• Users Online:461
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
REVIEW
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 77-85

Endoscopic ultrasound-guided fine needle aspiration: From the past to the future


1 Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania
2 Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark
3 Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania; Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark

Date of Submission26-Dec-2012
Date of Acceptance20-Feb-2021
Date of Web Publication6-Sep-2013

Correspondence Address:
Adrian Saftoiu
Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania; Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.117691

Rights and Permissions
  Abstract 

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained through aspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung, etc. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is supe­rior to computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detection of malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist during EUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently the procedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagno­sis of solid pancreatic masses.

Keywords: endoscopic ultrasound; fine needle aspiration; confocal laser endomicroscopy


How to cite this article:
Costache MI, Iordache S, Karstensen JG, Saftoiu A, Vilmann P. Endoscopic ultrasound-guided fine needle aspiration: From the past to the future. Endosc Ultrasound 2013;2:77-85

How to cite this URL:
Costache MI, Iordache S, Karstensen JG, Saftoiu A, Vilmann P. Endoscopic ultrasound-guided fine needle aspiration: From the past to the future. Endosc Ultrasound [serial online] 2013 [cited 2019 Jan 19];2:77-85. Available from: http://www.eusjournal.com/text.asp?2013/2/2/77/117691


  Introduction Top


Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is a technique which allows the study of human cells obtained through aspiration in different locations near the gastrointestinal tract. The procedure is usually performed after detection of a suspected mass through other imaging methods, including endoscopy, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), etc. [1] Thus, FNA is a minimally invasive method for cytological sampling of peripheral and deep-seated mass lesions. [2]

The attachment of ultrasound probes to endoscopes in the early 1980s (by DiMagno) [3] allowed an improved visualization of the gastrointestinal wall and abdominal organs [4] . Nevertheless, a need for tissue diagnosis was evident from the early work on EUS. [5] EUS-FNA has started in 1991 for pancreatic cancer [6] and at present is performed on a routine basis at many endoscopic centers, being evident that this procedure has a major impact on the therapeutic management of patients, by obtaining a definite tissue diagnosis from lesions outlined by EUS [7] . The ability to obtain cytologic material under direct visualization adds a new dimension to the diagnostic usefulness of this technique because it offers an opportunity for prompt and accurate diagnosis. [4]

EUS-FNA is used to acquire tissue from mucosal/ submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung, etc. [8] Based on the published literature, the pancreas and lymph nodes (intra-thoracic and intra-abdominal) are the most common organs targeted in EUS-FNA. [4]

Even though the EUS-FNA technique started twenty years ago, there are remarkable progresses culminating nowadays with the application of through the needle-based confocal laser endomicroscopy (CLE) methods that allow real-time optical biopsies.


  From The Past… Top


It is obvious that EUS-FNA is not at all limited to gastroenterology, as the gastrointestinal tract traverses through anatomical regions related to other medical specialties such as pulmonology, thoracic surgery, internal medicine, oncology, urology, gynecology and endocrinology. [7], [9] In the early 1990s, a special biopsy equipment was developed by Peter Vilmann and SĠren Hancke in collaboration with Medi-GlobeGmbH, Tόbingen, Germany, and this gave the final breakthrough for the EUS-guided biopsy method. [6], [7], [9] All needle assemblies that are commercially available today have basically similar characteristics and designs [Figure 1]A, B and C.
Figure 1: Initial designs of the endoscopic ultrasound-guided fine needle aspiration needle (Vilmann-Hancke needle).

Click here to view


Nevertheless, FNA was developed many centuries ago. The first report on the use of needles for therapeutic purposes can be found in the most influential book of Arab Medieval Medicine, who described for the first time therapeutic punctures of the thyroid gland, using instruments resembling modern aspiration needles. But the last century showed remarkable progress in terms of FNA, the use of surgical needles for the diagnosis and treatment of various diseases being widely used. [1] In 1912, a German haematologist, Hans Hirschfield (1873-1944), reported on FNA biopsy for diagnosis of cutaneous lymphomas and other tumors with the use of needle aspiration biopsy and histological process of the acquired cellular material. [10] Leonard Stanley Dudgeon was the first who scientifically established the technique of needle biopsy, [11] while Hayes Martin and Edward Ellis [12],[13] applied needle biopsies on a wide range of samples and clinical cases. But, the first report of the use of fine (22-G) needle should be attributed to Ernst Manheim (a German pathologist), in 1931. [14]

