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10 pages, 857 KiB

Open AccessArticle

Comparison of 22G Fork-Tip and Franseen Needles and Usefulness of Contrast-Enhanced Endoscopic Ultrasound for Diagnosis of Upper Gastrointestinal Subepithelial Lesions

by Yasunobu Yamashita, Reiko Ashida, Hirofumi Yamazaki, Yuki Kawaji, Toshio Shimokawa, Takashi Tamura, Keiichi Hatamaru, Masahiro Itonaga and Masayuki Kitano

Diagnostics 2022, 12(12), 3122; https://doi.org/10.3390/diagnostics12123122 - 11 Dec 2022

Cited by 5 | Viewed by 1195

Abstract

Endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) is less accurate in obtaining samples from gastrointestinal subepithelial lesions (SELs) ≤2 cm than from pancreatic cancers. The present study compared the usefulness of 22G Fork-tip and Franseen needles for EUS-TA and assessed the ability of contrast-enhanced [...] Read more.

Endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) is less accurate in obtaining samples from gastrointestinal subepithelial lesions (SELs) ≤2 cm than from pancreatic cancers. The present study compared the usefulness of 22G Fork-tip and Franseen needles for EUS-TA and assessed the ability of contrast-enhanced harmonic EUS (CH-EUS) to diagnose SELs ≤2 cm. Fifty-seven patients who underwent EUS-TA for SELs ≤2 cm were evaluated. The primary endpoint was to compare the rate of acquisition of sufficient samples by these two needles. Secondary endpoints included technical success rate, adverse events, numbers of needle passes, and diagnostic ability of CH-EUS for SELs. Of the 57 included patients, 23 and 34 underwent EUS-TA with Fork-tip and Franseen needles, respectively. Technical success rates were 100% with both needles and adverse events occurred in zero (0%) and one (2.9%) patient with Fork-tip and Franseen needles, respectively. The rate of adequate sample acquisition was significantly higher using Fork-tip than Franseen needles (96% vs. 74%; p = 0.038). The hyper- or iso-vascular pattern on CH-EUS correlated significantly with a diagnosis of gastrointestinal stromal tumor (p < 0.001). EUS-TA with Fork-tip needles were superior to EUS-TA with Franseen needles in acquiring sufficient samples and CH-EUS was also useful for the diagnosis of SELs ≤2 cm. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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10 pages, 4297 KiB

Open AccessArticle

Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy for Histological Diagnosis of Type 2 Autoimmune Pancreatitis

by Hidehiro Hayashi, Shin Miura, Fumiyoshi Fujishima, Shimpei Kuniyoshi, Kiyoshi Kume, Kazuhiro Kikuta, Shin Hamada, Tetsuya Takikawa, Ryotaro Matsumoto, Mio Ikeda, Takanori Sano, Fumiya Kataoka, Akira Sasaki, Misako Sakano and Atsushi Masamune

Diagnostics 2022, 12(10), 2464; https://doi.org/10.3390/diagnostics12102464 - 12 Oct 2022

Cited by 6 | Viewed by 1342

Abstract

In Japan, type 1 autoimmune pancreatitis (AIP) is the most common type of AIP; type 2 AIP is rare. The aim of this study was to clarify the usefulness of endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNAB) for the diagnosis of type 2 [...] Read more.

In Japan, type 1 autoimmune pancreatitis (AIP) is the most common type of AIP; type 2 AIP is rare. The aim of this study was to clarify the usefulness of endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNAB) for the diagnosis of type 2 AIP. We analyzed the tissue specimens of 10 patients with suspected type 2 AIP who underwent EUS-FNAB at our hospital between April 2009 and March 2021 for tissue volume and histopathological diagnostic performance. The male-to-female ratio of the patients was 8:2, and the patient age (mean ± standard deviation) was 35.6 ± 15.5 years. EUS-FNAB provided sufficient tissue volume, with high-power field >10 in eight patients (80.0%). Based on the International Consensus Diagnostic Criteria (ICDC), four patients (40.0%) had histological findings corresponding to ICDC level 1, and five patients (50.0%) had histological findings corresponding to ICDC level 2. The results of this study show that EUS-FNB can be considered an alternative method to resection and core-needle biopsy for the collection of tissue samples of type 2 AIP. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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10 pages, 805 KiB

Open AccessArticle

Franseen Needles May Be Promising for Improving the Sampling Adequacy of EUS-FNA for Subepithelial Lesions

by Noriki Kasuga, Yusuke Kurita, Emiko Tanida, Shin Yagi, Ko Suzuki, Sho Hasegawa, Takamitsu Sato, Kunihiro Hosono, Shingo Kato, Yusuke Sekino, Noritoshi Kobayashi, Itaru Endo, Kensuke Kubota and Atsushi Nakajima

Diagnostics 2022, 12(7), 1667; https://doi.org/10.3390/diagnostics12071667 - 09 Jul 2022

Viewed by 2007

Abstract

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for [...] Read more.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for SELs with Franseen needles. This retrospective study enrolled 130 patients who underwent EUS-FNA with a 22-gauge needle for SELs from January 2010 to March 2021. We compared sampling adequacy and predictive factors influencing the sampling adequacy of EUS-FNA for SELs between Franseen and conventional needles. The sampling adequacy rates were 95.0% (38/40) with Franseen needles and 76.7% (69/90) with conventional needles (p = 0.011). The mean number of punctures with Franseen needles (2.80) was significantly less than that with conventional needles (3.42) (p < 0.001). In the multivariate analysis, the use of Franseen needles (p = 0.029; odds ratio [OR], 5.37; 95% confidence interval [CI], 1.18–23.36) was an independent factor influencing the sampling adequacy. Compared to conventional needles, the Franseen needle could play a vital role in accurately diagnosing SELs by yielding better sampling adequacy and reducing the number of passes. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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11 pages, 12711 KiB

Open AccessArticle

Development of “Mathematical Technology for Cytopathology,” an Image Analysis Algorithm for Pancreatic Cancer

by Reiko Yamada, Kazuaki Nakane, Noriyuki Kadoya, Chise Matsuda, Hiroshi Imai, Junya Tsuboi, Yasuhiko Hamada, Kyosuke Tanaka, Isao Tawara and Hayato Nakagawa

Diagnostics 2022, 12(5), 1149; https://doi.org/10.3390/diagnostics12051149 - 05 May 2022

Cited by 2 | Viewed by 1683

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related death worldwide. The accuracy of a PDAC diagnosis based on endoscopic ultrasonography-guided fine-needle aspiration cytology can be strengthened by performing a rapid on-site evaluation (ROSE). However, ROSE can only be performed in a [...] Read more.

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related death worldwide. The accuracy of a PDAC diagnosis based on endoscopic ultrasonography-guided fine-needle aspiration cytology can be strengthened by performing a rapid on-site evaluation (ROSE). However, ROSE can only be performed in a limited number of facilities, due to a relative lack of available resources or cytologists with sufficient training. Therefore, we developed the Mathematical Technology for Cytopathology (MTC) algorithm, which does not require teaching data or large-scale computing. We applied the MTC algorithm to support the cytological diagnosis of pancreatic cancer tissues, by converting medical images into structured data, which rendered them suitable for artificial intelligence (AI) analysis. Using this approach, we successfully clarified ambiguous cell boundaries by solving a reaction–diffusion system and quantitating the cell nucleus status. A diffusion coefficient (D) of 150 showed the highest accuracy (i.e., 74%), based on a univariate analysis. A multivariate analysis was performed using 120 combinations of evaluation indices, and the highest accuracies for each D value studied (50, 100, and 150) were all ≥70%. Thus, our findings indicate that MTC can help distinguish between adenocarcinoma and benign pancreatic tissues, and imply its potential for facilitating rapid progress in clinical diagnostic applications. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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13 pages, 2850 KiB

Open AccessArticle

Development of a Novel Evaluation Method for Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Pancreatic Diseases Using Artificial Intelligence

by Takuya Ishikawa, Masato Hayakawa, Hirotaka Suzuki, Eizaburo Ohno, Yasuyuki Mizutani, Tadashi Iida, Mitsuhiro Fujishiro, Hiroki Kawashima and Kazuhiro Hotta

Diagnostics 2022, 12(2), 434; https://doi.org/10.3390/diagnostics12020434 - 08 Feb 2022

Cited by 9 | Viewed by 2055

Abstract

We aimed to develop a new artificial intelligence (AI)-based method for evaluating endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) specimens in pancreatic diseases using deep learning and contrastive learning. We analysed a total of 173 specimens from 96 patients who underwent EUS-FNB with a 22 [...] Read more.

