RÉSUMÉ
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to diagnose and stage lung cancer. In clinical practice, cytology specimens from EBUS-TBNA may be low in cellularity, especially with necrotic lesions. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) has recently become the preferred method for obtaining histology biopsy. This retrospective cohort study analysed the first 30 patients who have undergone EBUS-TBMC in a tertiary centre in Malaysia. EBUS-TBMC demonstrated a high diagnostic yield and good safety profile. All the samples obtained were adequate for the detection of driver alteration by next-generation sequencing.
Sujet(s)
Cytoponction sous échoendoscopie , Tumeurs du poumon , Humains , Études rétrospectives , Mâle , Adulte d'âge moyen , Femelle , Tumeurs du poumon/anatomopathologie , Tumeurs du poumon/diagnostic , Cytoponction sous échoendoscopie/méthodes , Cytoponction sous échoendoscopie/effets indésirables , Sujet âgé , Médiastin/anatomopathologie , Malaisie , Bronchoscopie/méthodes , Bronchoscopie/effets indésirables , Cryochirurgie/méthodes , AdulteRÉSUMÉ
BACKGROUND: Mediastinal tubercular lymphadenitis is form of extrapulmonary tuberculosis [EPTB]. Clinical presentations are non-specific and diagnosis remains great clinical challenge. Microbiological and or histopathological evidences need to be present in order make diagnosis secure before initiation of anti-tubercular therapy (ATT). Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) provides tissue samples and aids management of this difficult to diagnosed entity. Current study describe role of EUS-FNA and Gene Xpert (GXP) in mediastinal tubercular lymphadenitis. METHODS: Retrospective analysis of 72 patients with mediastinal lymphadenopathy who underwent EUS-FNA were carried out. Linear echoendoscope was used for evaluation mediastinum. EUS echo features of LNs were studied. Twenty two-G needle used was for aspiration tissue sample from pathologic lymph nodes (LNs). FNA samples were analysed by cytology, Acid-Fast Bacilli (AFB) staining and GXP study. All procedures were uneventful without any complications. RESULTS: Forty two patients were diagnosed as tuberculosis (TB) following first EUS-FNA setting. Six patients underwent repeat EUS-FNA procedure following which another 3 were diagnosed as TB while remaining 3 started on empirical ATT based on additional supportive evidences. Forty five patients showed granulomatous inflammation on cytological analysis, AFB positivity noted in 16 (33.33%) patients while GXP in 26 (57.78%) patients. Rifampicin resistance detected in 3 ((6.25%) patients. All patients were followed clinico-radiologically for response to treatment. CONCLUSION: Tuberculous lymphadenitis is the most common cause of mediastinal lymphadenopathy in TB endemic countries. EUS-FNA provides microbiological and histopathological/cytological evidences in this difficult to diagnosed EPTB and thereby avoids empirical ATT.
Sujet(s)
Cytoponction sous échoendoscopie , Noeuds lymphatiques , Tuberculose ganglionnaire , Humains , Cytoponction sous échoendoscopie/méthodes , Mâle , Tuberculose ganglionnaire/diagnostic , Tuberculose ganglionnaire/anatomopathologie , Tuberculose ganglionnaire/traitement médicamenteux , Femelle , Études rétrospectives , Adulte , Adulte d'âge moyen , Noeuds lymphatiques/anatomopathologie , Noeuds lymphatiques/imagerie diagnostique , Jeune adulte , Mycobacterium tuberculosis/isolement et purification , Adolescent , Maladies du médiastin/anatomopathologie , Maladies du médiastin/diagnostic , Sujet âgé , Médiastin/anatomopathologieSujet(s)
Cytoponction sous échoendoscopie , Tumeurs de l'estomac , Humains , Cytoponction sous échoendoscopie/méthodes , Tumeurs de l'estomac/imagerie diagnostique , Tumeurs de l'estomac/anatomopathologie , Muqueuse gastrique/anatomopathologie , Muqueuse gastrique/chirurgie , Muqueuse gastrique/imagerie diagnostique , Mâle , Femelle , Gastroscopie/méthodes , Adulte d'âge moyen , Gels , Endosonographie/méthodesRÉSUMÉ
