performed in the 6 participating centers during the 2-3 weeks of clinical application of the new scope. During this period, all diagnostic FNA as well as all PCD cases were attempted with the new scope. Main outcome parameters for diagnostic FNA were yield of adequate tissue for cytology (or histology if attempted) as well as the sensitivity for the diagnosis of malignancy and for PCD the establishement of a successful drainage. Results: Data from 11 FNA patients (4 men, mean age 66.6 years) were collected in 3 of the 6 centers. FNA indications were pancreatic mass lesions (n Z 6), bile duct strictures (n Z 3), and others (n Z 3, 1 esophageal and 1 gastric wall tumor, 1 paraesophageal lymph node). Adequate tissue was provided for analysis in all cases, and sensitivity for malignancy was 82%. Subjective impressions of the examiners from the new scope were positive with better manoeuvrability of the needle and less difficulties with needle exit especially in the duodenum. Conclusions: The new forward viewing echoendoscope provides tissue acquisition for FNA at least as successfully as conventional oblique-viewing linear echoendoscopes. The forward viewing optics may open new applications in diagnosis and therapy.
Background/Aims: EUS-guided fine-needle aspiration & core biopsy (EUS-FNA/CB) is a minimally invasive diagnostic modality for tissue confirmation of gastrointestinal or adjacent lesions. It would be more valuable in tuberculosisprevalent settings because in which lymph nodes often enlarge reactively. This study is aimed to evaluate the diagnostic yields of EUS-FNA/CB for undetermined mediastinal lesions, and further to assess its clinical value in patients with present or prior history of pulmonary tuberculosis. Methods: Thirty-nine consecutive cases consulted for undetermined mediastinal lesions from July 2005 to August 2006 were enrolled. Linear echoendoscope and 22-gauge aspiration or 19-gauge Trucut needles were used. Final diagnoses were determined by EUS-FNA/CB cytology, biospy, surgical pathology, or clinical follow-ups. Results: Indications for EUS-FNA/ CB were for histologic sampling in 24 cases (including suspected lung cancer, 9; other malignancy, 6; granulomatous disease, 3; unknown lesion, 6) and for stage confirmation of 15 proven malignancies (lung cancer, 11; extra-pulmonary malignancy, 4). FNA/CB was performed by mean number of 3.6 passes with four minimal complications (fever, 3; pain, 1). Malignant pathology was obtained in 12 cases (primary lung cancer, 7; unknown origin, 4; lymphoma, 1), and nine were defined as benign lesions (tuberculosis, 3; sarcoidosis, 1; reactive lymph node, 4; inconclusive bacterial infection, 1). In staging of 16 patients with proven malignancy (nodal staging of lung cancer, 11; metastasis of extra-pulmonary malignancy, 4; recurrence of breast cancer, 1), 14 cases were diagnostic (metastatic, 7; reactive, 7). Only four specimens (10.3%) were inadequate. Eleven of 39 patients (28.2%) had history of tuberculosis (prior pulmonary history, 7; present clinical impression, 4). Of the seven, six underwent FNA/CB for nodal staging of lung cancer and proved to be diagnostic (metastatic, 2; reactive, 4). The diagnostic accuracy of EUS-FNA/CB was as follows: overall, 87.2% (34/39); malignancy-related, 92.9% (26/28); lung cancer-related, 88.9% (16/18); tuberculosis-related, 90.9% (10/11). Conclusions: EUS-FNA/CB is an accurate diagnostic modality in tissue confirmation of undetermined mediastinal lesions. In addition, it should be recognized as an indispensable procedure to define benign reactive mediastinal lymph nodes that are commonly encountered in highly prevalent area of pulmonary tuberculosis.