Diagnostic role of EUS-FNA

The first EUS-FNA for cytologic diagnosis of a pancreatic lesion was performed by Peter Vilmann in 1991 [Figure 2] and published in 1992. [6] His thesis which is considered a landmark study was published as a book on EUS using curved linear array transducer with description and development of the biopsy needle and the EUS-FNA procedure [Figure 3] [9] , EUS-FNA from upper and lower gastrointestinal tract was further described in 1992 in separate studies by Wiersema et al. [15] and Vilmann et al. [2],[6] The regional anatomy of the pancreas is complex, making procurement of cytologic samples difficult without exploratory laparotomy. Traditionally, transcutaneous ultrasound, CT or EUS-FNA has been used for imaging guidance of the needle to obtain biopsies of the pancreas. [16] Since its development in the 1980s, EUS has been found utility in the investigation and staging of suspected pancreatic cancer. As compared to other imaging modalities (CT, MRI), EUS has the advantages of a better detection rate of pancreatic lesions under 3 cm in size and the ability to collect samples for cytopathologic analysis, being an integral part of the diagnosis and staging of pancreatic tumors. [17] Thus, the overall accuracy of EUS is superior to CT scan and MRI for detecting pancreatic lesions. [4],[18],[19],[20],[21] Actually, the main role of EUS-FNA in pancreatic lesions is to obtain the tissue diagnosis in suspected pancreatic masses. Thus, in most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. [4] A medical literature review to evaluate the role of EUS-FNA for diagnosis of solid pancreatic masses showed a 78%-95% sensitivity, 75%-100% specificity, and 78%-95% accuracy, [17],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33] confirming that EUS-FNA is an effective and safe method to obtain a cytological diagnosis of pancreatic tumors. [30]
Figure 2: Endoscopic ultrasound (EUS)-guided fine needle aspiration consisting of a linear EUS scope with the FNA needle exiting the biopsy channel in the plane of the ultrasound image.

Click here to view
Figure 3: Initial thesis was considered a landmark study and published as a book on endoscopic ultrasound (EUS) using curved linear array transducer with description and development of the biopsy needle and the EUS-guided fine needle aspiration procedure.

Click here to view


Many studies have noted the importance of performing EUS-FNA for mediastinal and intra-abdominal lymph nodes. Most of these studies have evaluated the use of EUS-FNA in the staging of malignant neoplasms of the lung, gastrointestinal tract, and pancreas [4] but many other such as sarcoidosis [34] , lymphomas [35] and tuberculosis [36] have been diagnosed by this method. Lymph node staging and the detection of metastatic lesions are essential issues of pancreatic cancer staging. EUS-FNA allows for sampling of suspicious-appearing lymph nodes and liver lesions. EUS-FNA has been shown to increase the accuracy of lymph node staging and thereby reduce the number of unnecessary surgical interventions. [16]

A meta-analysis from 76 studies (9310 patients) on mediastinal lymph nodes, demonstrated that FNA improved the sensitivity (from 84.7% to 88%) and specificity (from 88% to 96.4%) compared to EUS imaging alone. [37] Thus, EUS-FNA should be the diagnostic test of choice for assessment of mediastinal lymph nodes. [38],[39] A recent study also demonstrated an excellent specificity (100%) and a high accuracy (90%) for EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer, indicating that the procedure has a high clinical impact. [40]

Some meta-analyses and multicenter studies evaluated the accuracy of EUS-FNA in diagnosing other organ lesions like: mucinous pancreatic cystic neoplasms, solid pseudopapillary tumors, autoimmune pancreatitis, metastatic lesions of the pancreas, bile duct strictures and gallbladder masses, esophageal and gastric cancer, gastrointestinal stromal tumors (GISTs), non-small cell lung cancer staging, etc. [41],[42],[43],[44],[45],[46],[47],[48],[49] For diagnosing mucinous pancreatic cystic lesions, EUS-FNA has a pooled sensitivity of 63% and specifcity of 88%. [42],[50],[51],[52] Over a 6-year period, a retrospective, multicenter study demonstrated the usefulness of EUS-FNA in diagnosing a rare but important cause of focal pancreatic lesions (metastatic lesions of the pancreas). [44],[53],[54],[55],[56] Another meta-analysis (including 284 patients) has shown that EUS-FNA has a pooled sensitivity of 84% and a pooled specifcity of 100% in the evaluation of bile duct strictures and gallbladder masses. [45] A meta-analysis has also demonstrated that EUS-FNA substantially improves the sensitivity (from 84.7% to 96.7%) and specificity (from 84.6% to 95.5% ) compared to EUS imaging alone in evaluating N stage disease of esophageal cancer. [46],[57],[58],[59],[60],[61] Last, but not least, a recent study (over a 4-year period), has shown that the EUS-FNA performance characteristics for diagnosing GISTs yielded a sensitivity of 82%, a specificity of 100%, and an overall accuracy of 86%. [48],[61],[62],[63] Thus, EUS-FNA is an extremely valuable tool for diagnosing and characterizing submucosal lesions of the upper gastrointestinal tract. [49]

How to decrease the rate of false negative?

The specificity of EUS can be increased close to 100% with FNA with an accuracy of 95%. However, the negative predictive value of EUS-FNA is relatively low, especially when the diagnosis of pancreatic lesions is suspected. Data from the medical literature for diagnosis of solid pancreatic masses using EUS-FNA showed a 46%-80% negative predictive value. [17],[22],[23],[24],[25],[26],[27],[28],[31] For lymph nodes, the negative predictive value of EUS-FNA is higher, approximately 80% (78% - 85%). [16],[32],[33],[34],[35],[36],[37],[38],[39],[40] Hence, negative results do not completely exclude malignancy. Therefore, the need for routine EUS-FNA of potentially resectable pancreatic mass lesions noted on other imaging modalities is still controversial. [64],[65]

