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EUS for Biliopancreatic Tissue Acquisition

  • Tsu-Yao ChengEmail author
Chapter

Abstract

Endoscopic ultrasound (EUS) along with fine-needle aspiration (FNA) has become a popular method and safe bridge to accurate tissue diagnosis for biliopancreatic tissue acquisition. EUS-FNA can alter patient management after a definite cytopathologic diagnosis or tumor staging, and it also has an impact on facilitating medical decision-making of both patients and physicians. EUS-FNA procedure involves the aspiration of cell samples by passing an aspiration needle through the working channel of a curvilinear echoendoscope under real-time guidance into an EUS visualized lesion. Various techniques such as peripheral sampling and fanning aspiration have been developed and can improve the diagnostic accuracy and efficiency of the EUS-FNA tissue acquisition. EUS-FNA can be performed from either the trans-duodenal or the trans-gastric approach for pancreatic tumors at the head or body and tail, respectively. Besides, EUS can evaluate the biliary tract and associated tumors from the ampulla to the bifurcation. Being superior to ERCP tissue sampling in pancreatic tumors, EUS-FNA has comparable sensitivity to ERCP-related methods for biliary tumors in evaluating suspected malignant biliary obstruction.

Keywords

EUS-FNA Peripheral sampling technique Fanning technique Non-suction technique Slow-pull technique Pancreatic ductal adenocarcinoma Pancreatic neuroendocrine tumor Biliary tumor 

References

  1. 1.
    Dumonceau JM, Polkowski M, Larghi A, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2011;43:897–912.CrossRefPubMedGoogle Scholar
  2. 2.
    Hewitt MJ, McPhail MJ, Possamai L, et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012;75:319–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Karadsheh Z, Al-Haddad M. Endoscopic ultrasound guided fine needle tissue acquisition: where we stand in 2013? World J Gastroenterol. 2014;20:2176–85.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Erickson RA. EUS-guided FNA. Gastrointest Endosc. 2004;60:267–79.CrossRefPubMedGoogle Scholar
  5. 5.
    National Comprehensive Cancer Network. Pancreatic Adenocarcinoma (Version 1. 2017). http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed 28 Feb 2017.
  6. 6.
    Yamao K, Irisawa A, Inoue H, et al. Standard imaging techniques of endoscopic ultrasound-guided fine-needle aspiration using a curved linear array echoendoscope. Dig Endosc. 2007;19:S180–205.CrossRefGoogle Scholar
  7. 7.
    Yasuda I, Iwashita T, Doi S. Tips for endoscopic ultrasound-guided fine needle aspiration of various pancreatic lesions. J Hepatobiliary Pancreat Sci. 2014;21:E29–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Ekberg O, Bergenfeldt M, Aspelin P, et al. Reliability of ultrasound-guided fine-needle biopsy of pancreatic masses. Acta Radiol. 1988;29:535–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng TY, Wang HP, Jan IS, et al. Presence of intratumoral anechoic foci predicts an increased number of endoscopic ultrasound-guided fine-needle aspiration passes required for the diagnosis of pancreatic adenocarcinoma. J Gastroenterol Hepatol. 2007;22:315–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Bang JY, Magee SH, Ramesh J, et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy. 2013;45:445–50.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Zajdela A, Zillhardt P, Voillemot N. Cytological diagnosis by fine needle sampling without aspiration. Cancer. 1987;59:1201–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Puri R, Vilmann P, Săftoiu A, et al. Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis. Scand J Gastroenterol. 2009;44:499–504.CrossRefPubMedGoogle Scholar
  13. 13.
    Nakai Y, Isayama H, Chang KJ, et al. Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses. Dig Dis Sci. 2014;59:1578–85.CrossRefPubMedGoogle Scholar
  14. 14.
    Weilert F, Bhat YM, Binmoeller KF, et al. EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc. 2014;80:97–104.CrossRefPubMedGoogle Scholar
  15. 15.
    Draganov P, Chauhan S, Wagh M, et al. Diagnostic accuracy of conventional and cholangioscopic-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc. 2012;75:347–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
  2. 2.Department of Laboratory MedicineNational Taiwan University HospitalTaipeiTaiwan

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