M1214 Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) An Accurate Modality in the Diagnosis of Recurrent Lung Cancer Somal Shah, Sanjay Sikka, Theodore Paradowski, Daniel Ringold, John Maple, Richard Battafarano, Dayna S. Early, Steven A. Edmundowicz, Riad R. Azar
M1216 Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pleural Effusions Pradermchai Kongkam, Julia K. Leblanc, Stuart Sherman, Lee Mchenry, John M. Dewitt
Background: Despite surgical resection or chemo- radiation a significant percentage of patients with lung cancer develop recurrent disease. Although mediastinoscopy is a proven tool in the initial staging of patients, it is more difficult to perform after treatment in patients with suspected lung cancer recurrence. Thus alternative accurate and less invasive methods are needed. Objectives: Our goal was to assess the utility of Endoscopic Ultrasound with Fine Needle Aspiration (EUSFNA) in confirming suspected recurrences in patients who were previously treated for lung cancer. Patients and Methods: We retrospectively reviewed the charts of all patients that underwent EUS-FNA for diagnosis of suspected recurrent lung cancer between July 2003 through May 2006. Results: We identified 11 patients who underwent an EUS-FNA performed for suspected recurrent lung cancer. 9 patients had a previous diagnosis of non small cell lung cancer (NSCLC) and 2 patients had a previous diagnosis of small cell lung cancer (SLC).8 patients had prior thoracic surgeries (2 thoracotomies, 2 mediastinoscopies, and 4 both) with or without chemotherapy and/or radiation and 3 had only chemotherapy and/or radiation. All patients had abnormal imaging including chest CT and/or Positron Emission Tomography (PET) suggesting recurrent disease. All patients had the EUS-FNA performed at least 4 months after the completion of their therapy, with an average time of 19 months (range: 4 to 60 months). 8 patients underwent FNA of either a mediastinal lymph node or mass (average size 29 mm, range 10 to 38 mm), while 3 patients underwent FNA of an enlarged adrenal mass (average size 42 mm, range of 25 to 62 mm). EUS-FNA confirmed recurrence of lung cancer in 8 out of 11 patients: 6 had a positive FNA of mediastinal lymph nodes or masses, and 2 patients had a positive FNA of a left adrenal mass. Of the remaining 3 patients with a negative EUS-FNA, 1 had a follow-up mediastinoscopy with a left lower lobe biopsy that was positive for moderately differentiated squamous cell carcinoma with lymph node involvement. The other two patients have remained in remission with a follow up time of 20 and 11 months respectively. There were no procedure related complications noted. Conclusions: Our results suggest that EUS-FNA may be an effective and safe modality to evaluate for recurrent lung cancer after either a thoracotomy, mediastinoscopy or chemo-radiation. However further prospective studies will be needed to confirm our results.
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Introduction: Percutaneous thoracentesis may be associated with pneumothoraces in up to 10% of patients, some of whom eventually require tube thoracostomy. Endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA) is an important tool for staging many types of cancer yet few studies have evaluated the safety and utility of EUS-guided thoracentesis. Aim: To retrospectively report a single-center case series of the indications, safety profile and yield from EUS-FNA of pleural fluid. Methods: Using prospectively updated databases at our hospital from 2003 to 2006, we identified consecutive patients who underwent successful EUS-guided thoracentesis. All procedures were performed by one of four physicians with on-site cytology. Results: Eight patients (6 male, median age 66 yrs; range 55-79) were identified. Before EUS, five had a diagnosis of primary bile duct (1), esophageal (1), unknown primary cancer (1), colon (1) or kidney (1) cancer. Two with bile duct (1) and lung (1) cancer were diagnosed shortly after EUS. One patient had Barrett’s esophagus only without malignancy. Indications for EUS included: mediastinal mass (3), esophageal subepithelial mass (1), pancreatic cyst (1), duodenal mass (1), restaging of esophageal cancer after neoadjuvant therapy (1), or thoracentesis alone (1). Prior to EUS, CT revealed a pleural effusion in only 4 of 8 patients. During EUS-FNA, a median of 11 mls (range: 2.5-36) was aspirated from the right (7) or left (1) chest. Intravenous and/or outpatient oral antibiotics were given to all patients. No immediate or delayed complications were noted. Pleural fluid LDH and total protein classified the fluid as exudative in 4 and transudative in 1; three patients did not have fluid analysis. Pleural fluid cytology demonstrated non-small cell carcinoma from an unknown primary in one (fluid classified as exudative); the remaining seven were benign. Pleural fluid cultures were positive for alpha strep in one and Escherichia hermanni in one, both of which were considered contaminants. All patients with negative pleural fluid cytology were confirmed as benign by follow up and radiographic evidence of decreased or stable amount of pleural fluid. The sensitivity, specificity and accuracy for the diagnosis of malignancy were 100%, 100%, and 100%, respectively. Conclusion: EUS-guided thoracentesis is safe and may identify malignancy, particularly in patients with known or suspected cancer. This technique may be useful to identify pleural effusions after negative imaging tests or to perform thoracentesis in high-risk patients.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB197