OBJECTIVE: Although EBUS-TBNA combined with EUS-FNA or EUS-B-FNA stands as the primary approach for mediastinal staging in lung cancer, guidelines recommend mediastinoscopy confirmation if a lymph node identified on chest CT or showing increased PET scan uptake yields negativity on these techniques. This study aimed to assess the staging precision of EBUS/EUS. METHODS: We conducted a retrospective study comparing the clinical staging of non-small cell lung cancer patients undergoing EBUS/EUS with their post-surgery pathological staging. We analyzed the influence of histology, location, tumor size, and the time lapse between EBUS and surgery. Patients with N0/N1 staging on EBUS/EUS, undergoing surgery, and with at least one station approached in both procedures were selected. Post-surgery, patients were categorized into N0/N1 and N2 groups. RESULTS: Among the included patients (n = 47), pathological upstaging to N2 occurred in 6 (12.8%). Of these, 4 (66.7%) had a single N2 station, and 2 (33.3%) had multiple N2 stations. The adenopathy most frequently associated with upstaging was station 7. None of the analyzed variables demonstrated a statistically significant difference in the occurrence of upstaging. PET scan indicated increased uptake in only one of these adenopathies, and only one was visualized on chest CT. CONCLUSIONS: Upstaging proved independent of the studied variables, and only 2 patients with negative EBUS/EUS would warrant referral for mediastinoscopy. Exploring other noninvasive methods with even greater sensitivity for detecting micrometastatic lymph node disease is crucial.
Sujet(s)
Carcinome pulmonaire non à petites cellules , Cytoponction sous échoendoscopie , Tumeurs du poumon , Médiastin , Stadification tumorale , Humains , Tumeurs du poumon/anatomopathologie , Tumeurs du poumon/imagerie diagnostique , Carcinome pulmonaire non à petites cellules/anatomopathologie , Carcinome pulmonaire non à petites cellules/imagerie diagnostique , Études rétrospectives , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Médiastin/imagerie diagnostique , Médiastin/anatomopathologie , Médiastinoscopie , Noeuds lymphatiques/anatomopathologie , Noeuds lymphatiques/imagerie diagnostique , Métastase lymphatique/imagerie diagnostique , Métastase lymphatique/anatomopathologie , Reproductibilité des résultats , Adulte , Sujet âgé de 80 ans ou plus , TomodensitométrieRÉSUMÉ
BACKGROUND: Next-generation sequencing (NGS) is essential in treating advanced lung cancer. However, the effectiveness of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) in NGS remains unclear. This study examined the usefulness of EUS-B-FNA in lung cancer NGS cases where EUS-B-FNA was performed for specimen submission in a nationwide genomic screening platform (LC-SCRUM-Asia) and compared specimens collected using other bronchoscopy methods (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and EBUS-guided transbronchial biopsy with a guide sheath [EBUS-GS-TBB]) during the same period. METHODS: We retrospectively compared the NGS success rates of NGS, DNA and RNA yields for EUS-B-FNA, EBUS-TBNA, and EBUS-GS-TBB from the records of the patients recruited for the Lung Cancer Genomic Screening Project for Individualized Medicine (LC-SCRUM)-Asia. RESULTS: Fifty-one patients were enrolled, and the NGS success rates were comparable for samples obtained by EUS-B-FNA, EBUS-TBNA, and EBUS-GS-TBB (100%, 90.9%, and 81.0%, respectively). Genetic alterations were detected in 73.7%, 90.9%, and 85.7% of patients, respectively, with druggable genetic alterations found in 31.6%, 72.7%, and 61.9% of patients, respectively. The DNA and RNA yields were significantly higher in EUS-B-FNA samples than in EBUS-GS-TBB samples (50.4 (interquartile range (IR): 15.45-72.35) ng/µl and 33.9 (IR: 9-76.8) ng/µl from EUS-B-FNA, and 3.3 (IR: 1.4-7.1) ng/µl and 15.1 (IR: 8.3-31.5) ng/µl from EBUS-GS-TBB, respectively, p < 0.05). CONCLUSION: EUS-B-FNA emerges as a promising bronchoscopic method for obtaining adequate samples for NGS in advanced lung cancer cases.
