Procore and Flexible 19 Gauge Needle Can Replace Trucut Biopsy Needle?

방지영,Shyam Varadarajulu 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.5

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is routinely performed for establishing tissue diagnosis in patients with gastrointestinal tumors. The concept of delivering chemotherapy based on molecular markers and the ability to establish a reliable diagnosis in lieu of an onsite cytopathologist has fuelled the recent trend in procuring core tissue by means of EUS-guided fine needle biopsy. To overcome the technical limitations induced by the rigidity of the Trucut biopsy needle, a new ProCore needle with reverse bevel technology has been developed. Recent data suggests that the newly developed flexible 19 G needle can also procure core tissue and has easy maneuverability when navigating the transduodenal route. Irrespective of the needles being used, the best clinical outcomes can be attained only by practicing evidence-based techniques, procuring adequate quantity of sample for ancillary studies, and processing the specimens appropriately.

Prostate Cancer Screening in a Healthy Population Cohort in Eastern Nepal: an Explanatory Trial Study

Belbase, Narayan Prasad,Agrawal, Chandra Shekhar,Pokharel, Paras Kumar,Agrawal, Sudha,Lamsal, Madhab,Shakya, Vikal Chandra Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.5

Background: Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer, and it ranks among the top ten specific causes of death in males. Objective: To explore the situation of prostate cancer in a healthy population cohort in Eastern Nepal. Materials and Methods: This study was conducted in the Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010 to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in the study and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal. Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessment of serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormal PSA/DRE findings. Results: A total of 1,521 males more than 50 years of age were assessed and screened after meeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ${\leq}4.0$ ng/ml. Abnormal PSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were both abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%) and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% and a positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 19.0% Conclusions: The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.

다양한 질환에서 내시경초음파 유도하 Trucut 조직검사의 진단적 활용

이진호,이정환,송정훈,옥경선,장원철,류수형,김유선,문정섭 대한소화기내시경학회 2010 Clinical Endoscopy Vol.40 No.1

Background/Aims: Endoscopic ultrasound-guided trucut biopsy (EUS-TCB) is a relatively new method, which facilitates obtaining a core biopsy through the gut wall. We evaluated the diagnostic accuracy of EUS-TCB based on the types of lesions. Methods: We retrospectively reviewed the database of 37 cases in 35 patients (mean age, 57.2±2.3 years; 23 men) with thoracic and abdominal masses who got EUS-TCB between January 2007 and June 2008. Final diagnoses were determined by malignant positive EUS specimens, surgical pathology, or the clinical course. Results: Adequate samples were obtained by EUS-TCB in 78.4% (29/37) of the cases. The overall diagnostic accuracies of the EUS-TCB were 73.0%. The mean size of the masses was 3.7±2.6 cm. The diagnostic accuracies of EUS-TCB according to the lesions were as follows: lymph node, 85.7% (18/21); subepithelial lesion, 60.0% (6/10); and solid tumor, 50% (3/6). With respect to accuracy, lymph nodes were significantly superior to non-lymph node lesions (p=0.046). There was a minor bleeding controlled by hemoclipping (2.7%). Conclusions: EUS-TCB is a useful technique for the diagnosis of lymph nodes, subepithelial tumors, and solid tumors that were not able to be diagnosed by other methods. In addition, EUS-TCB is a safe and minimally invasive method. 목적: 내시경초음파 유도하 Trucut 조직검사는 경피적 접근이 어려운 종격동 병변과 위장관 간질종양의 진단에 유용한 방법으로 최근 소개되고 있다. 본 연구에서는 내시경초음파 유도하 Trucut 조직검사를 이용하여 림프절, 상피하 병변, 고형 장기에서 진단적 활용을 평가하고자 하였다. 대상 및 방법: 2007년 1월부터 2008년 6월까지 서울백병원에서 흉부와 복부 종괴가 있어 내시경초음파 유도하 Trucut 조직검사를 시행한 환자를 후향적으로 분석하였다. 이들 종괴의 최종 진단은 Trucut 조직검사에서 악성 세포가 진단되거나 수술 후 병리 소견 혹은 임상 경과로 판단하였다. 결과: 총 35명 환자, 37예의 시술 중 남자는 25명(65.7%), 여자는 12명(34.3%), 평균 연령은 57.2±12.3세였다. 내시경초음파 유도하 Trucut 조직검사를 이용하여 적절한 조직은 37예 중 29예(78.4%)에서 확보할 수 있었다. 내시경초음파 유도하 Trucut 조직검사를 이용한 진단의 정확도는 73.0%였다. 종괴의 평균 크기는 3.7±2.6 cm였다. 병변에 따른 정확도는 림프절 85.7% (18/21), 상피하 병변 60% (6/10), 고형 종양 50% (3/6)였다. 림프절은 비림프절 병변에 비해 진단의 정확도가 통계적으로 유의하게 높았다(p=0.046). 합병증으로는 경도의 출혈이 1예에서 발생하여 내시경을 이용한 클립으로 지혈할 수 있었다. 결론: 내시경초음파 유도하 Trucut 조직검사는 경피적으로 접근하기 힘든 림프절, 상피하 병변, 고형 장기의 진단적 활용에 유용하며 특히 림프절의 경우 정확성이 높은 안전한 검사 방법이다.

