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e72
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
OC.01 Endoscopy 1
OC.01.1
THE VALUE OF CONTRAST ENHANCED ENDOSCOPIC ULTRASOUND
IN THE FINE NEEDLE ASPIRATION
Tavani R.*
1
, Spezzaferro M.
2
, Della Sciucca A.
2
, Grossi L.
1
,
Ciccaglione A.F.
1
, Marzio L.
1
1
G. D’Annunzio University, Pescara, Italy,
2
P.O. S.Massimo Penne, Penne,
Italy
Background and aim:
Background:
The diagnosis of pancreatic
neoplasia can be reached with endoscopic ultrasound-fine needle
aspiration (EUS-FNA) that allows pancreatic tissue sampling.
However EUS-FNA is associated with a high risk of false-negative or
nondiagnostic results mainly due to inadequate biopsy specimens.
Contrast-enhanced harmonic endoscopic ultrasound (CH-EUS)
consists of an ultrasound scan performed after the infusion of
microbubbles of sulfur hexafluoride stabilized by a lipid monolayer
membrane (Sonovue®, Bracco, Italy) about one third of a Red Blood
Cell in size that produce a Doppler signal in the microvasculature
and are not absorbed by the parenchymal cell. With Sonovue an
accurate image of the vascular pattern of the pancreatic parenchyma
may be achieved without the artifacts of the classical Doppler EUS
and small lesions may be better identified.
Aims:
To evaluate whether the use of CH-EUS allows an improvement
in the identification of pancreatic masses in order to increase the
diagnostic yield of the EUS-FNA.
Material and methods:
A total of 29 patients with pancreatic solid
lesions were enrolled in the study. Nineteen patients underwent to
EUS-FNA and 10 were studied with the same procedure preceded by
of intravenous infusion Sonovue. All masses were punctured with a
minimum number of 4 passes. The adequacy of biopsy specimens
obtained by FNA was compared between the two groups.
Results:
Of the 19 patients undergoing EUS-FNA, in 4 cases (21%)
a non diagnostic cytology was obtained, while in 15 cases (79%)
a definitive diagnosis could be defined. Eight patients (53%) has
a cytologic diagnosis of malignancy and 7 (47%) of benign lesion.
None of the 10 patients who underwent to FNA preceded by CH-EUS
had an inadequate cytology for a definitive diagnosis. In all cases
the biopsy sampling was adequate to allow a definitive diagnosis.
In 6 patients (60%) a benign lesions was identified and in 4 (40%) a
malignant mass diagnosed.
Conclusions:
This study shows that a better view of the pancreatic
lesions vascularity by means of CH-EUS allows locate the proper
area for biopsy sampling improving the results of conventional EUS-
FNA and the probability to reach definitive diagnosis.
OC.01.2
PRELIMINARY RESULTS OF MACROSCOPIC VISUAL ADEQUACY
EVALUATION OF EUS-FNA SAMPLES
Mariniello A.*, Picconi F., Rea R., Guerra L., Pandolfi M.,
Di Matteo F.M.
Campus Bio-Medico, Roma, Italy
Background and aim:
The evaluation on site (ROSE) appears to have
a significant impact on EUS-FNA success rate, but the presence of a
cytopathologyst during the procedure is not guaranteed in all the
endoscopic centers. Macroscopic on-site evaluation (MOSE) was
efficacy to estimate the adequacy of a core specimen for histologic
diagnosis during EUS-FNA using a 19-G needle. Recently, increased
adequacy of EUS-FNA was reported even when ROSE was performed
by an expert endosonographer (79% vs 97%). Aim of this study was
to assess the relation of macroscopic visual adequacy (MVA) in the
FNA specimens and the diagnostic yields.
Material and methods:
A total of 17 patients, who underwent to
EUS-FNA, were prospectively enrolled. Macroscopic visual adequacy
(MVA) was performed evaluating each FNA pass in Cytorich®Red
Preservative Fluid prepared for cell block study. MVA was assessed
in terms of presence of blood (much, scant, absent or presence
of clots), frustule >3 mm (short, long, whitish or red, absent) and
fragments <3mm (representative, little representative, absent). EUS-
FNA was performed with 22-or 25-G needle.
Results:
There were 12 men and 5 women, 66±8.34 years old.
Thirteen were pancreatic solid lesions and four lymphadenopathy.
Median of needle passes was 3.7±0.85. When frustules or fragments
were absent, sample was not adequate. Among 17 EUS-FNA, 63
needle passes were performed: 11 passes (18%) with 22-G and 52
passes (83%) with 25-G needle. 17.5% samples were inadequate on
MVA and 14% were inadequate to the cytological diagnosis. 89%
samples were adequate on MVA and to cytological diagnosis.
Conclusions:
MVA can be an indicator of specimen adequacy and
could help to reduce number of EUS-FNA passes.
OC.01.3
ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION,
CELL-BLOCK APPROACH: EXPERIENCE IN A SINGLE CENTER
Armellini E.*, Crinò S.F., Pizio C., Leutner M., Ballarè M., Boldorini R.,
Occhipinti P.
Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
Background and aim:
Endoscopic ultrasound guided fine needle
aspiration (EUS-FNA) represents a pivotal diagnostic adjunct for
diagnosis of tumors of the gastrointestinal tract and of adjacent
structures.
EUS-FNA achieves a correct diagnosis in the majority of cases,
nevertheless cytological diagnosis may be missing due to the
presence of necrotic tissue, inflammation, tissue contamination by
mucosal cells or poor samples. European Society of Gastrointestinal
Endoscopy published the guidelines for EUS guided sampling, which
relies on factors involving the endoscopist and the cytopathologist
(expertise, training and reciprocal interaction) as well as the lesion
(size, site and echo-pattern).
It is reported in the literature that cell-block may increase the
diagnostic yeald of the procedure by preserving the tissue. In
particular, it offers the possibility of multiple sections allowing,
besides H&E staining, immunohistochemistry or molecular analysis.
Our aim is to evaluate the diagnostic sensibility and specificity of
EUS-FNA with cell-block tissue processing.
Material and methods:
We included all consecutive patients
undergoing EUS-FNA with cell-block procedure Between September
2014 and September 2015 in the Maggiore della Carità Hospital-
Novara (Italy).
Standard EUS FNA needles (19-22-25 G) were used, without on site
cytological evaluation.
Needle content was washed in lysing solution and centrifuged at
1,800g to prepare cell blocks; the pellet was congealed using human
plasma and thrombin with buffered formalin fixation. Subsequently,
paraffin-embedded cell blocks were prepared and sections obtained
by cutting cell blocks. Transferred to glass slides sections were
stained with H&E and investigated with immunohistochemical
analysis when required to define the histotype. DNA extraction and
appropriate molecular analysis were performed.
Adequacy and correct diagnosis were calculated on the base of
surgical specimens, clinical and radiological follow-up.
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