Endoscopic ultrasound-guided fine-needle aspiration and cytology for differentiating benign from malignant lymph nodes

Background and study aims: Intra-abdominal and mediastinal lymphadenopathy are often difficult to diagnose, particularly in the absence of a primary lesion. Endosonography [EUS]-guided fine-needle aspiration and cytology [FNAC] has provided an easy and safe access to these lymph nodes, sparing the use of invasive and costly interventions. The main aim of this study is to assess the specificity, sensitivity, and predictive value of EUS-guided FNAC in the diagnosis of benign and malignant lymph nodes. In addition, the study aims to determine significant EUS features that could help in predicting lymph node malignancy

Patients and methods: This prospective study included 142 patients with intra-abdominal or intrathoracic lymphadenopathy who were referred for EUS-guided FNAC because of inaccessibility by other imaging modalities. Ninety [63.3%] patients were found to have malignant lymph nodes, and 52 [36.6%] had lymphadenopathy of benign nature

Results: EUS-guided FNAC had a sensitivity and specificity of 92% and 100% respectively. It had positive and negative predictive values of 100% and 88% for malignancy, respectively. By logistic regression analysis, EUS features and shortest diameter were found to be potential predictors of malignancy with p-value of <0.0001

Conclusion: EUS-guided FNAC is a powerful modality in the diagnosis of benign and malignant lymph nodes. Additional complementary EUS features could be added to this technique for definitive diagnosis

Role of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic head lesions, Egyptian experience

Pancreatic carcinoma is one of the leading cancer morbidity and mortality worldwide. Endoscopic Ultrasound [EUS] provides good direct visualization of the pancreas and EUS-FNA raises the accuracy for diagnosing pancreatic malignancies. US-FNA is another established method for diagnosing pancreatic malignancies. To determine the Role of Percutaneous US-FNA and EUS-FNA in diagnosis of pancreatic lesions. 131 patients with pancreatic masses were included in the study and sub-classified into 2 groups according to the imaging tool used, US-FNA [group I] and EUS-FNA [group II]. Using the appropriate statistical tools, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and diagnostic accuracy were calculated for both groups. It was 88.2%, 93.9%, 96.8%, 97.5% and 90.1% respectively in group I. It was 77.8%, 100%, 100%, 75% and 86.7% respectively in group II. US-FNA/EUS-FNA are safe reliable tools for diagnosis of pancreatic lesions

Role of spiral CT scan and endoscopic ultrasonography in assessing operability of peri-ampullary tumors

Pancreatic cancer is associated with an extremely poor prognosis with less than 5% of patients surviving 5 years after the diagnosis. Current preoperative staging modalities include various cross sectional imaging techniques. including spiral CT and endoscopic ultrasound [EUS]. This prospective study aimed at demonstrating the role of spiral CT and endoscopic ultrasonography in early diagnosis staging and assessment of operability of periampullary tumors. Sixty-two patients with periampullary tumors were included in this study. All cases were subjected to abdominal ultrasound. Spiral CT. ERCP. EUS and operative interference. Surgical findings were considered the gold standard for assessing the sensitivity of spiral CT and EUS in diagnosing, staging arid estimating resectability of periampullary tumors. Endoscopic Ultrasonography was very sensitive in detecting periampullary masses [93.5%] especially masses smaller than 20mm while the sensitivity of spiral CT was 71%. EUS was also very sensitive in detecting ampullary masses [100%] in contrast to spiral CT chat missed the diagnosis of the 14 ampullary masses found in our work. EUS was more sensitive than Spiral CT in detecting malignant vascular invasion [95% versus 75%] while it was slightly less specific than spiral CT in that context [74 versus 80%]. The predictive value of spiral CT was 60% for tumor resectability while it was 100% for tumor unresectability. The predictive value of EUS was 735% for tumor resectability while it was 96.4% for tumor unresectability. When combining both techniques the predictive value for tumor resectability was 65% while it was 100% for tumor unresectability. No complications were encountered in both techniques. We concluded that EUS is more sensitive than spiral CT in detection and staging of periampullary masses. Also. the non-invasive spiral CT and the minimally invasive EUS are very valuable tools in predicting uresectability of periampullary masses while EUS is slightly more valuable in detecting tumor resectability

Role of ultrasound guided fine needle biopsy, EUS and serum CA19-9 level in diagnosis of pancreatic masses

Pancreatic Cancer is a very aggressive tumor with an extremely poor prognosis. Early diagnosis, accurate preoperative staging and better adjuvant treatment remain a challenge. Abdominal ultrasound, abdominal CT, EUS and ERCP are common tools used for imaging of pancreatic cancer. Fine needle aspiration has made significant contribution to the diagnosis of cancer pancreas. The aim of the present work was to evaluate the role of ultrasound guided fine needle aspiration cytology [FNAC] in the diagnosis of pancreatic masses and in the differentiation of cancer pancreas from benign lesions. In addition to that, the level of serum CA 19-was measured to assess its accuracy in differentiating cancerous from benign lesions. This cross sectional study included forty patients with pancreatic lesions. They were subjected to full clinical examination, laboratory tests [including serum level CA 19- 9], abdominal ultrasound, percutaneous sonar guided FNAC of pancreatic lesions, endosonography and surgical interference [was done to 32 patients]. Thirty three patients proved to have pancreatic malignancy while seven patients proved to have pancreatitis. Ultrasonography [US] showed a sensitivity of 70%, specificity of 86% and accuracy of 73% for malignancy detection. Adding CAI9-9 to ultrasound raised the sensitivity to 94%, specificity remained 86% and accuracy to 93%. Adding FNAC to US raised the sensitivity to 85%, specificity remained 86% and accuracy to 91%. EUS showed a sensitivity of 90%, specificity of 100% and accuracy of 91%. Adding CA to EUS showed a sensitivity of 94%, specificity of 100% and accuracy of 91%. Adding FNAC to EUS showed a sensitivity of 97%, specificity of 86% and accuracy of 97%. The combination of EUS, serum CAI9-9 level and sonar guided fine needle aspiration showed an accuracy of 97% in the diagnosis of pancreatic lesions. These investigatory tools are cheap and available and thus may be an excellent alternative to EUS guided fine needle aspiration which is expensive and available in only a few centres

Abnormal iron metabolism in non alcoholic steatohepatitis

Non-alcoholic steatohepatitis [NASH] is a form of liver disease resembling alcoholic liver disease in a patient who did not consume significant amount of alcohol. Our study is concerned with the relation between NASH and iron level in serum and liver tissue. 44 patients with NASH proved by liver biopsy were the subjects of our study. The investigations done to all of them included: fasting and post prandial blood glucose, hepatitis markers, lipid profile, liver function tests, serum iron, total iron binding capacity [TIBC], serum ferritin, prothrombin time and concentration, abdominal ultrasonography, ultrasonography guided liver biopsy and histopathological examination of the specimen. Our results showed elevation of the serum levels of iron, total iron biding capacity, serum ferritin and total iron score in 84% of our NASH patients. There was no significant difference in the studied iron parameters in different grades of steatosis and in different grades of activity while there was significant difference in different stages of fibrosis. Thus we might conclude that in addition to diabetes mellitus, lipid abnormalities and obesity, increased iron stores may play important role in the development of NASH and this may be through increased oxidative stress that ultimately lead to fibrosis and iron reduction might be of benefit in the treatment of this disease