A prospective study comparing rapid assessment of smears and ThinPrep for endoscopic ultrasound-guided fine-needle aspirates.

BACKGROUND AND STUDY AIMS: ThinPrep is often used for endoscopic ultrasound fine-needle aspiration (EUS-FNA) samples but the sensitivity of this method is unknown. The objective of the study was to compare sensitivity and accuracy of ThinPrep versus the smear method in pancreas and lymph node samples obtained by EUS-FNA. PATIENTS AND METHODS: Patients with suspected malignancy in the pancreas or lymph node underwent EUS-FNA. On-site rapid assessment of all aspirates using the smear method was performed. After rapid assessment, three additional passes from each site were submitted into ThinPrep liquid medium. Cytopathologists interpreting the smear method and ThinPrep slides were blinded to each other. The gold standard was final cytology or pathology results. RESULTS: A total of 130 patients (36 % women, mean age 63 years) underwent EUS-FNA of 139 sites (50 pancreas, 89 lymph node). Malignancy was confirmed in 47 pancreas samples (94 %) and 48 lymph node samples (54 %). Mean +/- SD number of passes made for the smear method was 2.6 +/- 1.3. For pancreatic cancer, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the ThinPrep versus the smear method were: 62 % versus 98 %, 100 % versus 100 %, 100 % versus 100 %, 14 % versus 75 %, and 64 % versus 98 %, respectively. For lymph nodes the values were 67 % versus 92 %, 100 % versus 98 %, 100 % versus 98 %, 72 % versus 72 %, and 82 % versus 94 %, respectively. CONCLUSIONS: The smear method is more sensitive and accurate than ThinPrep in detecting malignancy from EUS-FNA samples of the pancreas and lymph nodes. Smear method with on-site rapid assessment should be favored over ThinPrep in suspected malignancy.

Diagnosis of recurrent rectal cancer deep into the vaginal wall by transvaginal endoscopic ultrasound-guided fine needle aspiration.

Local recurrent rectal cancer may present with extraluminal lesions. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is good for diagnosis of such an extraluminal lesion. A 51-year-old Asian female was diagnosed with uT3N0M0 rectal adenocarcinoma 31 months ago. She had undergone chemotherapy, radiotherapy and abdominoperineal resection (APR). Eight months ago, colonoscopy and computed tomography (CT) were unremarkable. Carcinoembryonic antigen was 1.1 ng/ml. Pelvic examination revealed a 3 x 2 cm firm soft-tissue mass palpable through the left vaginal wall. EUS revealed a mass in the left lateral vaginal wall measuring up to 21 x 27 mm in cross section without invasion of adjacent pelvic structures. Transvaginal EUS-FNA was performed with a 22-gauge needle. Final cytology confirmed recurrent rectal adenocarcinoma. Subsequent surgery also confirmed a 2.3 cm grade II adenocarcinoma. The tumor focally extended to the inked margin. The uterus and ovary specimen were negative for disease. We herein report a successful role of transvaginal EUS-FNA for early detection of recurrent rectal cancer at the vaginal wall after abdominoperineal resection (APR).

An overview of endoscopic ultrasound equipment.

Endoscopic ultrasound imaging technology has significantly improved over the last decade. Innovative design of equipment and devices has broadened the utility of EUS as diagnostic and therapeutic tools. Lesions as small as 3 mm can be imaged and targeted for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS imaging with the latest generation electronic radial and linear scopes is excellent and does not vary significantly between models. Miniprobes should not be used in place of routine EUS echoendoscopes when available and technically feasible. The drawbacks of ultrasound miniprobes are the inability to perform fine needle aspiration and the limited depth of imaging. Transpapillary intraductal ultrasound (IDUS) improves staging of biliary tumors and improves imaging of biliary and pancreatic duct strictures. Endoscopic ultrasound-guided celiac plexus neurolysis or block (EUS-CPN/CPB) can be performed with the EUS-FNA needle or a specially designed celiac plexus block needle which distributes the neurolytic agent into the celiac plexus in a radial fashion. Use of the core biopsy needle is safe and should be used with a therapeutic linear scope through the gastric wall.

Giant fibrovascular polyp of the esophagus.

The role of endoscopic ultrasound (EUS) in the diagnosis and management of a giant fibrovascular polyp of the esophagus in a 46-year-old woman is described here. The fibrovascular polyp was detected at esophagogastroduodenoscopy, and EUS demonstrated that it originated from the submucosa. EUS-guided fine-needle aspiration was performed, and cytological examination of the specimen revealed benign fibro-fatty elements. The lesion was resected via a transcervical esophagotomy. The literature on fibrovascular polyps is reviewed.