For effective assessment of the EUS-FNA samples, a cytopathologist or an advanced trainee in cytopathology should be on site to ensure that the samples taken are adequate. The presence of a cytopathologist during EUS-FNA, improves the diagnostic yield, decreasing unsatisfactory samples, reducing the need for additional passes, and consequently the procedural time. [4],[8] In many centers, EUS-FNA samples are obtained by the endoscopist and samples are sent in a fixative to the cytopathology laboratory for sample preparation. In other institutions, technologists and trainees in cytopathology go to the endoscopy suite and provide on-site assessment of sample adequacy. In a few centers, cytopathologists go to the endoscopy suite and provide an on-site, prompt interpretation. [4] So, onsite cytopathological assessment is accepted as a quality control measure for EUS and is the standard of care at most academic EUS centers. In a recent study of 182 patients with pancreatic masses who underwent EUS-FNA, the presence of an on-site cytopathologist was associated with a significantly lower number of inadequate samples and a higher diagnostic sensitivity. [66],[67],[68],[69]

But another emerging concept is telecytopathology which may be a valid substitute for onsite cytopathologic evaluation. The slides are initially prepared and prescreened by a cytotechnologist or pathology resident and then analyzed by an offsite cytopathologist using real-time remotely operated system. [64] A retrospective study demonstrated the potential use of telecytopathology as a valid substitute for onsite evaluation of pancreatic carcinoma by EUS-FNA. [70]

A retrospective review showed that the cytotechnologists and cytopathologists are comparably accurate in on-site evaluations of adequacy of EUS-guided pancreatic FNA. The adequacy and accuracy of the on-site evaluation increases with institutional experience, and this increase is not solely attributable to cytologist factors. [71],[72]

The goal of performing FNA is to obtain a positive diagno sis in the quickest possible time with the least number of passes. The number of passes to be made depends on the presence or absence of on-site cytopathologist for assessment of specimen adequacy, for establishment of on-site diagnosis, and to guide the need for further sampling. In the absence of an on-site cytopathologist, adequate number of passes should be performed to avoid the need for repeat procedures. [8] Studies have shown that with solid pancreatic mass lesions, the optimal number of EUS-FNA needle passes ranged from 2 to 6. [73],[74] Moreover, using suction increases the diagnostic yield of a higher number of slides without increasing bloodiness. [75][Figure 4]
Figure 4. Endoscopic ultrasound-guided fine needle aspiration performed with a 22-G needle on the side of a hypoechoic pancreatic tumor mass, with both cytology and microhistology performed after at least 3 passes. Cytology showed a clump of malignant cells, while microhistology confirmed the diagnosis of adenocarcinoma.

Click here to view


The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. 19-G needles seem to be able to provide a higher amount of tissue material as compared to 22-G needles, without supplemental complications. Anyway, EUS-FNA with a 19-G aspiration needle may be a valuable method for the diagnosis of pancreatic/peri-pancreatic masses when the cytopathologist is not available in endoscopy room. [76] There was no difference in accuracy, number of passes or complications between 25-G and 22-G needles. Anyway, targeting of lesions in the distal duodenum may be easier by using the 25-G needle due to less friction and easier penetration. [77] Another recent study demonstrated that with an adequate tissue sample, broad application of cytometry and immunohistochemistry increased the diagnostic yield of EUS-FNA. [78] Recently, EUS-FNA biopsy can be performed with a new 19-G histology needle, being feasible for histopathology diagnosis of intraintestinal and extraintestinal mass lesions, offering the possibility of obtaining a core sample for histological evaluation in the majority of cases, with an overall diagnostic accuracy of over 85%. [79][Figure 5]
Figure 5: Needle based confocal laser endomicroscopy (nCLE) image of pancreatic tissue using fluorescein as a systemic contrast agent, presenting grey lobular structures of tissue with thin white lines crossing representing fibrosis in a patient with chronic pancreatitis. Another nCLE image of pancreatic tissue, demonstrating dark lobular structures and large vessels obtained in a patient with pancreatic ductal carcinoma.

Click here to view


However, EUS-FNA is technically challenging and requires special training, being a difficult technique to master, with a prolonged learning curve. The American Society for Gastrointestinal Endoscopy (ASGE) recommends that for "comprehensive competence in all aspects of EUS, a minimum of 150 supervised cases, of which 75 should be pancreaticobiliary, and 50 EUS-FNA" should be performed. The current ASGE guideline of 25 supervised EUS-FNA procedures for the diagnosis of pancreatic adenocarcinoma is reasonable. [80],[81],[82],[83],[84]


  To the Future Top


CLE is a novel endoscopic method that was first introduced in 2004 into the endoscopist's toolbox. [85] Whereas techniques such as chromoendoscopy and conventional magnification endoscopy try to predict histology from mucosal patterns, CLE actually allows intravital microscopy of the human gastrointestinal mucosa during ongoing endoscopy, enabling real-time optical biopsy. [86]

CLE is based on tissue illumination with a low-power laser with subsequent detection of the fuorescence light refected from the tissue. [87], [88] Confocal imaging can be based on tissue reflectance or tissue fluorescence. [89], [90] CLE based on tissue fluorescence uses local and/or intravenous contrast agents and generates high-quality images comparable with traditional histological examination. The contrast agents can be applied systemically (fuorescein, tetracycline) or topically (acrifavine, cresyl violet) by using a spraying catheter. [90] Development of organ- and tissue-specific contrast agents will further expand the indications for confocal endomicroscopy, which can potentially be used to assess extraluminal (e.g., biliary, pancreatic, intraperitoneal) pathology.