Sujet(s)
Bronchoscopie , Carcinome pulmonaire non à petites cellules , Cytoponction sous échoendoscopie , Séquençage nucléotidique à haut débit , Tumeurs du poumon , Humains , Carcinome pulmonaire non à petites cellules/génétique , Carcinome pulmonaire non à petites cellules/anatomopathologie , Tumeurs du poumon/anatomopathologie , Tumeurs du poumon/génétique , Tumeurs du poumon/imagerie diagnostique , Bronchoscopie/méthodes , Cytoponction sous échoendoscopie/méthodes , Études rétrospectives , Séquençage nucléotidique à haut débit/méthodes , Mâle , Femelle , Sujet âgé , Adulte d'âge moyenRÉSUMÉ
This study aimed to evaluate the diagnostic efficacy of cell block (CB) and liquid-based cytology (LBC) for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic tumors. The study included patients who underwent EUS-FNA for pancreatic tumors between January 2015 and February 2021 and whose cytology samples were both processed for LBC and CB. Data of 390 patients (220 men, mean age: 64.2 ± 11.4 years) were retrospectively analyzed. Of the detected lesions (size: 17-120 mm; mean: 39.9 ± 13.9 mm), 220 (56.4%) were located in the head and uncinate process of the pancreas. Lesions in 339 (86.9%) patients were diagnosed as malignant using CB and/or LBC and suspicious for malignancy in 44 (11.3%) patients. In 7 patients with non-diagnostic (6 cases) or negative for malignancy (1 case) EUS-FNA results using both methods, the diagnosis of malignancy was established via ultrasound-guided percutaneous biopsy. Malignancy was detected in 324 (92.4%), 313 (87.9%), and 298 (87.9%) patients using CB, LBC, and both CB and LBC, respectively. Final diagnosis was obtained in 339 (98%) patients by using CB and/or LBC. The combined use of the both methods exhibited significantly superior diagnostic accuracy compared with CB and LBC alone (P < .001). Liquid-based cytology and CB exhibit high diagnostic accuracy for the detection of pancreatic tumors in patients undergoing EUS-FNA. The combined use of both methods showed a significantly higher diagnostic accuracy than LBC and CB alone.
Sujet(s)
Cytoponction sous échoendoscopie , Tumeurs du pancréas , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Cytoponction sous échoendoscopie/méthodes , Pancréas/anatomopathologie , Pancréas/imagerie diagnostique , Tumeurs du pancréas/diagnostic , Tumeurs du pancréas/anatomopathologie , Études rétrospectives , Sensibilité et spécificité , Biopsie liquide/méthodesRÉSUMÉ
Mucormycosis is an invasive fungal infection that can result in severe lung infections, with pulmonary mucormycosis (PM) being one of the most prevalent manifestations. Prompt diagnosis is crucial for patient survival, as PM often exhibits rapid clinical progression and carries a high fatality rate. Broncho-alveolar lavage fluid or endobronchial biopsy (EBB) has been commonly employed for diagnosing PM, although there is limited mention of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the literature. In this report, we present a case of PM in a patient with diabetes. While EBB did not yield evidence of Rhizopus infection, a definitive diagnosis was obtained through EBUS-TBNA. The patient underwent combination therapy, including oral medication, nebulization, and EBUS-guided intrafocal amphotericin B injection, which resulted in significant improvement following the failure of initial therapy with amphotericin B injection cholesterol sulfate complex. Our case highlights the potential of EBUS-TBNA not only for mediastinal lymphadenopathy but also for obtaining extraluminal lesion specimens. Furthermore, for patients with an inadequate response to mono-therapy and no access to surgical therapy, the addition of EBUS-guided intralesional amphotericin B injection to systemic intravenous therapy may yield unexpected effects.