M1213 Pilot Study On the Technical Performance of a New Forward Viewing Linear Echoendoscope for FNA and Cyst Drainage. An Arcade Group Study Thomas Roesch, Ioannis S. Papanikolaou, Thierry Ponchon, Horst Neuhaus, Guido Costamagna, Paul Fockens, Jacques M. Deviere
M1215 Trans-Esophageal EUS-Guided Fine-Needle Aspiration and Core Biopsy for Undetermined Mediastinal Lesions Ho June Song, Se Jin Jang, Dong Wan Seo, Tae Sun Shim, Woo Sung Kim, Kee Don Choi, Sang Soo Lee, Gin Hyug Lee, Hwoon-Yong Jung, Sung Koo Lee, Jin-Ho Kim
Background: Endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) for tissue diagnosis and various therapies such as pancreatic cyst drainage is firmly established in gastroenterologic endoscopy. A new prototype forward EUS scope was tested which due its straight channel may overcome some of the remaining limitations of EUS-FNA such as limited needle manoeuvrability in the duodenum and restricted endoscopic control by oblique viewing optics. Methods: We collected retrospective data of all diagnostic FNA cases performed in the 6 participating centers during the 2-3 weeks of clinical application of the new scope. During this period, all diagnostic FNA as well as all PCD cases were attempted with the new scope. Main outcome parameters for diagnostic FNA were yield of adequate tissue for cytology (or histology if attempted) as well as the sensitivity for the diagnosis of malignancy and for PCD the establishement of a successful drainage. Results: Data from 11 FNA patients (4 men, mean age 66.6 years) were collected in 3 of the 6 centers. FNA indications were pancreatic mass lesions (n Z 6), bile duct strictures (n Z 3), and others (n Z 3, 1 esophageal and 1 gastric wall tumor, 1 paraesophageal lymph node). Adequate tissue was provided for analysis in all cases, and sensitivity for malignancy was 82%. Subjective impressions of the examiners from the new scope were positive with better manoeuvrability of the needle and less difficulties with needle exit especially in the duodenum. Conclusions: The new forward viewing echoendoscope provides tissue acquisition for FNA at least as successfully as conventional oblique-viewing linear echoendoscopes. The forward viewing optics may open new applications in diagnosis and therapy.
Background/Aims: EUS-guided fine-needle aspiration & core biopsy (EUS-FNA/CB) is a minimally invasive diagnostic modality for tissue confirmation of gastrointestinal or adjacent lesions. It would be more valuable in tuberculosisprevalent settings because in which lymph nodes often enlarge reactively. This study is aimed to evaluate the diagnostic yields of EUS-FNA/CB for undetermined mediastinal lesions, and further to assess its clinical value in patients with present or prior history of pulmonary tuberculosis. Methods: Thirty-nine consecutive cases consulted for undetermined mediastinal lesions from July 2005 to August 2006 were enrolled. Linear echoendoscope and 22-gauge aspiration or 19-gauge Trucut needles were used. Final diagnoses were determined by EUS-FNA/CB cytology, biospy, surgical pathology, or clinical follow-ups. Results: Indications for EUS-FNA/ CB were for histologic sampling in 24 cases (including suspected lung cancer, 9; other malignancy, 6; granulomatous disease, 3; unknown lesion, 6) and for stage confirmation of 15 proven malignancies (lung cancer, 11; extra-pulmonary malignancy, 4). FNA/CB was performed by mean number of 3.6 passes with four minimal complications (fever, 3; pain, 1). Malignant pathology was obtained in 12 cases (primary lung cancer, 7; unknown origin, 4; lymphoma, 1), and nine were defined as benign lesions (tuberculosis, 3; sarcoidosis, 1; reactive lymph node, 4; inconclusive bacterial infection, 1). In staging of 16 patients with proven malignancy (nodal staging of lung cancer, 11; metastasis of extra-pulmonary malignancy, 4; recurrence of breast cancer, 1), 14 cases were diagnostic (metastatic, 7; reactive, 7). Only four specimens (10.3%) were inadequate. Eleven of 39 patients (28.2%) had history of tuberculosis (prior pulmonary history, 7; present clinical impression, 4). Of the seven, six underwent FNA/CB for nodal staging of lung cancer and proved to be diagnostic (metastatic, 2; reactive, 4). The diagnostic accuracy of EUS-FNA/CB was as follows: overall, 87.2% (34/39); malignancy-related, 92.9% (26/28); lung cancer-related, 88.9% (16/18); tuberculosis-related, 90.9% (10/11). Conclusions: EUS-FNA/CB is an accurate diagnostic modality in tissue confirmation of undetermined mediastinal lesions. In addition, it should be recognized as an indispensable procedure to define benign reactive mediastinal lymph nodes that are commonly encountered in highly prevalent area of pulmonary tuberculosis.
