Diagnostic accuracy of 22/25-gauge core needle in endoscopic ultrasound-guided sampling: systematic review and meta-analysis

( Hyoung-chul Oh ),( Hyun Kang ),( Jae Young Lee ),( Geun Joo Choi ),( Jung Sik Choi ) 대한내과학회 2016 The Korean Journal of Internal Medicine Vol.31 No.6

Background/Aims: To compare the diagnostic accuracy of endoscopic ultrasound- guided core needle aspiration with that of standard fine-needle aspiration by systematic review and meta-analysis. Methods: Studies using 22/25-gauge core needles, irrespective of comparison with standard fine needles, were comprehensively reviewed. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves for the diagnosis of malignancy were used to estimate the overall diagnostic effi ciency. Results: The pooled sensitivity, specificity, and DOR of the core needle for the diagnosis of malignancy were 0.88 (95% confidence interval [CI], 0.84 to 0.90), 0.99 (95% CI, 0.96 to 1), and 167.37 (95% CI, 65.77 to 425.91), respectively. The pooled sensitivity, specificity, and DOR of the standard needle were 0.84 (95% CI, 0.79 to 0.88), 1 (95% CI, 0.97 to 1), and 130.14 (95% CI, 34.00 to 495.35), respectively. The area under the curve of core and standard needle in the diagnosis of malignancy was 0.974 and 0.955, respectively. The core and standard needle were comparable in terms of pancreatic malignancy diagnosis. There was no significant difference in procurement of optimal histologic cores between core and standard needles (risk ratio [RR], 0.545; 95% CI, 0.187 to 1.589). The number of needle passes for diagnosis was significantly lower with the core needle (standardized mean difference, .0.72; 95% CI, .1.02 to .0.41). There were no significant differences in overall complications (RR, 1.26; 95% CI, 0.34 to 4.62) and technical failure (RR, 5.07; 95% CI, 0.68 to 37.64). Conclusions: Core and standard needles were comparable in terms of diagnostic accuracy, technical performance, and safety profile.

Comparison of the Diagnostic Yield of the Standard 22-Gauge Needle and the New 20-Gauge Forward-Bevel Core Biopsy Needle for Endoscopic Ultrasound-Guided Tissue Acquisition from Pancreatic Lesions

( Shinya Fujie ),( Hirotoshi Ishiwatari ),( Keiko Sasaki Junya Sato ),( Hiroyuki Matsubayashi ),( Masao Yoshida ),( Sayo Ito ),( Noboru Kawata ),( Kenichiro Imai ),( Naomi Kakushima ),( Kohei Takizawa 대한간학회 2019 Gut and Liver Vol.13 No.3

Background/Aims: To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. Methods: The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. Results: There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. Conclusions: Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle. (Gut Liver 2019;13:349-355)

首都圈地域에서 리기다소나무 잎과 잔뿌리 속의 陽이온 부족

Rhyu, Tae-Cheol,Kim, Kee-Dae,Kim, Joon-Ho 한국생태학회 1994 Journal of Ecology and Environment Vol.17 No.3