Sujet(s)
Amphotéricine B , Antifongiques , Cytoponction sous échoendoscopie , Mycoses pulmonaires , Mucormycose , Humains , Amphotéricine B/administration et posologie , Mucormycose/diagnostic , Mucormycose/traitement médicamenteux , Antifongiques/administration et posologie , Mycoses pulmonaires/traitement médicamenteux , Mycoses pulmonaires/diagnostic , Mycoses pulmonaires/microbiologie , Mâle , Résultat thérapeutique , Injections intralésionnelles , Adulte d'âge moyen , BronchoscopieSujet(s)
Tumeurs stromales gastro-intestinales , Tumeurs du foie , Tomographie par émission de positons couplée à la tomodensitométrie , Humains , Tumeurs stromales gastro-intestinales/anatomopathologie , Tumeurs stromales gastro-intestinales/imagerie diagnostique , Tomographie par émission de positons couplée à la tomodensitométrie/méthodes , Tumeurs du foie/anatomopathologie , Tumeurs du foie/imagerie diagnostique , Cytoponction/méthodes , Mâle , Femelle , Adulte d'âge moyen , Cytoponction sous échoendoscopie/méthodes , Sujet âgé , Biopsie guidée par l'image/méthodesRÉSUMÉ
Pancreatic lesions can be solid or cystic and comprise a wide range of benign, premalignant, and malignant entities. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the current primary sampling method for the preoperative diagnosis of pancreatic lesions. Optimal handling of cytology/small tissue specimens is critical to ensure that the often-scant diagnostic material is appropriately utilized for ancillary and/or molecular studies when appropriate. Ultimately, evaluation of EUS-FNA cytology and small biopsy material can provide accurate and timely diagnoses to guide patient management and triage them to surveillance or surgical intervention.
Sujet(s)
Cytoponction sous échoendoscopie , Pancréas , Tumeurs du pancréas , Humains , Cytoponction sous échoendoscopie/méthodes , Tumeurs du pancréas/anatomopathologie , Tumeurs du pancréas/diagnostic , Pancréas/anatomopathologie , Cytoponction/méthodes , Maladies du pancréas/anatomopathologie , Maladies du pancréas/diagnosticRÉSUMÉ
Objective: To evaluate the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) puncture to obtain intrathoracic lymph node samples combined with Xpert MTB/RIF (Xpert) detection for the diagnosis of intrathoracic lymph node tuberculosis. Methods: From March 2018 to June 2021, 106 patients [55 males and 51 females, age (45.1±18.6) years] with suspected intrathoracic lymph node tuberculosis and EBUS-TBNA were collected in Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, including 64 patients with subsequent diagnosis of intrathoracic lymph node tuberculosis and 42 patients without tuberculosis. Xpert test and traditional etiology test were performed on the patients' intrathoracic lymph node puncture specimens. The positive results of different detection methods and different methods were analyzed, and the influencing factors of Xpert independent detection positive were analyzed by univariate and multivariate logistic regression. Results: The sensitivity of Xpert was 65.6% (95%CI: 52.7%-77.1%), the specificity was 97.6% (95%CI: 87.4%-99.9%), the positive predictive value was 97.7% (95%CI: 85.7%-99.7%), the negative predictive value was 65.1% (95%CI: 57.0%-72.4%). The positive rate of Xpert alone (65.6%, 42/64) was not significantly different from that of MGIT960, histopathology and Xpert combined detection (70.3%, 45/64) (P<0.05). Multivariate logistic regression analysis showed that the location of the diseased lymph nodes in the mediastinum (OR=5.84, 95%CI: 1.112-30.704, P=0.037), necrosis in the lymph nodes (OR=6.32, 95%CI: 1.460-27.384, P=0.014), and the axial depth of the lymph nodes≥17 mm (OR=6.61, 95%CI: 1.408-30.969, P=0.017) were the promoting factors for the positive Xpert test. Conclusions: EBUS-TBNA combined with Xpert detection has a high clinical diagnostic value for intrathoracic lymph node tuberculosis. When the number of puncture samples is small, Xpert detection can be preferred. The positive rate of Xpert detection can be improved by selecting lymph nodes with mediastinal lesions, lymph nodes necrosis, and axial lymph nodes depth≥17 mm for puncture.
Sujet(s)
Cytoponction sous échoendoscopie , Noeuds lymphatiques , Sensibilité et spécificité , Tuberculose ganglionnaire , Humains , Mâle , Femelle , Adulte d'âge moyen , Tuberculose ganglionnaire/diagnostic , Noeuds lymphatiques/anatomopathologie , Cytoponction sous échoendoscopie/méthodes , AdulteRÉSUMÉ
Although sequence-based studies show that basal-like features lead to worse prognosis and chemotherapy-resistance compared to the classical subtype in advanced pancreatic ductal adenocarcinoma (PDAC), a surrogate biomarker distinguishing between these subtypes in routine diagnostic practice remains to be identified. We aimed to evaluate the utility of immunohistochemistry (IHC) expression subtypes generated by unsupervised hierarchical clustering based on staining scores of four markers (CK5/6, p63, GATA6, HNF4a) applied to endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) materials. EUS-FNAB materials taken from 190 treatment-naïve advanced PDAC patients were analyzed, and three IHC patterns were established (Classical, Transitional, and Basal-like pattern). Basal-like pattern (high co-expression of CK5/6 and p63 with low expression of GATA6 and HNF4a) was significantly associated with squamous differentiation histology (p < 0.001) and demonstrated the worst overall survival among our cohort (p = 0.004). IHC expression subtype (Transitional, Basal vs Classical) was an independent poor prognosticator in multivariate analysis [HR 1.58 (95% CI 1.01-2.38), p = 0.047]. Furthermore, CK5/6 expression was an independent poor prognostic factor in histological glandular type PDAC [HR 2.82 (95% CI 1.31-6.08), p = 0.008]. Our results suggest that IHC expression patterns successfully predict molecular features indicative of the Basal-like subgroup in advanced PDAC. These results provide the basis for appropriate stratification for therapeutic selection and prognostic estimation of advanced PDAC in a simplified manner.
Sujet(s)
Marqueurs biologiques tumoraux , Carcinome du canal pancréatique , Facteur de transcription GATA-6 , Facteur nucléaire hépatocytaire HNF-4 , Immunohistochimie , Tumeurs du pancréas , Humains , Facteur de transcription GATA-6/métabolisme , Facteur de transcription GATA-6/génétique , Carcinome du canal pancréatique/métabolisme , Carcinome du canal pancréatique/anatomopathologie , Carcinome du canal pancréatique/génétique , Carcinome du canal pancréatique/mortalité , Mâle , Femelle , Facteur nucléaire hépatocytaire HNF-4/métabolisme , Facteur nucléaire hépatocytaire HNF-4/génétique , Sujet âgé , Marqueurs biologiques tumoraux/métabolisme , Adulte d'âge moyen , Tumeurs du pancréas/métabolisme , Tumeurs du pancréas/anatomopathologie , Tumeurs du pancréas/mortalité , Tumeurs du pancréas/génétique , Pronostic , Kératine-5/métabolisme , Kératine-6/métabolisme , Sujet âgé de 80 ans ou plus , Adulte , Cytoponction sous échoendoscopie , Facteurs de transcription , Protéines suppresseurs de tumeursSujet(s)
Cytoponction sous échoendoscopie , Tumeur glomique , Tumeurs du pancréas , Humains , Cytoponction sous échoendoscopie/méthodes , Tumeurs du pancréas/anatomopathologie , Tumeurs du pancréas/imagerie diagnostique , Tumeur glomique/anatomopathologie , Tumeur glomique/imagerie diagnostique , Tumeur glomique/diagnostic , Mâle , FemelleRÉSUMÉ
The role and risks of pre-operative endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound with fine needle aspiration (EUS/FNA), in patients undergoing robotic pancreaticoduodenectomy are not well-defined despite a broad consensus on the utility of these interventions for diagnostic and therapeutic purposes prior to major pancreatic operations. This study investigates the impact of such preoperative endoscopic interventions on perioperative outcomes in robotic pancreaticoduodenectomy. With Institutional Review Board (IRB) approval we retrospectively analyzed 772 patients who underwent robotic pancreatectomies between 2012 and 2023. Specifically, 430 of these patients underwent a robotic pancreaticoduodenectomy were prospectively evaluated: 93 (22%) patients underwent ERCP with EUS and FNA, 45 (10%) ERCP only, and 31 (7%) EUS and FNA, while 261 (61%) did not. Statistical analyses were performed using chi-square tests and Student's t-tests to compare perioperative outcomes between the two cohorts. Statistically significant differences were observed in patients who underwent a pre-operative endoscopic intervention and were more likely to have converted to an open operation (p = 0.04). The average number of harvested lymph nodes for patients who underwent preoperative endoscopic intervention was statistically significant compared to those who did not (p = 0.0001). All other perioperative variables were consistent across all cohorts. Patients who underwent endoscopic intervention before robotic pancreaticoduodenectomy were more likely to have an unplanned open operation. This study demonstrates the increased operative difficulties introduced by preoperative endoscopic interventions. Although there was no impact on overall patient outcomes, surgeons' experience can minimize the associated risks.
Sujet(s)
Cholangiopancréatographie rétrograde endoscopique , Duodénopancréatectomie , Soins préopératoires , Interventions chirurgicales robotisées , Humains , Duodénopancréatectomie/méthodes , Interventions chirurgicales robotisées/méthodes , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Études rétrospectives , Résultat thérapeutique , Soins préopératoires/méthodes , Cholangiopancréatographie rétrograde endoscopique/méthodes , Cytoponction sous échoendoscopie/méthodes , Tumeurs du pancréas/chirurgieRÉSUMÉ
OBJECTIVE: To assess both solid and cystic pancreatic lesions using endoscopic ultrasound (EUS), and the effect of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in patient management. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Gastroenterology, Division of Internal Diseases, Sivas Cumhuriyet University Hospital, Sivas, Turkiye, from January 2018 to 2022. METHODOLOGY: Patients with pancreatic mass, who underwent EUS-FNA were inducted in the study. EUS-FNA was performed using a 22-gauge needle via both transgastric and transduodenal routes. The size of the pancreatic lesion, its location, and whether there was SMA or CA invasion were evaluated on CT and EUS scans. Biopsy results of 64 patients who received EUS-FNA due to pancreatic lesions were considered. The results were divided into malignancy or benign pathology. RESULTS: A total of 64 cases were compared. Crosstable Chi-square analysis showed a statistically significant difference between CT and EUS (p <0.001). EUS-FNA results revealed that out of the 64 patients with pancreatic mass detected in EUS, 46 had adenocarcinoma, 7 were negative for malignancy, 4 had intraductal papillary mucinous neoplasia (IPMN), 3 had neuroendocrine tumour (NET), 2 had lymphoma, and 2 had solid pseudopapillary neoplasia (SPN). In the 2-year follow-up of the seven patients who were negative for malignancy in EUS-FNA, there were no clinical, laboratory or imaging findings indicating pancreatic malignancy or distant metastasis. CONCLUSION: Tissue sampling through EUS-FNA has minimal side effects and remains useful in managing preoperative patients with resectable or suspicious pancreatic masses. KEY WORDS: Pancreatic cancer, Abdominal CT, Endoscopic ultrasound (EUS), Ultrasound-guided fine-needle aspiration (EUS-FNA).
Sujet(s)
Cytoponction sous échoendoscopie , Tumeurs du pancréas , Humains , Cytoponction sous échoendoscopie/méthodes , Tumeurs du pancréas/anatomopathologie , Tumeurs du pancréas/imagerie diagnostique , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Adulte , Pancréas/anatomopathologie , Endosonographie/méthodes , TomodensitométrieRÉSUMÉ
INTRODUCTION: The role of Xpert Ultra in bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for pulmonary and mediastinal lymph node tuberculosis (TB) remains unclear. METHODS: This was a retrospective observational service evaluation at a tertiary TB centre in a low-incidence setting. The diagnostic indices of Xpert Ultra, smear and culture (with cytology for EBUS-TBNA samples) were compared with culture positivity or a composite reference standard of clinical TB diagnosis. Trace readouts, a new category of results for Xpert Ultra indicating low bacillary load, were analysed in two ways as a true positive or true negative result. 282 BAL and 139 EBUS-TBNA samples were included in the analysis. RESULTS: BAL: sensitivity with 95% CI against culture-confirmed pulmonary TB from BAL samples for Xpert Ultra (trace as positive) was 0.91 (0.82 to 0.98), Xpert Ultra (trace as negative) was 0.76 (0.69 to 0.83), smear was 0.38 (p=0.0009) and culture was 1.00 (0.91 to 1.00). Specificities for all the tests were ≥0.99 (0.98 to 1.00). The addition of smear to Xpert Ultra did not improve the diagnostic accuracy.EBUS-TBNA: sensitivity against culture-confirmed TB from EBUS-TBNA samples for Xpert Ultra (trace as positive) was 0.71 (0.63 to 0.78), Xpert Ultra (trace as negative) was 0.59 (0.54 to 0.63), smear was 0.12 (p=0.002), culture was 1.00 (0.89 to 1.00), cytology was 0.87 (0.76 to 0.98) and rapid on-site evaluation of cytology (ROSE) was 0.92 (0.78 to 1.00). Specificities were 0.99 (0.97 to 1.00), 0.99 (0.97 to 1.00), 1.00 (0.98 to 1.00), 1.00 (0.98 to 1.00), 0.67 (0.67 to 0.68) and 0.42, respectively. CONCLUSION: Xpert Ultra had a significantly higher sensitivity compared with smear in both BAL and EBUS-TBNA samples. Xpert Ultra had a lower sensitivity compared with culture but comparable specificity with results being available within <24 hours. Trace readings in our low-incidence setting were associated with culture positivity in all BAL samples.
Sujet(s)
Liquide de lavage bronchoalvéolaire , Cytoponction sous échoendoscopie , Tuberculose ganglionnaire , Tuberculose pulmonaire , Humains , Études rétrospectives , Tuberculose ganglionnaire/diagnostic , Tuberculose ganglionnaire/microbiologie , Tuberculose ganglionnaire/anatomopathologie , Mâle , Femelle , Tuberculose pulmonaire/diagnostic , Tuberculose pulmonaire/microbiologie , Adulte d'âge moyen , Liquide de lavage bronchoalvéolaire/microbiologie , Liquide de lavage bronchoalvéolaire/cytologie , Adulte , Médiastin/microbiologie , Sensibilité et spécificité , Mycobacterium tuberculosis/isolement et purification , Mycobacterium tuberculosis/génétique , Réaction de polymérisation en chaîne/méthodes , Noeuds lymphatiques/anatomopathologie , Noeuds lymphatiques/microbiologie , Sujet âgéSujet(s)
Cytoponction sous échoendoscopie , Transplantation hépatique , Humains , Transplantation hépatique/effets indésirables , Cytoponction sous échoendoscopie/méthodes , Mâle , Tumeurs du médiastin/imagerie diagnostique , Tumeurs du médiastin/anatomopathologie , Tumeurs du médiastin/chirurgie , Endosonographie/méthodes , Médiastin , Femelle , Biopsie guidée par l'image/méthodesRÉSUMÉ
BACKGROUND AND AIMS: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is an important diagnostic tool for suspected parenchymal lesions in the gastrointestinal tract and adjacent organs. Our study aimed to evaluate the safety and effectiveness of EUS-FNA in focal liver lesions (FLLs). METHOD: Data from 88 patients diagnosed with FLLs by imaging who underwent EUS-FNA from 1 January 2017 to 31 August 2022 were reviewed in our retrospective study at the Second Affiliated Hospital of Soochow University and Ruijin Hospital of the School of Medicine of Shanghai Jiao Tong University. The EUS-FNA biopsy results were compared with the final diagnosis to evaluate diagnostic value. The relevant factors were analysed to determine their influence on EUS-FNA biopsy results. RESULTS: The 88 patients analysed in this study resulted in a final diagnosis of 86 malignant and two benign cases. The overall diagnostic accuracy of EUS-FNA in FLLs was 93.18 % (82/88; 95 % Confidence Interval [CI], 87.9-98.5), with a sensitivity, specificity, positive predictive value, and negative predictive value of 93.02 % (80/86; 95 %CI, 87.6-98.4), 100 % (2/2; 95 %CI, 100-100), 100 % (80/80; 95 %CI, 100-100), and 25 % (2/8; 95 %CI, -5-55.0), respectively. The parameters related to lesion and procedure were not significantly different between these two groups (p > 0.05). The number of puncture needles in the groups showed a statistically significant difference between multiple and single punctures (p = 0.001). CONCLUSION: Our data revealed that EUS-FNA is a safe and reliable diagnostic method for FLLs that shows high accuracy.