Since the first description of use of an endoscope-based CLE (eCLE) system in humans in 2004, the technology of eCLE has been studied for several indications. These include use to identify Barrett esophagus, esophageal and gastric cancer, gastric intestinal metaplasia, celiac disease, colorectal polyps, ulcerative colitis surveillance, graft-versus-host disease, biliary tract strictures, pancreatic cysts, and use in association with endoscopic mucosal resection. [91],[92],[93],[94],[95],[96] Recent technology allows a confocal miniprobe (pCLE) to be passed through the biopsy channel of the endoscope, while the optical biopsy images are usually co-registered with the histopathology results performed at the conclusion of pCLE imaging. Based on the same CLE system, microprobe-based CLE has been combined with EUS-guided puncture of pancreatic cystic lesions, a procedure termed needle-based CLE (nCLE), in a proof-of-principle approach. Although follow-up trials are to be awaited, nCLE may be proved valuable in the evaluation of such cystic lesions [97] , but also focal masses [98] .

Molecular markers

Pancreatic cancer is characterized by a variety of molecular alterations [99] , and therefore, identifcation and quantifcation of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses. [100] EUS-FNA can provide material for molecular biology analysis [101] ; moreover EUS-FNA allows the extraction of suffcient quantities of RNA to perform quantitative real­time polymerase chain reaction (PCR) analysis [99] , which is currently the most accurate method for detecting differential gene expression. A recent study demonstrated that molecular studies on EUS-FNA material (using low density array on EUS-FNA biopsies from solid pancreatic masses) are promising investigational techniques for the identification and quantifcation of markers in pancreatic adenocarcinoma patients diagnosed with non-resectable tumors. [102]

Accurate diagnosis of malignant and benign pancreatic masses can be challenging, potentially delaying treatment for cancer and subjecting patients with benign disease to unnecessary surgery. EUS-FNA of pancreatic masses remains inconclusive in a subset of patients and several other innovative approaches have been proposed. Broad panel microsatellite loss and k-ras point mutation analysis can be reliably performed on EUS-FNA samples from pancreatic masses and improves the diagnostic accuracy. Furthermore, it accurately differentiates between malignant and benign pancreatic masses. [103] K-ras mutation analysis may be helpful in patients with suspected pancreatic ductal adenocarcinoma (PDAC) yet inconclusive EUS-FNA findings, a study from this year demonstrating that k-ras mutations were extremely rare in pancreatic inflammation and other pancreatic tumors. [104],[105] Autoimmune pancreatitis may mimic pancreatic cancer, and thus the detection of DNA mutations in EUS-FNA material may improve discrimination between autoimmune pancreatitis and pancreatic cancer. A k-ras mutation in EUS/FNA material from a pancreatic mass is associated with malignancy and may help to discriminate from benign conditions such as autoimmune pancreatitis. [106] Mucins (MUC) are aberrantly expressed in various malignancies, [107] while alterations in mucin glycosylation and expression have been described in cancer. MUC7 could serve as a potential biological marker to identify malignant lesions, especially pancreatic adenocarcinoma. [101] Another approach is to use mismatch excision repair (MMR), a DNA repair system that eliminates mismatched base pairs and it plays an important role in the maintaining of genomic integrity. The use of MMR genes for the differentiation between pseudotumoral chronic pancreatitis and pancreatic cancer using a minimally invasive sampling technique could be a promising technique. [99]

In conclusion, large-scale gene analysis has been widely proposed as a powerful method for diagnosis of malignancy, but also to predict prognosis, invasion and metastasis through the identification of biomarkers. Future studies will clarify the role of molecular markers-based techniques associated with EUS-FNA.


  Conclusions Top


EUS-FNA is used to acquire tissue from different tissue structures located in the vicinity of the gastrointestinal tract. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. This minimally invasive procedure has an excellent sensitivity and specificity for the diagnosis of solid pancreatic masses and lymph nodes. Nevertheless, the negative predictive value of EUS-FNA is relatively low, especially for the diagnosis of pancreatic neoplasms. There are several issues to be taken into consideration to improve this: the presence of a cytopathologist during the procedure or the alternative of telecytopathology, application of immunohistochemistry, performance of various sampling techniques, including fine needle aspiration biopsy (FNB), the prolonged learning curve, etc. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of nCLE. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses


  Acknowledgments Top


Establishement of nCLE in Copenhagen was possible based on the contribution of A.P. Mäller and Chastine McKinney Mällers Foundation, The Foundation of Arvid Nilsson, Foundation Juchum, The Toyota Foundation Denmark, Lundbeck Foundation and The Foundation of Aase and Ejnar Danielsen. The activity of several authors (CMI, SI, AS) was supported by the research grant "Minimal invasive assessment of angiogenesis in pancreatic cancer based on imaging methods and molecular techniques (Angio-PAC)", Ideas programme, 164/2011, NRC - UEFISCDI, project number PN-II-ID-PCE-2011- 3-0589. Also, a great thanks to Pia Helene Klausen and Daniela Burtea, they have been of great help organizing the work in both centers.