M1214 Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) An Accurate Modality in the Diagnosis of Recurrent Lung Cancer Somal Shah, Sanjay Sikka, Theodore Paradowski, Daniel Ringold, John Maple, Richard Battafarano, Dayna S. Early, Steven A. Edmundowicz, Riad R. Azar
M1216 Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pleural Effusions Pradermchai Kongkam, Julia K. Leblanc, Stuart Sherman, Lee Mchenry, John M. Dewitt
Background: Despite surgical resection or chemo- radiation a significant percentage of patients with lung cancer develop recurrent disease. Although mediastinoscopy is a proven tool in the initial staging of patients, it is more difficult to perform after treatment in patients with suspected lung cancer recurrence. Thus alternative accurate and less invasive methods are needed. Objectives: Our goal was to assess the utility of Endoscopic Ultrasound with Fine Needle Aspiration (EUSFNA) in confirming suspected recurrences in patients who were previously treated for lung cancer. Patients and Methods: We retrospectively reviewed the charts of all patients that underwent EUS-FNA for diagnosis of suspected recurrent lung cancer between July 2003 through May 2006. Results: We identified 11 patients who underwent an EUS-FNA performed for suspected recurrent lung cancer. 9 patients had a previous diagnosis of non small cell lung cancer (NSCLC) and 2 patients had a previous diagnosis of small cell lung cancer (SLC).8 patients had prior thoracic surgeries (2 thoracotomies, 2 mediastinoscopies, and 4 both) with or without chemotherapy and/or radiation and 3 had only chemotherapy and/or radiation. All patients had abnormal imaging including chest CT and/or Positron Emission Tomography (PET) suggesting recurrent disease. All patients had the EUS-FNA performed at least 4 months after the completion of their therapy, with an average time of 19 months (range: 4 to 60 months). 8 patients underwent FNA of either a mediastinal lymph node or mass (average size 29 mm, range 10 to 38 mm), while 3 patients underwent FNA of an enlarged adrenal mass (average size 42 mm, range of 25 to 62 mm). EUS-FNA confirmed recurrence of lung cancer in 8 out of 11 patients: 6 had a positive FNA of mediastinal lymph nodes or masses, and 2 patients had a positive FNA of a left adrenal mass. Of the remaining 3 patients with a negative EUS-FNA, 1 had a follow-up mediastinoscopy with a left lower lobe biopsy that was positive for moderately differentiated squamous cell carcinoma with lymph node involvement. The other two patients have remained in remission with a follow up time of 20 and 11 months respectively. There were no procedure related complications noted. Conclusions: Our results suggest that EUS-FNA may be an effective and safe modality to evaluate for recurrent lung cancer after either a thoracotomy, mediastinoscopy or chemo-radiation. However further prospective studies will be needed to confirm our results.
www.giejournal.org
Introduction: Percutaneous thoracentesis may be associated with pneumothoraces in up to 10% of patients, some of whom eventually require tube thoracostomy. Endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA) is an important tool for staging many types of cancer yet few studies have evaluated the safety and utility of EUS-guided thoracentesis. Aim: To retrospectively report a single-center case series of the indications, safety profile and yield from EUS-FNA of pleural fluid. Methods: Using prospectively updated databases at our hospital from 2003 to 2006, we identified consecutive patients who underwent successful EUS-guided thoracentesis. All procedures were performed by one of four physicians with on-site cytology. Results: Eight patients (6 male, median age 66 yrs; range 55-79) were identified. Before EUS, five had a diagnosis of primary bile duct (1), esophageal (1), unknown primary cancer (1), colon (1) or kidney (1) cancer. Two with bile duct (1) and lung (1) cancer were diagnosed shortly after EUS. One patient had Barrett’s esophagus only without malignancy. Indications for EUS included: mediastinal mass (3), esophageal subepithelial mass (1), pancreatic cyst (1), duodenal mass (1), restaging of esophageal cancer after neoadjuvant therapy (1), or thoracentesis alone (1). Prior to EUS, CT revealed a pleural effusion in only 4 of 8 patients. During EUS-FNA, a median of 11 mls (range: 2.5-36) was aspirated from the right (7) or left (1) chest. Intravenous and/or outpatient oral antibiotics were given to all patients. No immediate or delayed complications were noted. Pleural fluid LDH and total protein classified the fluid as exudative in 4 and transudative in 1; three patients did not have fluid analysis. Pleural fluid cytology demonstrated non-small cell carcinoma from an unknown primary in one (fluid classified as exudative); the remaining seven were benign. Pleural fluid cultures were positive for alpha strep in one and Escherichia hermanni in one, both of which were considered contaminants. All patients with negative pleural fluid cytology were confirmed as benign by follow up and radiographic evidence of decreased or stable amount of pleural fluid. The sensitivity, specificity and accuracy for the diagnosis of malignancy were 100%, 100%, and 100%, respectively. Conclusion: EUS-guided thoracentesis is safe and may identify malignancy, particularly in patients with known or suspected cancer. This technique may be useful to identify pleural effusions after negative imaging tests or to perform thoracentesis in high-risk patients.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB197