PDF icon Download PDF
Open Access
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(02): 099-105
DOI: 10.1055/s-0040-1714046
Review Article

EUS-Guided FNA: Tips and Tricks

Rinkesh Kumar Bansal
1   Department of Gastroenterology & Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Rajesh Puri
2   Department of Interventional Gastroenterology, Institute of Digestive & Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, Haryana, India
› Author Affiliations
› Further Information
Also available ateRef
  Permissions and Reprints
Preview

Abstract

The development of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) technique has been proved to be a great armamentarium to gastroenterologists and other branches including surgery, oncology, hepatology, pulmonary medicine, and internal medicine. EUS-FNA is quite safe and allows tissue acquisition from difficult anatomical locations like retroperitoneum, pancreas, and mediastinum. The current review discusses basic techniques steps of EUS-FNA including tips and tricks. Also, false negative FNA and EUS-FNA in difficult locations are discussed. We also discussed about EUS-guided fine needle biopsy.

Keywords

EUS - EUS-FNA - EUS-FNB - needle


Publication History

Article published online:
06 July 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Vilmann P, Jacobsen GK, Henriksen FW, Hancke S. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992; 38 (02) 172-173
    CrossrefPubMedSearch in Google Scholar
  • 2 Ge N, Zhang S, Jin Z. et al. Clinical use of endoscopic ultrasound-guided fine-needle aspiration: guidelines and recommendations from Chinese Society of Digestive Endoscopy. Endosc Ultrasound 2017; 6 (02) 75-82
    CrossrefPubMedSearch in Google Scholar
  • 3 Tharian B, Tsiopoulos F, George N, Pietro SD, Attili F, Larghi A. Endoscopic ultrasound fine needle aspiration: technique and applications in clinical practice. World J Gastrointest Endosc 2012; 4 (12) 532-544
    CrossrefPubMedSearch in Google Scholar
  • 4 Yoshinaga S, Suzuki H, Oda I, Saito Y. Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 2011; 23 (Suppl. 01) 29-33
    CrossrefPubMedSearch in Google Scholar
  • 5 Vilmann P, Clementsen PF, Colella S. et al. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy 2015; 47 (06) 545-559
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Levy MJ. EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc 2011; 74 (04) 897-905
    CrossrefPubMedSearch in Google Scholar
  • 7 Puri R, Thandassery RB, Choudhary NS. et al. Endoscopic ultrasound-guided fine-needle aspiration of the adrenal glands: analysis of 21 patients. Clin Endosc 2015; 48 (02) 165-170
    CrossrefPubMedSearch in Google Scholar
  • 8 Choudhary NS, Bodh V, Kumar N. et al. Yield of endoscopic ultrasound-guided fine needle aspiration for subcentimetric lymph nodes: a comparison to larger nodes. Endosc Ultrasound 2017; 6 (03) 168-173
    CrossrefPubMedSearch in Google Scholar
  • 9 Choudhary N, Bansal RK, Puri R. et al. Impact and safety of endoscopic ultrasound guided fine needle aspiration on patients with cirrhosis and pyrexia of unknown origin in India. Endosc Int Open 2016; 4 (09) E953-E956
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Choudhary NS, Puri R, Saigal S. et al. Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy. Indian J Gastroenterol 2016; 35 (06) 465-468
    CrossrefPubMedSearch in Google Scholar
  • 11 Veitch AM, Vanbiervliet G, Gershlick AH. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut 2016; 65 (03) 374-389
    CrossrefPubMedSearch in Google Scholar
  • 12 Ootaki C, Stevens T, Vargo J. et al. Does general anesthesia increase the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses?. Anesthesiology 2012; 117 (05) 1044-1050
    CrossrefPubMedSearch in Google Scholar
  • 13 Madhoun MF, Wani SB, Rastogi A. et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis. Endoscopy 2013; 45 (02) 86-92
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Fuccio L, Larghi A. Endoscopic ultrasound-guided fine needle aspiration: how to obtain a core biopsy. ? Endosc Ultrasound 2014; 3 (02) 71-81
    CrossrefPubMedSearch in Google Scholar