 
  References Top

1.Diamantis A, Magiorkinis E, Koutselini H. Fine-needle aspiration (FNA) biopsy: historical aspects. Folia Histochem Cytobiol 2009: 47: 191-7.  Back to cited text no. 1
    
2.Logroño R, Waxman I. Interactive role of the cytopathologist in EUS-FNA. Gastrointest Endosc 2001; 54: 485-90.  Back to cited text no. 2
    
3.DiMagno EP, Buxton JL, Regan PT, et al . Ultrasonic endoscope. Lancet 1980; 1: 629-31.  Back to cited text no. 3
[PUBMED]    
4.Jhala NC, Jhala DN, Chhieng DC, et al . Endoscopic Ultrasound- Guided Fine-Needle Aspiration: A Cytopathologist's Perspective. Am J Clin Pathol 2003; 120: 351-67.  Back to cited text no. 4
[PUBMED]    
5.Caletti GC, Brocchi E, Ferrari A, et al . Guillotine needle biopsy as a supplement to endosonography in the diagnosis of gastric submucosal tumors. Endoscopy 1991; 23: 251-4.  Back to cited text no. 5
[PUBMED]    
6.Vilmann P, Hancke S, Henriksen FW, et al . Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992; 38: 172-3.  Back to cited text no. 6
    
7.Vilmann P, Saftoiu A. Endoscopic ultrasound-guided fine needle aspiration biopsy: Equipment and technique. J Gastroenterol Hepatol 2006; 21: 1646-55.  Back to cited text no. 7
    
8.Ramesh J, Varadarajulu S How can we get the best results with endoscopic ultrasound-guided fine needle aspiration? Clin Endosc 2012: 45: 132-7.  Back to cited text no. 8
    
9.Vilmann P. Endoscopic ultrasonography with curved array transducer in diagnosis of cancer in and adjacent to the upper gastrointestinal tract. Scanning and guided fine needle aspiration biopsy [Dissertation]. Copenhagen: Munksgaard, 1998.  Back to cited text no. 9
    
10.Hirschfield H. Über isolierte aleukämische Lymphadenose der Haut. Z Krebsforsch 1912; 11: 397-407.  Back to cited text no. 10
    
11.Dudgeon LS, Patrick SV. A new method for the rapid microscopical diagnosis of tumors: with an account of 200 cases so examined. Br J Surg 1927; 15: 250-61.  Back to cited text no. 11
    
12.Martin H, Ellis E. Biopsy by needle puncture and aspiration. Ann Surg 1930; 92: 169-81.  Back to cited text no. 12
    
13.Martin H, Ellis E. Aspiration biopsy. Surg Gynecol Obstet 1934; 59: 578-89.  Back to cited text no. 13
    
14.Mannheim E. Die Bedeutung der Tumorpunktion für die Tumordiagnose. Z Krebsforsch 1931; 34: 572-93.  Back to cited text no. 14
    
15.Wiersema MJ, Hawes RH, Tao LC, et al . Endoscopic ultrasonography as an adjunct to fine needle aspiration cytology of the upper and lower gastrointestinal tract. Gastrointest Endosc 1992; 38: 35-9.  Back to cited text no. 15
[PUBMED]    
16.Noh KW, Wallace MB. Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis and Staging of Pancreatic Adenocarcinoma. Med Gen Med 2005; 7: 15.  Back to cited text no. 16
    
17.Hewitt MJ, McPhail MJ, Possamai L, et al . EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-31.  Back to cited text no. 17
[PUBMED]    
18.Volmar KE, Vollmer RT, Jowell PS, et al . Pancreatic FNA in 1000 cases: a comparison of imaging modalities. Gastrointest Endosc 2005; 61: 854-61.  Back to cited text no. 18
[PUBMED]    
19.Gress FG, Hawes RH, Savides TJ, et al . Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience. Gastrointest Endosc 1999; 50: 786-91.  Back to cited text no. 19
[PUBMED]    
20.Will U, Mueller A, Topalidis T, et al . Value of endoscopic ultrasonography-guided fine needle aspiration (FNA) in the diagnosis of neoplastic tumor(-like) pancreatic lesions in daily clinical practice. Ultraschall Med 2010; 31: 169-74.  Back to cited text no. 20
[PUBMED]    
21.Horwhat JD, Paulson EK, McGrath K, et al . A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions. Gastrointest Endosc 2006; 63: 966-75.  Back to cited text no. 21
[PUBMED]    
22.Gress F, Gottlieb K, Sherman S, et al . Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med 2001; 134: 459-64.  Back to cited text no. 22
[PUBMED]    
23.Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol 2002; 97: 1386-91.  Back to cited text no. 23
[PUBMED]    
24.Ylagan LR, Edmundowicz S, Kasal K, et al . Endoscopic ultrasound guided fine-needle aspiration cytology of pancreatic carcinoma: a 3-year experience and review of the literature. Cancer 2002; 96: 362-9.  Back to cited text no. 24
[PUBMED]    
25.Bhutani MS, Hawes RH, Baron PL, et al . Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy 1997; 29: 854-8.  Back to cited text no. 25
[PUBMED]    
26.Wilson JL, Kalade A, Prasad S, et al . Diagnosis of solid pancreatic masses by endoscopic ultrasound-guided fine-needle aspiration. Int Med J 2009; 39: 32-7.  Back to cited text no. 26
    
27.Turner BG, Cizginer S, Agarwal D, et al . Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc 2010; 71: 91-8.  Back to cited text no. 27
[PUBMED]    
28.Zhang S, Defrias DV, Alasadi R, et al . Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA): experience of an academic centre in the USA. Cytopathology 2010; 21: 35-43.  Back to cited text no. 28
[PUBMED]    
29.Chen J, Yang R, Lu Y, et al . Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesion: a systematic review. J Cancer Res Clin Oncol 2012; 138: 1433-41.  Back to cited text no. 29
[PUBMED]    
30.Baghbanian M, Shabazkhani B, Ghofrani H, et al . Efficacy of endoscopic ultrasound guided fine needle aspiration in patients with solid pancreatic neoplasms. Saudi J Gastroenterol 2012; 18: 358-63.  Back to cited text no. 30
[PUBMED]    
31.Yoshinaga S, Suzuki H, Oda I, et al . Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 2011; 23(S1): 29-33.  Back to cited text no. 31
    
32.Chang KJ, Nguyen P, Erickson RA, et al . The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1996; 45: 387-93.  Back to cited text no. 32
    
33.Fisher L, Segarajasingam DS, Stewart C, et al . Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: performance and outcomes. J Gastroenterol Hepatol 2009; 24: 90-6.  Back to cited text no. 33
[PUBMED]    
34.von Bartheld MB, Veselic-Charvat M, Rabe KF, et al . Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Endoscopy 2010; 42: 213-7.  Back to cited text no. 34
    
35.Ribeiro A, Pereira D, Escalon MP, et al . EUS-guided biopsy for the diagnosis and classifcation of lymphoma. Gastrointest Endosc 2010; 71: 851-5.  Back to cited text no. 35
    
36.Puri R, Vilmann P, Sud R, et al . Endoscopic ultrasound-guided fine needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy. Endoscopy 2010; 42: 462-7.  Back to cited text no. 36
[PUBMED]    
37.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: 3028-37.  Back to cited text no. 37
[PUBMED]    
38.Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997; 112: 1087-195.  Back to cited text no. 38
[PUBMED]    
39.Pedersen BH, Vilmann P, Folke K, et al . Endoscopic ultrasonography and real-time guided fine-needle aspiration biopsy of solid lesions of the mediastinum suspected of malignancy. Chest 1996; 110: 539-44.  Back to cited text no. 39
[PUBMED]    
40.Srinivasan R, Bhutani MS, Thosani N, et al . Clinical impact of EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer or mediastinal lymph nodes of unknown etiology. J Gastrointestin Liver Dis 2012; 21: 145-52.  Back to cited text no. 40
[PUBMED]    
41.Jani N, Dewitt J, Eloubeidi M, et al . Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy 2008; 40: 200-3.  Back to cited text no. 41
[PUBMED]    
42.Thosani N, Thosani S, Qiao W, et al . Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig Dis Sci 2010; 55: 2756-66.  Back to cited text no. 42
[PUBMED]    
43.Kanno A, Ishida K, Hamada S, et al . Diagnosis of autoimmune pancreatitis by EUS-FNA by using a 22-gauge needle based on the International Consensus Diagnostic Criteria. Gastrointest Endosc 2012; 76: 594-602.  Back to cited text no. 43
[PUBMED]    
44.DeWitt J, Jowell P, Leblanc J, et al . EUS-guided FNA of pancreatic metastases: a multicenter experience. Gastrointest Endosc 2005; 61: 689-96.  Back to cited text no. 44
[PUBMED]    
45.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: 113-20.  Back to cited text no. 45
[PUBMED]    
46.Puli SR, Reddy JB, Bechtold ML, et al . Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review. World J Gastroenterol 2008; 14: 1479-90.  Back to cited text no. 46
[PUBMED]    
47.Micames CG, McCrory DC, Pavey DA, et al . Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and metaanalysis. Chest 2007; 131: 539-48.  Back to cited text no. 47
[PUBMED]    
48.Watson RR, Binmoeller KF, Hamerski CM, et al . Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors. Dig Dis Sci 2011; 56: 1757-62.  Back to cited text no. 48
[PUBMED]    
49.Turhan N, Aydog G, Ozin Y, et al . Endoscopic ultrasonography-guided fine-needle aspiration for diagnosing upper gastrointestinal submucosal lesions: a prospective study of 50 cases. Diagn Cytopathol 2011; 39: 808-17.  Back to cited text no. 49
[PUBMED]    
50.Hernandez LV, Mishra G, Forsmark C, et al . Role of endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration in the diagnosis and treatment of cystic lesions of the pancreas. Pancreas 2002; 25: 222-28.  Back to cited text no. 50
[PUBMED]    
51.Frossard JL, Amouyal P, Amouyal G, et al . Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions. Am J Gastroenterol 2003; 98: 1516-24.  Back to cited text no. 51
[PUBMED]    
52.Attasaranya S, Pais S, LeBlanc J, et al . Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP 2007; 8: 553-63.  Back to cited text no. 52
[PUBMED]    
53.DeWitt JM, Chappo J, Sherman S. EUS-FNA of metastatic malignant melanoma to the pancreas: report of two cases and review. Endoscopy 2003; 35: 219-22.  Back to cited text no. 53
[PUBMED]    
54.Béchade D, Palazzo L, Fabre M, et al . EUS-guided FNA of pancreatic metastasis from renal cell carcinoma. Gastrointest Endosc 2003; 58: 784-8.  Back to cited text no. 54
    