We aimed to develop a new artificial intelligence (AI)-based method for evaluating endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) specimens in pancreatic diseases using deep learning and contrastive learning. We analysed a total of 173 specimens from 96 patients who underwent EUS-FNB with a 22 G Franseen needle for pancreatic diseases. In the initial study, the deep learning method based on stereomicroscopic images of 98 EUS-FNB specimens from 63 patients showed an accuracy of 71.8% for predicting the histological diagnosis, which was lower than that of macroscopic on-site evaluation (MOSE) performed by EUS experts (81.6%). Then, we used image analysis software to mark the core tissues in the photomicrographs of EUS-FNB specimens after haematoxylin and eosin staining and verified whether the diagnostic performance could be improved by applying contrastive learning for the features of the stereomicroscopic images and stained images. The sensitivity, specificity, and accuracy of MOSE were 88.97%, 53.5%, and 83.24%, respectively, while those of the AI-based diagnostic method using contrastive learning were 90.34%, 53.5%, and 84.39%, respectively. The AI-based evaluation method using contrastive learning was comparable to MOSE performed by EUS experts and can be a novel objective evaluation method for EUS-FNB. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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14 pages, 2820 KiB

Open AccessArticle

A New Preoperative Scoring System for Predicting Aggressiveness of Non-Functioning Pancreatic Neuroendocrine Neoplasms

by Tetsuya Takikawa, Kazuhiro Kikuta, Shin Hamada, Kiyoshi Kume, Shin Miura, Naoki Yoshida, Yu Tanaka, Ryotaro Matsumoto, Mio Ikeda, Fumiya Kataoka, Akira Sasaki, Hidehiro Hayashi, Waku Hatta, Yohei Ogata, Kei Nakagawa, Michiaki Unno and Atsushi Masamune

Diagnostics 2022, 12(2), 397; https://doi.org/10.3390/diagnostics12020397 - 03 Feb 2022

Cited by 3 | Viewed by 1378

Abstract

The management of non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs) is still controversial. This study aimed to develop a new scoring system for treatment decisions at initial diagnosis based on the identification of the predictive factors for aggressive NF-PanNENs. Seventy-seven patients who had been pathologically [...] Read more.

The management of non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs) is still controversial. This study aimed to develop a new scoring system for treatment decisions at initial diagnosis based on the identification of the predictive factors for aggressive NF-PanNENs. Seventy-seven patients who had been pathologically diagnosed with NF-PanNENs were enrolled. We retrospectively reviewed 13 variables that could be assessed preoperatively. Univariate and multivariate stepwise logistic regression analyses were performed to identify factors for the aggressiveness of NF-PanNENs, and a scoring system was developed by assigning weighted points proportional to their β regression coefficient. Tumor size > 20 mm on contrast-enhanced computed tomography, tumor non-vascularity, and Ki-67 labeling index ≥5% on endoscopic ultrasound-guided fine-needle aspiration specimens were identified as independent factors for predicting the aggressiveness of NF-PanNENs. The new scoring system, developed using the identified factors, had an excellent discrimination ability, with area under the curve of 0.92 (95% CI, 0.85–0.99), and good calibration (p = 0.72, Hosmer-Lemeshow test). Ten-year overall survival rates in low-risk (0 point), intermediate-risk (1 to 2 points), and high-risk (3 to 4 points) groups were 100%, 90.9%, and 24.3%, respectively. This new scoring system would be useful for treatment decisions and prognostic prediction at initial diagnosis. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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10 pages, 5021 KiB

Open AccessArticle

Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions

by Przemysław Dyrla, Arkadiusz Lubas, Jerzy Gil, Marek Saracyn and Maciej Gonciarz

Diagnostics 2021, 11(12), 2289; https://doi.org/10.3390/diagnostics11122289 - 07 Dec 2021

Cited by 2 | Viewed by 1904

Abstract

Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom [...] Read more.

