Endoscopic Ultrasonography in the Diagnosis and Treatment Strategy Choice of Esophageal Leiomyoma

OBJECTIVES: Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions. METHODS: Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis. RESULTS: One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (p<0.05). SMA (smooth muscle antibody) (97.2%) and desmin (94.5%) were positive in the majority of patients. In terms of treatments, patients preferred endoscopic therapies, which led to less adverse events (e.g., intraoperative bleeding, local infection, pleural effusion) than surgical operations (p<0.05). The superficial leiomyomas presented less adverse events and better recovery (p<0.05) than deep leiomyomas. CONCLUSION: Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely avoid misdiagnosis, so combining it with other examinations may be a good strategy to solve this problem.

Rapid on-site cytopathological examination (ROSE) performed by endosonagraphers and its improvement in the diagnosis of pancreatic solid lesions

PURPOSE: To evaluate the diagnosis improvement of EUS-FNA when using ROSE performed by the endosonographer. METHODS: A retrospective study was conducted. A total of 48 pancreatic solid masses EUS-FNA were divided into two groups according to the availability of on-site cytology (ROSE) - the first 24 patients (group A-without ROSE) and the latter 24 cases (group B-with ROSE). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, complications and inadequacy rate of EUS-FNA were determined and compared. RESULTS: Among the 48 EUS-FNA, the overall performance was: sensitivity 82%; specificity 100%; positive predictive value (PPV) 100%; negative predictive value (NPV) 70% and accuracy 87%. The sensitivity of the Group A was 71%, versus 94% in-group B (p=0.61). Moreover, the negative predictive value was 58% versus 87% (p=0.72). The accuracy rate increased from 79% to 96% (p=0.67) in the ROSE group. The number of punctures was similar between the groups. No major complications were reported. CONCLUSION: Rapid on-site cytopathological examination, even when performed by the endosonographer, may improve the diagnostic performance in the diagnosis of solid pancreatic lesions, regardless of the slight increase in the number of punctures. .

Identificação dos insulinomas pela ecoendoscopia / Identification of insulinomas by endoscopic ultrasonography

OBJETIVO: Demonstrar a sensibilidade da ecoendoscopia (EE) no diagnóstico pré-operatório dos insulinomas e comparar com outros testes diagnósticos como tomografia helicoidal e ressonância magnética. MÉTODOS: Trinta pacientes foram examinados prospectivamente pela ecoendoscopia com o diagnóstico clínico de insulinoma antes de serem submetidos ao tratamento cirúrgico. O exame ecoendoscópico sempre foi precedido pelo US, TC helicoidal e em 10 pacientes pela RM. Em 12 casos foi indicada a punção aspirativa com agulha fina eco-guiada para confirmar a suspeita de insulinoma. RESULTADOS: A sensibilidade da EE na identificação dessas lesões foi de 86,6 por cento (26/30 tumores). Vinte e seis tumores foram benignos (86,6 por cento) e quatro malignos (13,4 por cento). Realizamos punção biópsia aspirativa em 12 pacientes (40 por cento) e o diagnóstico histológico foi feito em 10/12 pacientes (83,3 por cento). Nessa casuística, 25 tumores foram menores que 2 cm (83,3 por cento) e cinco maiores que 2 cm (16,7 por cento). Os tumores detectados pela EE tinham tamanho médio de 1,5 cm (0,6 a 5,4 cm). A identificação dos tumores pela EE na cabeça, corpo e cauda foi de 100 por cento, 100 por cento e 55,5 por cento, respectivamente. CONCLUSÃO: A EE tem alta sensibilidade na identificação e localização dessas lesões e deve ser recomendada quando os métodos tradicionais de imagem empregados falham no diagnóstico. A PAAF é uma tentativa para evitarmos falso-positivos.