55.Roland CF, van Heerden JA. Nonpancreatic primary tumors with metastasis to the pancreas. Surg Gynecol Obstet 1989; 168: 345-7.  Back to cited text no. 55
[PUBMED]    
56.David O, Green L, Reddy V, et al . Pancreatic masses: a multi-institutional study of 364 fine-needle aspiration biopsies with histopathologic correlation. Diagn Cytopathol 1998; 19: 423-7.  Back to cited text no. 56
[PUBMED]    
57.Vilmann P. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes. Gastrointest Endosc 1996; 43: S24-S29.  Back to cited text no. 57
[PUBMED]    
58.Kondo D, Imaizumi M, Abe T, et al . Endoscopic ultrasound examination for mediastinal lymph node metastases of lung cancer. Chest 1990; 98: 586-93.  Back to cited text no. 58
[PUBMED]    
59.Vickers J. Role of endoscopic ultrasound in the preoperative assessment of patients with oesophageal cancer. Ann R Coll Surg Engl 1998; 80: 233-9.  Back to cited text no. 59
[PUBMED]    
60.Familiari P, Marchese M, Larghi A, et al . Staging of esophageal carcinoma: endoscopic ultrasonography. Rays 2005; 30: 357-62.  Back to cited text no. 60
[PUBMED]    
61.Vazquez-Sequeiros E, Norton ID, Clain JE, et al . Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma. Gastrointest Endosc 2001; 53: 751-7.  Back to cited text no. 61
[PUBMED]    
62.Chatzipantelis P, Salla C, Karoumpalis I, et al . Endoscopic ultrasound-guided fine needle aspiration biopsy in the diagnosis of gastrointestinal stromal tumors of the stomach: A study of 17 cases. J Gastrointest Liver Dis 2008; 17: 15-20.  Back to cited text no. 62
    
63.Akahoshi K, Sumida Y, Matsui N, et al . Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 2007; 13: 2077-82.  Back to cited text no. 63
[PUBMED]    
64.Iqbal S, Friedel D, Gupta M, et al . Endoscopic-Ultrasound-Guided Fine-Needle Aspiration and the Role of the Cytopathologist in Solid Pancreatic Lesion Diagnosis. Pathol Res Internat 2012; ID 317167.  Back to cited text no. 64
    
65.Wallace MB, Woodward T, Raimondo M. Endoscopic ultrasound and fine-needle aspiration for pancreatic cancer. Digest Endosc 2004; 16: S193-S196.  Back to cited text no. 65
    
66.Vignesh S, Hoffe SE, Saif MW. EUS-Guided Pancreatic Diagnosis and Beyond JOP. J Pancreas 2011; 12: 86-91.  Back to cited text no. 66
    
67.Chang KJ, Katz KD, Durbin TE, et al . Endoscopic ultrasound- guided fine-needle aspiration. Gastrointest Endosc 1994; 40: 694-9.  Back to cited text no. 67
[PUBMED]    
68.Jihala D, Eloubeidi M, Chhieng D, et al . Accuracy of preliminary malignant diagnosis on endoscopic ultrasound guided fine needle aspiration: analysis of 120 cases [abstract]. Acta Cytol 2001; 45: 859.  Back to cited text no. 68
    
69.Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, et al . Infuence of on-site cytopathology evaluation on the diagnostic accuracy of en­doscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 2011; 106: 1705-10.  Back to cited text no. 69
[PUBMED]    
70.Kim B, Chhieng DC, Crowe DR, et al . Dynamic telecytopathology of on site rapid cytology diagnoses for pancreatic carcinoma. Cytojournal 2006; 3: 27.  Back to cited text no. 70
[PUBMED]    
71.Buxbaum JL, Eloubeidi MA, Lane CJ, et al . Dynamic Telecytology Compares Favorably to Rapid Onsite Evaluation of Endoscopic Ultrasound Fine Needle Aspirates. Dig Dis Sci 2012; 57: 3097-7.  Back to cited text no. 71
    
72.Olson MT, Ali SZ. Cytotechnologist on-site evaluation of pancreas fine needle aspiration adequacy: comparison with cytopathologists and correlation with the final interpretation. Acta Cytol 2012; 56: 340-6.  Back to cited text no. 72
[PUBMED]    
73.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: 475-81.  Back to cited text no. 73
[PUBMED]    
74.Möller K, Papanicolaou IS, Toermer T, et al . EUS-guided FNA of solid pancreatic masses: high yield of 2 passes with combined histologic-cytologic analysis. Gastrointest Endosc 2009; 70: 60-9.  Back to cited text no. 74
    
75.Puri R, Vilmann P, Sãftoiu 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: 499-504.  Back to cited text no. 75
    
76.Song TJ, Kim JH, Lee SS, et al . The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22-G and 19-G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol 2010; 105: 1739-45.  Back to cited text no. 76
[PUBMED]    
77.Affolter KE, Schmidt RL, Matynia AP, et al . Needle size has only a limited effect on outcomes in eus-guided fine needle aspiration: a systemic reviw and meta-analysis. Dig Dis Sci 2013; 58: 1026-34.  Back to cited text no. 77
[PUBMED]    
78.Sodikoff JB, Johnson HL, Lewis MM, et al . Increased diagnostic yield of endoscopic ultrasound-guided fine needle aspirates with flow cytometry and immunohistochemistry. Diagn Cytopathol 2012 Jul 26. doi: 10.1002/dc.22903. [Epub head of print]  Back to cited text no. 78
    