Original Article : Rescue Endoscopic Ultrasound (EUS)-Guided Trucut Biopsy Following Suboptimal EUS-Guided Fine Needle Aspiration for Mediastinal Lesions

( Min Cho Chang ),( Mohammad Al Haddad ),( Julia K. Leblanc ),( Stuart Sherman ),( Mchenry Lee ),( John Dewitt ) 대한간학회 2013 Gut and Liver Vol.7 No.2

Background/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and Trucut biopsy (TCB) are sensitive techniques for diagnosing mediastinal lesions, but it is unclear how either one or both should be used to obtain a pathologic diagnosis. The objective of our study was to evaluate whether EUS-TCB impacts the diagnosis of mediastinal lesions after the initial on-site review of EUS-FNA specimen suggests a suboptimal result. Methods: We enrolled consecutive patients with mediastinal lesions who underwent EUS-TCB during the same procedure if the initial EUS-FNA demonstrated an inadequate FNA sample or suggested that histopathology was required for diagnosis. Diagnostic accuracies between procedures were compared as the main outcome. Results: Twenty-seven patients (14 men; median age, 56 years; range, 19 to 82 years) underwent EUS-FNA and EUS-TCB to evaluate a mediastinal lymphadenopathy or mass (n=17), to determine the cancer stage (n=3) or to exclude tumor recurrence or metastasis (n=7). The overall diagnostic accuracies of EUS-FNA and EUS-TCB were 78% and 67%, respectively (p=0.375). The combined diagnostic accuracy of EUS-FNA plus EUS-TCB was 82%. In six patients with nondiagnostic EUS-FNA, EUS-TCB provided a final diagnosis in one patient (17%). Conclusions: In the current series of patients with mediastinal masses or adenopathy, the administration of EUS-TCB following suboptimal results for the on-site cytology review did not increase the diagnostic yield. (Gut Liver 2013;7:150-156)

Gastric Schwannoma Diagnosed by Endoscopic Ultrasonography-Guided Trucut Biopsy

홍성욱,조원영,김진오,천창균,심광연,복진현,엄욱현,이지은 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.3

Schwannomas of the gastrointestinal (GI) tract are rare subepithelial tumors comprising approximately 3.3% to 12.8% of all mesenchymal tumors of the GI tract. On endoscopic ultrasound (EUS) they are seen as hypoechoic tumors arising most commonly from the 4th proper muscle layer. Although EUS helps to distinguish tumor characteristics, tissue sampling is required for differentiation with other more common tumors such as GI stromal tumors. Both EUS-guided fine needle aspiration and EUS-guided trucut biopsy (EUS-TCB) can be used for tissue sampling. However, only EUS-TCB allows core biopsy and a high yield of immunohistochemical staining. We report a case of a gastric schwannoma diagnosed by EUS-TCB.