Dynamic tissue perfusion measurement (DTPM) and single vessel flow measurement (SVFM) were assessed in differentiating inflammatory and malignant lesions of the pancreas. Sixty-nine patients (age 62.0 ± 14.7; 33 Female and 36 Men; 40 with malignant and 29 with inflammatory lesions) in whom during the endoscopic ultrasound (EUS) of focal pancreatic lesions it was possible to adequately evaluate the flow in the color Doppler, and then perform a biopsy, were qualified for the study. The assessed DTPM parameters flow velocity (TFV), perfusion intensity (TPI), and resistive index (TRI) as well as the following SVFM parameters: flow velocity (FV), volume flow (VolF), and resistive index (RI) differed significantly between the malignant and inflammatory lesions (p < 0.005). TFV and TPI have slightly better discriminatory properties than the corresponding FV and VolF parameters (p < 0.10). Considering the Doppler parameters usually evaluated in a given method, the TPI = 0.009 cm/s (sensitivity 79%, specificity 92%, AUC 0.899, p < 0.001) was significantly better (p = 0.014) in differentiating between inflammatory and malignant pancreatic lesions in comparison to FV = 2.526 cm/s (sensitivity 79%, specificity 70%, AUC 0.731, p < 0.001). Tissue perfusion has better discriminatory properties in the differentiation of solid pancreatic lesions than the Doppler blood flow examination in the single vessel within the tumor. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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Review

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13 pages, 589 KiB

Open AccessReview

Promising Genomic Testing for Biliary Tract Cancer Using Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy Specimens

by Masaki Kuwatani, Kazumichi Kawakubo and Naoya Sakamoto

Diagnostics 2022, 12(4), 900; https://doi.org/10.3390/diagnostics12040900 - 05 Apr 2022

Cited by 3 | Viewed by 1878

Abstract

The undesired prognosis of biliary tract cancer is mainly attributed to the difficult detection of cancer lesions, including intraepithelial neoplasia and no standard examination for screening. In addition, pathological diagnosis of biliary stricture, whether it is malignant or benign, is not so easy, [...] Read more.

The undesired prognosis of biliary tract cancer is mainly attributed to the difficult detection of cancer lesions, including intraepithelial neoplasia and no standard examination for screening. In addition, pathological diagnosis of biliary stricture, whether it is malignant or benign, is not so easy, because of difficult optimal sampling by forceps biopsy and brush cytology, although various devices and methods for pathological diagnosis have been reported. Furthermore, we have to be careful about post-endoscopic retrograde cholangiography pancreatitis when we approach the biliary tract lesion via a transpapillary route. In order to improve the diagnostic accuracy, there have been several studies that indicate the feasibility and efficacy of genomic analysis for accurate diagnosis of biliary tract cancer by using pathological specimens, including endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) samples. For efficient and precision medicine for patients with biliary tract cancer, future diagnosis and treatment should also be based on molecular and genetic analyses. In this article, we review and summarize the past knowledge and cutting edge of genomic testing for biliary tract cancer, using EUS-FNA/FNB specimens, and indicate some ingenuities in sample processing to promote effective clinical practice and future perspectives. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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15 pages, 522 KiB

Open AccessReview

The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

by Masanari Sekine, Takeharu Asano and Hirosato Mashima

Diagnostics 2022, 12(4), 810; https://doi.org/10.3390/diagnostics12040810 - 25 Mar 2022

Cited by 5 | Viewed by 3356

Abstract

Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic [...] Read more.

Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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23 pages, 3380 KiB

Open AccessReview

The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions

by Hiroki Tanaka and Shimpei Matsusaki

Diagnostics 2022, 12(3), 753; https://doi.org/10.3390/diagnostics12030753 - 19 Mar 2022

Cited by 9 | Viewed by 3100

Abstract

Endoscopic-ultrasonography-guided tissue acquisition (EUS-TA) has been widely performed for the definitive diagnosis of solid pancreatic lesions (SPLs). As the puncture needles, puncture techniques, and sample processing methods have improved, EUS-TA has shown higher diagnostic yields and safety. Recently, several therapeutic target genomic biomarkers [...] Read more.

Endoscopic-ultrasonography-guided tissue acquisition (EUS-TA) has been widely performed for the definitive diagnosis of solid pancreatic lesions (SPLs). As the puncture needles, puncture techniques, and sample processing methods have improved, EUS-TA has shown higher diagnostic yields and safety. Recently, several therapeutic target genomic biomarkers have been clarified in pancreatic ductal carcinoma (PDAC). Although only a small proportion of patients with PDAC can benefit from precision medicine based on gene mutations at present, precision medicine will also be further developed for SPLs as more therapeutic target genomic biomarkers are identified. Advances in next-generation sequencing (NGS) techniques enable the examination of multiple genetic mutations in limited tissue samples. EUS-TA is also useful for NGS and will play a more important role in determining treatment strategies. In this review, we describe the utility of EUS-TA for SPLs. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA))

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