25-gauge histology needle versus 22-gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathy.

BACKGROUND AND STUDY AIMS: A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ProCore; Cook Medical, Bloomington, Indiana, USA) has been developed, which features a hollowed-out reverse bevel to trap core samples. However, data on the differences between the diagnostic yield of the 25G EchoTip ProCore and that of a 22G standard needle are limited. PATIENTS AND METHODS: This pilot study included 27 patients referred during an 11-month period for EUS-FNA of pancreatic masses and enlarged lymph nodes adjacent to the upper gastrointestinal tract. Each lesion was punctured once by both a 25G EchoTip ProCore needle and a 22G standard needle (EchoTip; Cook Medical) with capillary sampling. Blinded histocytologic analyses were conducted. The final diagnosis was based on FNA findings of malignant cells, pathologic analysis of the surgical specimen, and/or radiologic and clinical follow-up of at least 7 months. RESULTS: A total of 28 EUS-FNA procedures targeting masses of the pancreas (n = 19) and lymph nodes (n = 9) were performed. No complications were encountered. Single-pass sensitivity rates for pancreatic and lymph node malignancy were equal for the needle types: 89.5 % (95 %CI 66.82 - 98.39) and 66 % (95 %CI 24.1 - 94), respectively. There were no significant differences between the needles in terms of EUS visualization (P = 0.125), amount of blood contamination (P = 0.705), macroscopic quantity of the material (P = 0.858), quality of the cytology (P = 0.438), and adequacy and accuracy of the cell block material (P = 0.220). CONCLUSIONS: Both needles were safe and successful in terms of a high diagnostic yield, with similar histocytologic results. The results of this study were presented at Digestive Disease Week (DDW) 2014, Chicago, Illinois. This trial was registered at ClinicalTrials.gov (B027201316271).

Expanding the horizons of endoscopic ultrasound: diagnosis of non-digestive pathologies.

Endoscopic ultrasound (EUS) is mainly used for the evaluation and sampling of mediastinal and abdominal lymph nodes, luminal and submucosal lesions of the upper and lower gastrointestinal tract, as well as in the diagnostic approach for pancreatic, biliary and liver disease. However, several non-digestive pathologies may be encountered as well, expanding the diagnostic potential of EUS. In this article, we present nine examples of extra-digestive abnormalities detected by means of EUS, including pathologies of the thyroid gland, mediastinal and abdominal vessels, lungs, kidney and the urinary bladder. The purpose of this article is to review the capabilities of EUS beyond routine evaluation of gastrointestinal organs.