  • 15 Bansal RK, Choudhary NS, Puri R. et al. Comparison of endoscopic ultrasound-guided fine-needle aspiration by capillary action, suction, and no suction methods: a randomized blinded study. Endosc Int Open 2017; 5 (10) E980-E984
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000; 51 (02) 184-190
    CrossrefPubMedSearch in Google Scholar
  • 17 LeBlanc JK, Ciaccia D, Al-Assi MT. et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc 2004; 59 (04) 475-481
    CrossrefPubMedSearch in Google Scholar
  • 18 Iwashita T, Nakai Y, Samarasena JB. et al. High single-pass diagnostic yield of a new 25-gauge core biopsy needle for EUS-guided FNA biopsy in solid pancreatic lesions. Gastrointest Endosc 2013; 77 (06) 909-915
    CrossrefPubMedSearch in Google Scholar
  • 19 Lee JK, Choi JH, Lee KH. et al. A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses. Gastrointest Endosc 2013; 77 (05) 745-751
    CrossrefPubMedSearch in Google Scholar
  • 20 Puri R, Vilmann P, Săftoiu A. et al. Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis. Scand J Gastroenterol 2009; 44 (04) 499-504
    CrossrefPubMedSearch in Google Scholar
  • 21 Wallace MB, Kennedy T, Durkalski V. et al. Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy. Gastrointest Endosc 2001; 54 (04) 441-447
    CrossrefPubMedSearch in Google Scholar
  • 22 Wani S, Muthusamy VR, Komanduri S. EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014; 80 (06) 939-959.e7
    CrossrefPubMedSearch in Google Scholar
  • 23 Attam R, Arain MA, Bloechl SJ. et al. “Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc 2015; 81 (06) 1401-1407
    CrossrefPubMedSearch in Google Scholar
  • 24 Mukai S, Itoi T, Ashida R. et al. Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos). Gastrointest Endosc 2016; 83 (06) 1210-1217
    CrossrefPubMedSearch in Google Scholar
  • 25 Bang JY, Magee SH, Ramesh J, Trevino JM, Varadarajulu S. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45 (06) 445-450
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Gimeno-García AZ, Paquin SC, Gariépy G, Sosa AJ, Sahai AV. Comparison of endoscopic ultrasonography-guided fine-needle aspiration cytology results with and without the stylet in 3364 cases. Dig Endosc 2013; 25 (03) 303-307
    CrossrefPubMedSearch in Google Scholar
  • 27 Wani S, Early D, Kunkel J. et al. Diagnostic yield of malignancy during EUS-guided FNA of solid lesions with and without a stylet: a prospective, single blind, randomized, controlled trial. Gastrointest Endosc 2012; 76 (02) 328-335
    CrossrefPubMedSearch in Google Scholar
  • 28 Colán-Hernández J, Sendino O, Loras C. et al. Antibiotic prophylaxis is not required for endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions, based on a randomized trial. Gastroenterology 2020; 158 (06) 1642-1649.e1
    CrossrefPubMedSearch in Google Scholar
  • 29 Puli SR, Bechtold ML, Buxbaum JL, Eloubeidi MA. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass? A meta-analysis and systematic review. Pancreas 2013; 42 (01) 20-26
    CrossrefPubMedSearch in Google Scholar
  • 30 Wang J, Zhao S, Chen Y, Jia R, Zhang X. Endoscopic ultrasound guided fine needle aspiration versus endoscopic ultrasound guided fine needle biopsy in sampling pancreatic masses: a meta-analysis. Medicine (Baltimore) 2017; 96 (28) e7452
    Search in Google Scholar
  • 31 Puli SR, Batapati Krishna Reddy J, Bechtold ML. et al. Endoscopic ultrasound: it’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review. World J Gastroenterol 2008; 14 (19) 3028-3037
    CrossrefPubMedSearch in Google Scholar
  • 32 Patil R, Ona MA, Papafragkakis C, Duddempudi S, Anand S, Jamil LH. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions. Ann Gastroenterol 2016; 29 (03) 307-311
    PubMedSearch in Google Scholar
  • 33 Zhang XC, Li QL, Yu YF. et al. Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis. Surg Endosc 2016; 30 (06) 2431-2441
    CrossrefPubMedSearch in Google Scholar
  • 34 Thornton GD, McPhail MJ, Nayagam S, Hewitt MJ, Vlavianos P, Monahan KJ. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology 2013; 13 (01) 48-57
    CrossrefPubMedSearch in Google Scholar
