BOOK
EUS-Guided Tissue Acquisition, An Issue of Gastrointestinal Endoscopy Clinics, E-Book
Shyam Varadarajulu | Robert H. Hawes
(2014)
Additional Information
Book Details
Abstract
This issue should serve as a primer to endoscopists who are seeking state-of-the-art clinical guidance on endoscopic ultrasound tissue acquisition. Authors address the changing paradigm in EUS-guided tissue acquisition and when does the oncologist require core tissue? Articles offer a comprehensive look at the core topics, including definitions in tissue acquisition, selection of FNA needles, and techniques for EUS-guides FNA and FNB. Expert authors also give their recommendations for overcoming technical challenges in EUS-guided tissue acquisition and what the pitfalls are. Readers will have a full understanding of EUS-guided tissue acquisition as well as the future directions
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Comprehensive Primeron EUS-Guided Tissue Acquisition\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | v | ||
| Gastrointestinal Endoscopy Clinics Of North America\r | viii | ||
| Foreword\r | ix | ||
| Preface\r | xi | ||
| The Changing Paradigm in EUS-Guided Tissue Acquisition | 1 | ||
| Key points | 1 | ||
| Limitations of EUS-guided FNA cytology | 2 | ||
| On-site Cytopathology Support | 2 | ||
| Pitfalls in EUS-FNA Cytology | 3 | ||
| Assessment for Molecular Markers | 3 | ||
| The future of EUS-guided tissue acquisition | 4 | ||
| References | 5 | ||
| Beyond Cytology | 9 | ||
| Key points | 9 | ||
| Introduction | 9 | ||
| Diagnosis of pancreatic and periampullary tumors | 10 | ||
| Diagnosis and characterization of GIST and retroperitoneal soft tissue sarcomas | 11 | ||
| Diagnosis of deep-seated lymphomas | 12 | ||
| Staging lymphatic spread of upper GI, pancreatic, and biliary tumors | 12 | ||
| Molecular profiling of tumors | 12 | ||
| Complications and concerns | 13 | ||
| Summary | 14 | ||
| References | 14 | ||
| Definitions in Tissue Acquisition | 19 | ||
| Key points | 19 | ||
| Introduction | 19 | ||
| Sample acquisition | 20 | ||
| Fine-Needle Aspiration | 20 | ||
| Core-Needle Biopsy | 20 | ||
| Key Features: Sample Acquisition | 21 | ||
| Handling a cytology sample | 21 | ||
| Handling of Cytology Samples | 21 | ||
| Appropriate fixation | 21 | ||
| Wet fixation | 21 | ||
| Dry fixation | 21 | ||
| Appropriate number of slides | 21 | ||
| Appropriate handling of excess blood | 22 | ||
| Potential Pitfalls | 22 | ||
| Liquid-Based Technologies | 22 | ||
| Staining | 23 | ||
| Romanowsky stains | 23 | ||
| Papanicolaou stain | 24 | ||
| Key Features: Handling of Cytology Samples | 24 | ||
| Handling a histology sample | 24 | ||
| Cell Blocks | 24 | ||
| Key Features: Handling of Histology Samples | 25 | ||
| Telepathology and telecytology | 25 | ||
| Telepathology | 25 | ||
| Virtual slides using whole-slide scanning | 25 | ||
| Real-time telepathology systems | 26 | ||
| Key Features: Telepathology and Telecytology | 26 | ||
| References | 26 | ||
| How Can an Endosonographer Assess for Diagnostic Sufficiency and Options for Handling the Endoscopic Ultrasound-Guided Fine ... | 29 | ||
| Key points | 29 | ||
| Introduction | 29 | ||
| FNA prerequisites | 30 | ||
| On-Site Evaluation | 30 | ||
| Deferring to Laboratory Evaluation | 30 | ||
| Support Staff | 31 | ||
| Supplies Needed | 31 | ||
| Ancillary Studies and Processing | 32 | ||
| Immunocytochemistry | 32 | ||
| Microbiology | 32 | ||
| Flow cytometry | 33 | ||
| Cell block | 33 | ||
| Molecular testing | 33 | ||
| Preparation and processing | 33 | ||
| Glass Slides | 34 | ||
| Direct Smears | 34 | ||
| The snail | 34 | ||
| The ape | 34 | ||
| Direct Smear Technique | 34 | ||
| Materials for Ancillary Testing | 35 | ||
| Carrying solutions | 35 | ||
| Assessment | 37 | ||
| Technique/Procedure | 37 | ||
| Adequacy assessment (quantity and quality of material) | 37 | ||
| Visual inspection of smears | 38 | ||
| Visual inspection of collected fluid | 38 | ||
| Liquids | 38 | ||
| Semisolid aspirate (the worm) | 39 | ||
| Options for Handling | 39 | ||
| Needle rinsing | 39 | ||
| Direct smears | 40 | ||
| Handling bloody or excessive specimens | 40 | ||
| Handling mucoid specimens | 41 | ||
| Postaspiration protocol | 42 | ||
| On-Site Evaluation | 43 | ||
| Presence of a cytopathologist | 43 | ||
| Self-assessment | 43 | ||
| Benign and normal findings | 43 | ||
| Benign duodenal epithelial cells | 43 | ||
| Benign gastric epithelium | 44 | ||
| Benign pancreatic acini | 44 | ||
| Benign pancreatic ductal cells | 44 | ||
| Chronic pancreatitis | 44 | ||
| Reactive lymph node | 44 | ||
| Benign squamous epithelium | 44 | ||
| Pseudocyst | 47 | ||