Sujet(s)
Cytoponction sous échoendoscopie , Tumeurs du foie , Humains , Mâle , Adulte d'âge moyen , Femelle , Études rétrospectives , Sujet âgé , Adulte , Tumeurs du foie/anatomopathologie , Tumeurs du foie/diagnostic , Tumeurs du foie/imagerie diagnostique , Sensibilité et spécificité , Sujet âgé de 80 ans ou plus , Valeur prédictive des tests , Maladies du foie/anatomopathologie , Maladies du foie/diagnostic , Maladies du foie/imagerie diagnostiqueRÉSUMÉ
INTRODUCTION: Lymph node fine-needle aspiration cytology (LN-FNAC) is a common, rapid, minimally invasive and cost-effective diagnostic method. For mediastinal lymph nodes, endobronchial ultrasound (EBUS) guided LN-FNAC is a first-line investigation and has an indispensable role in the diagnosis and staging of patients with suspected lung cancer. Recently, a new WHO system has been proposed for classification of LN-FNAC heralding five different diagnostic categories; insufficient, benign, atypical, suspicious for malignancy and malignant. The aim of this study was to evaluate the diagnostic accuracy and risk of malignancy (ROM) of these categories in EBUS-guided LN-FNAC from mediastinal lymph nodes. METHOD: We evaluated 2110 consecutive mediastinal lymph nodes during this one-year retrospective study. Corresponding radiological images and histologic material were used as ground truth to calculate accuracy, sensitivity, specificity and ROM. RESULTS: The WHO system showed an overall accuracy of 93.7% with a sensitivity of 83.0% and a specificity of 97.5%. The positive predictive value was 92.3% and the negative predictive value 94.2%. The overall ROM for each category in the WHO classification system was 12.8% for the inadequate, 2.4% for the benign, 47.4% for the atypical, 81.0% for the suspicious for malignancy and 93.6% for the malignant category. CONCLUSION: The results of the present study indicate that the new WHO system entails a high diagnostic accuracy regarding EBUS-guided LN-FNAC assessment of mediastinal lymph nodes and supports its integration into clinical practice. Application of the WHO system standardizes risk assessment thus facilitating communication between cytopathologists and clinicians and minimizes the need for histopathological analysis.
Sujet(s)
Cytoponction sous échoendoscopie , Noeuds lymphatiques , Lymphadénopathie , Médiastin , Humains , Cytoponction sous échoendoscopie/méthodes , Lymphadénopathie/anatomopathologie , Lymphadénopathie/diagnostic , Lymphadénopathie/imagerie diagnostique , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Médiastin/anatomopathologie , Médiastin/imagerie diagnostique , Noeuds lymphatiques/anatomopathologie , Noeuds lymphatiques/imagerie diagnostique , Études rétrospectives , Adulte , Organisation mondiale de la santé , Sujet âgé de 80 ans ou plus , Sensibilité et spécificité , Tumeurs du poumon/anatomopathologie , Tumeurs du poumon/imagerie diagnostique , Tumeurs du poumon/diagnosticRÉSUMÉ
We report two patients with pancreatic tophaceous gout diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of presumed cystic mass lesions. The first case involved a patient who had a recent episode of acute pancreatitis 6 months prior, with subsequent imaging concerning for a pseudocyst or mass lesion. The second case involved a patient with epigastric pain associated with a pancreatic head cystic mass and an erroneous original diagnosis of a mucinous pancreatic neoplasm on EUS-FNA. Diff-Quik stained direct smears on fresh material obtained from EUS-FNA of the lesions showed chalky debris with needle shaped negatively birefringent crystals consistent with gout. For the first case, the chalky material was not present on the H&E stained paraffin embedded formalin fixed cellblock slides. The importance of inclusion of cytologic specimen preparations to examine monosodium urate crystals is emphasized.