  • 35 Navaneethan U, Njei B, Venkatesh PG, Lourdusamy V, Sanaka MR. Endoscopic ultrasound in the diagnosis of cholangiocarcinoma as the etiology of biliary strictures: a systematic review and meta-analysis. Gastroenterol Rep (Oxf) 2015; 3 (03) 209-215
    CrossrefPubMedSearch in Google Scholar
  • 36 Wu LM, Jiang XX, Gu HY. et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy in the evaluation of bile duct strictures and gallbladder masses: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2011; 23 (02) 113-120
    CrossrefPubMedSearch in Google Scholar
  • 37 Klapman JB, Logrono R, Dye CE, Waxman I. Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 2003; 98 (06) 1289-1294
    CrossrefPubMedSearch in Google Scholar
  • 38 Wani S, Mullady D, Early DS. et al. The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: a prospective multicenter randomized controlled trial. Am J Gastroenterol 2015; 110 (10) 1429-1439
    CrossrefPubMedSearch in Google Scholar
  • 39 Matynia AP, Schmidt RL, Barraza G, Layfield LJ, Siddiqui AA, Adler DG. Impact of rapid on-site evaluation on the adequacy of endoscopic-ultrasound guided fine-needle aspiration of solid pancreatic lesions: a systematic review and meta-analysis. J Gastroenterol Hepatol 2014; 29 (04) 697-705
    CrossrefPubMedSearch in Google Scholar
  • 40 Kong F, Zhu J, Kong X. et al. Rapid on-site evaluation does not improve endoscopic ultrasound-guided fine needle aspiration adequacy in pancreatic masses: a meta-analysis and systematic review. PLoS One 2016; 11 (09) e0163056
    CrossrefPubMedSearch in Google Scholar
  • 41 Iwashita T, Yasuda I, Mukai T. et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study). Gastrointest Endosc 2015; 81 (01) 177-185
    CrossrefPubMedSearch in Google Scholar
  • 42 Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 2005; 62 (05) 728-736, quiz 751, 753
    CrossrefPubMedSearch in Google Scholar
  • 43 Bang JY, Varadarajulu S. Neoplasia in chronic pancreatitis: how to maximize the yield of endoscopic ultrasound-guided fine needle aspiration. Clin Endosc 2014; 47 (05) 420-424
    CrossrefPubMedSearch in Google Scholar
  • 44 Mitchell RA, Stanger D, Shuster C, Telford J, Lam E, Enns R. Repeat endoscopic ultrasound-guided fine-needle aspiration in patients with suspected pancreatic cancer: diagnostic yield and associated change in access to appropriate care. Can J Gastroenterol Hepatol 2016; 2016: 7678403
    PubMedSearch in Google Scholar
  • 45 Téllez-Ávila FI, Martínez-Lozano JA, Rosales-Salinas A. et al. Repeat endoscopic ultrasound fine needle aspiration after a first negative procedure is useful in pancreatic lesions. Endosc Ultrasound 2016; 5 (04) 258-262
    CrossrefPubMedSearch in Google Scholar
  • 46 Spier BJ, Johnson EA, Gopal DV. et al. Predictors of malignancy and recommended follow-up in patients with negative endoscopic ultrasound-guided fine-needle aspiration of suspected pancreatic lesions. Can J Gastroenterol 2009; 23 (04) 279-286
    CrossrefPubMedSearch in Google Scholar
  • 47 von MB Bartheld, Rabe KF, Annema JT. Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes. Gastrointest Endosc 2009; 69 (02) 345-349
    CrossrefPubMedSearch in Google Scholar
  • 48 Choudhary NS, Bansal RK, Puri R, Guleria M, Sud R. Endoscopic ultrasound-guided fine-needle aspiration of an aortocaval lymph node by the transcaval approach. J Dig Endosc 2016; 7: 158-159
    Thieme ConnectSearch in Google Scholar
  • 49 Sofocleous CT, Schubert J, Brown KT, Brody LA, Covey AM, Getrajdman GI. CT-guided transvenous or transcaval needle biopsy of pancreatic and peripancreatic lesions. J Vasc Interv Radiol 2004; 15 (10) 1099-1104
    CrossrefPubMedSearch in Google Scholar
  • 50 Rana A, Rana SS. Endoscopic ultrasound-guided tissue acquisition: techniques and challenges. J Cytol 2019; 36 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 51 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48 (04) 339-349
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 James TW, Baron TH. A comprehensive review of endoscopic ultrasound core biopsy needles. Expert Rev Med Devices 2018; 15 (02) 127-135
    CrossrefPubMedSearch in Google Scholar