수도권과 그 주변 지역의 33지소의 리기다소나무 숲에서 리기다소나무 잎과 잔뿌리의 주요이온의 함량을 정량하였다. 잎 속의 N, P, K 및 Mg 함량운 전년도 잎에 비해 당해연도 잎속에 높았지만, Al과 Ca은 그 반대였다. 잎 속의 N, P, K 및 Al 함랴은 지역간의 차이가 없었지만, Ca과 Mg 함량은 전원지에 비해 도심지에서 낮았다. 그러나 잎속의 N/Ca와 N/Mg의 비의 값은 전원지에보다 도심지에서 컸다. 표토 잔뿌리 속의 Mg 함량은 도심으로부터 거리가 멀어짐에 따라 증가하였으나, 심층토 잔뿌리 속의 Al 함량은 그 반대였다. 토양층 잔뿌리 속의Al 함량은 도심지보다 전원지에서 낮았다. 토양층 잔뿌리속의 Al 함량은 낙엽층의 잔뿌리에 비하여 2~3배 높았다. 그리고 표토보다 심층토에 존재하는 잔뿌리 속에 Al 함량이 높았다. 그러므로 수도권 지역에서 리기다소나무의 생장감소는 조직 속의 Ca과 Mg 부족, N/Ca과 N/Mg 비의증가 및 잔뿌리 생장에 대한 Al 독성에 있었다. 그리고 수도권 지역에서 잔뿌리의 비정상적인 분포는 산성토양에서 Al 독성에 의한 잔뿌리의 생장감소가 그 원인으로 해석된다. The contents of major elements were determined in current-year and previous-year needles and fine roots of pitch pine (Pinus yzgida) at 33 sites in Seoul and its vicinity. Contrary to Ca and Al in needles, N, P, Mg and K contents in current-year needles were higher than those in previous-year needles. The N, P, K and Al contents in current-year needles in Seoul were not significantly different from those in rural areas. In contrast, Ca and Mg contents in needles in Seoul were significantly lower than those in suburbs and rural areas. The N /Ca and N /Mg ratios in needles in urban Seoul were higher than those in rural areas. Mg contents in fine roots in soil of 0-5 cm depth increased along with distance from the center of Seoul, while Al contents in fine root in soil of 5-10 cm depth decreased along with distance from the center of Seoul. Al contents in fine roots in soil layer in Seoul and suburbs were higher than those in rural areas. Al contents in fine roots in litter layer were 1 /3 - 1 /2 times lower than those in soil layer for all areas. A1 content in fine roots in deep soil was higher than that in top soil. Therefore growth decline of pitch pine in Seoul and suburbs was thought to be caused by Ca and Mg deficiency in plant tissues and Al toxicity to fine roots. Abnormal vertical distribution of fine roots of pitch pine in Seoul and its vicinity were interpreted as the result of growth reduction of fine roots by Al toxicity in deep layer of acid soil.

Fine-Needle Biopsy: Should This Be the First Choice in Endoscopic Ultrasound-Guided Tissue Acquisition?

Eun Young Kim 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5

Endoscopic ultrasound (EUS)-guided tissue acquisition is an indispensable technique for the diagnosis of many diseases of the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) is known for its high accuracy and low complication rate. However, the outcome of EUS-FNA highly depends on several factors such as the location and characteristics of the lesion, endosonographer’s experience, technique of sampling and sample preparation, type and size of the needle used, and presence of a cytopathologist for rapid on-site examination. EUS-guided fine-needle biopsy is useful to obtain core tissue samples with relatively fewer passes. Aspiration of core tissue with preserved architecture is beneficial for the diagnosis of certain diseases and the performance of ancillary testing such as tumor molecular profiling. Issues related to needle size, type, and their acquired samples for cytologic and histologic evaluation are discussed here.

세침 흡인 생검을 이용한 안와 후반부 종양의 진단

사호석,오동은,김윤덕,Ho-Seok Sa,Dong-Eun Oh,Yoon-Duck Kim 대한안과학회 2005 대한안과학회지 Vol.46 No.9

Purpose: To evaluate the effectiveness and safety of fine-needle aspiration biopsies of mass lesions located in the posterior orbit. Methods: Eight patients with mass lesions in the posterior orbit underwent fine-needle aspiration biopsy with 21-gauge needles using the freehand technique. Results: Fine-needle aspiration biopsies were performed easily and safely. One patient developed subconjunctival hemorrhage following biopsy, but no major complications were observed. Diagnostic specimens were obtained in 6 patients (75%). Of these diagnostic cases, 3 were benign, and the other 3 were malignant. In 3 of 6 patients we performed surgical excisions, while in the others we performed radiotherapy and/or chemotherapy. In 2 patients (25%) the cytologic specimens were inadequate. Conclusions: Fine-needle aspiration biopsy is useful and safe in evaluating orbital mass lesions, especially when they are not surgically accessible due to their location in the posterior orbit.

Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis

Benjamin D. Renelus,Daniel S. Jamorabo,Iman Boston,William M. Briggs,John M. Poneros 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2

Background/Aims: Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) andendoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clearsuperiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques. Methods: We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primaryoutcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologicaccuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and randomeffect models with pooled estimates of target outcomes were developed. Results: Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significantreduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There wasno difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64). Conclusions: FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should bereadily considered by endosonographers when evaluating solid pancreatic masses.

이하선 Warthin 종양의 세침흡인검사 후 발생한 육아종성 괴사 1예

오현식(Hyeon Sik Oh),이은섭(Eun Sub Lee),조용태(Young Tae Jo),권민수(Minsu Kwon) 대한두경부종양학회 2018 대한두경부 종양학회지 Vol.34 No.2

Fine needle aspiration is usually performed as a preoperative cytologic evaluation in salivary gland tumors, and complications of the lesion after fine needle aspiration are scarcely developed. The secondary change of tissue by fine needle aspiration can make the diagnostic and subsequent therapeutic difficulties for clinicians and require a careful approach. Fine needle aspiration can cause variety of changes in Warthin tumor, and it is presumed that those changes are mainly caused by the infarction of the mass due to vascular injury and following inflammatory reactions. We would introduce our experience of granulomatous and necrotic change after fine needle aspiration on parotid Warthin tumor with consequent difficulties in diagnostic and surgical approach to the patient.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

김동욱,김기남,노명호 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.5

Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia. Objective: This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. Materials and Methods: A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). Results: The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was administered. Four patients had an equivalent pain score for both treatments. This finding was also statistically significant (p = 0.001). Conclusion: In our study, patient pain scales were significantly lower when no local anesthesia was used prior to US-FNABs of thyroid nodules as compared to when local anesthesia was administered. Therefore, we believe that when one needle puncture is used, US-FNAB should be performed without administering local anesthesia.

갑상선 결절의 크기와 수술 전 세침흡인검사 결과가 갑상선절제술을 받은환자의 악성 진단에 미치는 영향

임휘빈,박유영,조재구,백승국,권순영,정광윤,우정수 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.6

Background and Objectives The frequency of ultrasonography and cytological examinations for thyroid nodules has increased. But the efficacy of fine needle aspiration biopsy varies according to the size of the nodules. The study aimed to identify the effect of thyroid nodule size on malignancy. Subjects and Method The medical records of patients who underwent total or hemithryoidectomy in a single tertiary hospital were retrospectively analyzed. A total of 204 nodules were obtained from 193 patients who underwent fine needle aspiration biopsy before thyroid surgery. After each nodule was classified by size, the results of the fine needle aspiration test and risk of the final diagnosis were evaluated using logistic regression analysis. Results The average size of 204 Bethesda class 2 (benign) nodules was 2.99 cm, which was larger than those of other classes (p<0.05). In the final histopathologic diagnosis, there was a difference in size between benign (2.41 cm) and malignant nodules (1.23 cm) (p<0.05). In addition, a logistic regression analysis showed that the nodules below 2.0 cm in size showed an odd ratio of 7.81, compared to the nodules larger than 2.0 cm (p<0.05). Conclusion According to the results of this study, malignancy was higher when the thyroid nodule was less than 2 cm. Therefore, a careful observation is needed for nodules less than 2 cm for which fine needle aspiration biopsy would be recommended. Conversely, it is necessary to reconsider the diagnostic surgery for nodules larger than 2 cm. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(6):308-13

Arterial Bleeding of a Thyroid Mass After Thyroid Fine-Needle Aspiration Biopsy: A Case Report

박철희,변성수,김정호,황희영,김하나,정동진,김형식 대한영상의학회 2009 대한영상의학회지 Vol.60 No.6

Thyroid fine needle aspiration biopsy is a very common procedure that is used to assess thyroid nodules; any complications from this procedure are rather rare. We report here on an unusual case of active bleeding with the formation of a large hematoma from a branch of the superior thyroidal artery, and this was caused by a thyroid fine needle aspiration biopsy. To the best of our knowledge, this is the first report of active arterial bleeding after thyroid fine needle aspiration biopsy. The active bleeding was successfully treated by interventional embolization.