Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications（pneumothorax and pulmonary hemorrhage） of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax（13 cases, 27.1%） and pulmonary hemorrhage（14 cases, 20.24%）. ？2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases（17.5%） out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases（60%） out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases（41.4%） out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases（70%） out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words： biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage

Diagnostic approach using endosonography guided fine needle aspiration for lymphadenopathy in primary sclerosing cholangitis

We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.

Endoscopic ultrasound-guided fine-needle aspiration pancreatic adenocarcinoma samples yield adequate DNA for next-generation sequencing:A cohort analysis

BACKGROUND Genetic tests are increasingly performed for the management of unresectable pancreatic cancer.For genotyping aimed samples current guidelines recommend using core specimens,although based on moderate quality evidence.However,in clinical practice among the endoscopic ultrasound(EUS) guided tissue acquisition methods,fine needle aspiration(FNA) is the most widely performed.AIM To assess the adequacy for next generation sequencing(NGS) of the DNA yielded from EUS-FNA pancreatic adenocarcinoma(PDAC) samples.METHODS Between November 2018 and December 2021,105 patients with PDAC confirmed by EUS-FNA were included in the study at our tertiary gastroenterology center.Either 22 gauge(G) or 19G FNA needles were used.One pass was dedicated to DNA extraction.DNA concentration and purity(A260/280,A260/230) were assessed by spectrophotometry.We assessed the differences in DNA parameters according to needle size and tumor characteristics(size,location) and the adequacy of the extracted DNA for NGS(defined as A260/280 ≥ 1.7,and DNA yield:≥ 10 ng for amplicon based NGS,≥ 50 ng for whole exome sequencing [WES],≥ 100 ng for whole genome sequencing [WGS]) by analysis of variance and ttest respectively.Moreover,we compared DNA purity parameters across the different DNA yield categories.RESULTS Our cohort included 49% male patients,aged 67.02 ± 8.38 years.The 22G needle was used in 71%of the cases.The DNA parameters across our samples varied as follows:DNA yield:1289 ng(inter quartile range:534.75-3101),A260/280 = 1.85(1.79-1.86),A260/230 = 2.2(1.72-2.36).DNA yield was > 10 ng in all samples and > 100 ng in 93% of them(one sample < 50 ng).There were no significant differences in the concentration and A260/280 between samples by needle size.Needle size was the only independent predictor of A260/230 which was higher in the 22G samples(P =0.038).NGS adequacy rate was 90% for 19G samples regardless of NGS type,and for 22G samples it reached 89% for WGS adequacy and 91% for WES and amplicon based NGS.Samples with DNA yield > 100 ng had significantly higher A260/280(1.89 ± 0.32 vs 1.34 ± 0.42,P = 0.013).Tumor characteristics were not corelated with the DNA parameters.CONCLUSION EUS-FNA PDAC samples yield DNA adequate for subsequent NGS.DNA amount was similar between 22G and 19G FNA needles.DNA purity parameters may vary indirectly with needle size.

Endobronchial ultrasound-guided transbronchial needle aspiration： unraveling myths of mass in the chest

Lung cancer is one of the most common neoplasms worldwide and a major cause of cancer death.Rapid diagnosis and accurate staging for patients with suspected lung cancer are essential to appropriate treatment.However,many of submucosal or parabronchial intrapulmonary lesions are invisible by bronchoscopy despite their adjacency

Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid mass.METHODS Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. RESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

Castleman disease in the hepatic-gastric space: A case report

BACKGROUND Castleman disease, also known as giant lymph node hyperplasia, was first reported in 1956. It is a rare benign proliferative pathological change of the lymph nodes.CASE SUMMARY The patient, a 33-year-old woman, had epigastric distension for half a year.Examinations were performed in a local hospital. Computed tomography scan showed round soft tissue nodules, about 5.45 cm in diameter, in the hepaticgastric space. Endoscopic ultrasound and endoscopic ultrasound guided fine needle aspiration was performed on the patient. Rapid on-site evaluation,hematoxylin eosin staining and histopathology of the puncture smear was performed. According to the Diff-Quik staining and hematoxylin eosin staining results of preoperative endoscopic ultrasound guided fine needle aspiration puncture smears as well as the immunohistochemistry results, Castleman disease was highly suspected. A sufficient preoperative evaluation was made, and a precise surgical plan was developed. Postoperative pathology confirmed Castleman disease.CONCLUSION Endoscopic ultrasound guided fine needle aspiration can extract internal tissues of the tumor for histological and cytological examinations and provide accurate diagnosis as much as possible. Therefore, a sufficient preoperative evaluation can be made, and a precise surgical plan can be developed.