| Acute inflammation of bile duct | 47 | ||
| Common lesions | 47 | ||
| Non-Hodgkin B-cell lymphoma | 47 | ||
| Intraductal papillary mucinous neoplasm | 48 | ||
| Serous cystadenoma | 48 | ||
| Pancreatic endocrine neoplasm | 48 | ||
| Solid pseudopapillary tumor | 50 | ||
| Signet-ring carcinoma | 50 | ||
| Ductal adenocarcinoma | 50 | ||
| Metastatic carcinoma | 54 | ||
| Gastrointestinal stromal tumor | 54 | ||
| Bile-duct adenocarcinoma | 54 | ||
| Summary | 54 | ||
| References | 54 | ||
| Endoscopic Ultrasound-Guided Fine-Needle Aspiration Needles | 57 | ||
| Key points | 57 | ||
| Introduction | 57 | ||
| Size of needle | 58 | ||
| Sampling methods and technical factors | 60 | ||
| Site of the lesion | 61 | ||
| Type of the specimen | 63 | ||
| Complications rate | 65 | ||
| Summary | 66 | ||
| Supplementary data | 66 | ||
| References | 66 | ||
| Techniques for EUS-guided FNA Cytology | 71 | ||
| Key points | 71 | ||
| Introduction | 71 | ||
| Cytology: advantages, limitations | 71 | ||
| Indications/contraindications | 72 | ||
| The basic EUS-FNA technique | 73 | ||
| Identify and Characterize the Lesion | 73 | ||
| Assess the Indication and Rule out Contraindications for EUS-FNA | 73 | ||
| Position the Echoendoscope (as Straight as Possible) | 74 | ||
| Select the Appropriate Needle | 74 | ||
| Insert the Needle into the Scope | 74 | ||
| Position the Lesion in the Needle Path | 75 | ||
| Puncture the Lesion and Move the Needle Within the Lesion | 78 | ||
| Withdraw the Needle | 80 | ||
| Process the Aspirate | 80 | ||
| Prepare the Needle for Subsequent Passes | 80 | ||
| Potential modifications to the basic technique: stylet, suction | 81 | ||
| Summary | 81 | ||
| References | 81 | ||
| Techniques for Endoscopic Ultrasound-Guided Fine-Needle Biopsy | 83 | ||
| Key points | 83 | ||
| Introduction | 83 | ||
| EUS-guided Tru-Cut biopsy | 84 | ||
| Background | 84 | ||
| Design and Technique | 84 | ||
| Results | 86 | ||
| EUS-FNB using a standard 22-gauge needle | 87 | ||
| Background | 87 | ||
| Design and Technique | 90 | ||
| Results | 90 | ||
| EUS-FNB using a standard 19-gauge needle | 92 | ||
| Background | 92 | ||
| EUS-FNTA Technique | 92 | ||
| Results | 93 | ||
| EUS-FNB using ProCore needles | 98 | ||
| Introduction | 98 | ||
| Design and Technique | 98 | ||
| Results | 101 | ||
| Summary and future perspective | 102 | ||
| References | 102 | ||
| Tips to Overcome Technical Challenges in EUS-guided Tissue Acquisition | 109 | ||
| Key points | 109 | ||
| Background | 109 | ||
| Problems related to the lesion and its surroundings | 110 | ||
| Difficult Location of Lesions | 110 | ||
| Characteristics of Lesions | 110 | ||
| Impaired Passage or Altered Anatomy | 111 | ||
| Problems related to endoscope and needle | 112 | ||
| Inadequate EUS Imaging | 112 | ||
| Choice of Needle | 113 | ||
| Choice of Biopsy Method | 115 | ||
| Technical Challenges During Biopsy | 117 | ||
| References | 118 | ||
| Pitfalls in EUS FNA | 125 | ||
| Key points | 125 | ||
| Introduction | 125 | ||
| Preprocedural pitfalls | 125 | ||
| Failure to Establish Clinical and Procedural Goals | 125 | ||
| Failure to Obtain a Thorough Informed Consent | 126 | ||
| Failure to Review Noninvasive Imaging and Laboratory Test Results | 126 | ||
| Insufficient Training or Experience | 127 | ||
| Intraprocedural pitfalls | 127 | ||
| Inability to Access the Target Lesion | 127 | ||
| Failure to Obtain FNAs in an Algorithmic Manner | 129 | ||
| Lesion Characteristics that Contribute to a Difficult FNA | 129 | ||
| Echoendoscope position | 129 | ||
| Lesion size | 130 | ||
| Lesion consistency | 130 | ||
| Incorrect Specimen Handling and Preparation | 130 | ||
| Poor Endosonographer and Cytopathologist Communication | 131 | ||
| Incorrect or Misleading On-site Cytopathology Review | 131 | ||
| Incorrect or Misleading Final Cytopathology Review | 131 | ||
| Diagnostic Challenges by Site | 133 | ||
| Failure to Use Ancillary Techniques | 133 | ||
| Postprocedural pitfalls | 136 | ||
| Suboptimal Timing for Conveying the Results of EUS FNA | 136 | ||
| Poor Understanding of Staging Criteria of Malignancy | 137 | ||
| Poor Understanding of Cytologic Interpretation | 137 | ||
| Summary | 138 | ||
| References | 138 | ||
| Future Directions in EUS-guided Tissue Acquisition | 143 | ||
| Key points | 143 | ||
| Introduction | 143 | ||
| Improvement of sampling and sample processing | 144 | ||
| Need for new needles | 145 | ||
| Optical biopsy rather than tissue acquisition? | 145 | ||
| What about molecular testing? | 146 | ||
| EUS elastography: good example of a facilitating ancillary technique | 146 | ||
| Summary | 147 | ||
| References | 147 | ||
| Index | 151 |