79.Iglesias-Garcia J, Poley JW, Larghi A, et al . Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-96.  Back to cited text no. 79
[PUBMED]    
80.Eloubeidi MA, Tamhane A. EUS-guided FNA of solid pancreatic masses: a learning curve with 300 consecutive procedures. Gastrointest Endosc 2005; 61: 700-8.  Back to cited text no. 80
[PUBMED]    
81.Eisen GM, Dominitz JA, Faigel DO, et al . Guidelines for credentialing and granting privileges for endoscopic ultrasound. Gastrointest Endosc 2001; 54: 811-4.  Back to cited text no. 81
[PUBMED]    
82.Konge L, Vilmann P, Clementsen P, et al . Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer. Endoscopy 2012; 44: 928-33.  Back to cited text no. 82
[PUBMED]    
83.Barthet M, Gasmi M, Boustiere C, et al . EUS training in a live pig model: does it improve echo endoscope hands-on and trainee competence? Endoscopy 2007; 39: 535-9.  Back to cited text no. 83
[PUBMED]    
84.Mertz H, Gautam S. The learning curve for EUS-guided FNA of pancreatic cancer. Gastrointest Endosc 2004; 59: 33-7.  Back to cited text no. 84
[PUBMED]    
85.Kiesslich R, Burg J, Vieth M, et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127: 706-13.  Back to cited text no. 85
[PUBMED]    
86.Goetz M. Confocal laser endomicroscopy: Current indications and future perspectives in gastrointestinal diseases. Endoscopia 2012; 24: 67-74.  Back to cited text no. 86
    
87.Wang TD. Confocal microscopy from the bench to the bedside. Gastrointest Endosc 2005; 62: 696-7.  Back to cited text no. 87
[PUBMED]    
88.American Society For Gastrointestinal Endoscopy Confocal Laser Endomicroscopy. Gastrointest Endosc 2009; 70: 197-200.  Back to cited text no. 88
    
89.Yoshida S, Tanaka S, Hirata M, et al . Optical biopsy of GI lesions by reflectance-type laser-scanning confocal microscopy. Gastrointest Endosc 2007; 66: 144-9.  Back to cited text no. 89
[PUBMED]    
90.Kiesslich R, Neurath MF. Endomicroscopy is bornddo we still need the pathologist? Gastrointest Endosc 2007; 66: 150-3.  Back to cited text no. 90
[PUBMED]    
91.Giovanni D, De Palma. Confocal laser endomicroscopy in the "in vivo " histological diagnosis of the gastrointestinal tract. World J Gastroenterol 2009; 15: 5770-5.  Back to cited text no. 91
    
92.Wallace MB, Fockens P. Probe-based confocal laser endomicroscopy. Gastroenterology 2009; 136: 1509-13.  Back to cited text no. 92
[PUBMED]    
93.Becker V, Vercauteren T, von Weyhern CH, et al . High-resolution miniprobe-based confocal microscopy in combination with video mosaicing (with video). Gastrointest Endosc 2007; 66: 1001-7.  Back to cited text no. 93
[PUBMED]    
94.Gheonea DI, Cârþânã T, Ciurea T, et al . Confocal laser endomicroscopy and immunoendoscopy for real-time assessment of vascularization in gastrointestinal malignancies. World J Gastroenterol 2011; 17: 21-7.  Back to cited text no. 94
    
95.Rispo A, Castiglione F, Staibano S, et al . Diagnostic accuracy of confocal laser endomicroscopy in diagnosing dysplasia in patients affected by long-standing ulcerative colitis. World J Gastrointest Endosc 2012; 4: 414-20.  Back to cited text no. 95
[PUBMED]    
96.Hundorfean G, Chiriac MT, Siebler J, et al . Confocal laser endomicroscopy for the diagnosis of diversion colitis. Endoscopy 2012; 44 (Suppl 2): E358-9.  Back to cited text no. 96
    
97.Konda VJ, Aslanian HR, Wallace MB, et al . First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos). Gastrointest Endosc 2011; 74: 1049-60.  Back to cited text no. 97
[PUBMED]    
98.Saftoiu A, Vilmann P, Bhutani MS. Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy: Using the Optical Needle into the Acoustic Haystack. Euro J Ultrasound 2012; 33: 607-10.  Back to cited text no. 98
    
99.Gheonea DI, Ciurea ME, Saftoiu A, et al . Quantitative RT-PCR analysis of MMR genes on EUS-guided FNA samples from focal pancreatic lesions. Hepatogastroenterology 2012; 59: 916-20.  Back to cited text no. 99
    
100.Laurell H, Bouisson M, Berthelemy P, et al . Identification of biomarkers of human pancreatic adenocarcinomas by expression profiling and validation with gene expression analysis in endoscopic ultrasound-guided fine needle aspiration samples. World J Gastroenterol 2006; 12: 3344-51.  Back to cited text no. 100
[PUBMED]    
101.Carrara S, Cangi MG, Arcidiacono PG, Perri F, et al . Mucin expression pattern in pancreatic diseases: findings from EUS-guided fine-needle aspiration biopsies. Am J Gastroenterol 2011; 106: 1359-63.  Back to cited text no. 101
[PUBMED]    
102.Bournet B, Pointreau A, Souque A, et al . Gene expression signature of advanced pancreatic ductal adenocarcinoma using low density array on endoscopic ultrasound-guided fine needle aspiration samples. Pancreatology 2012; 12: 27-34.  Back to cited text no. 102
[PUBMED]    
103.Khalid A, Nodit L, Zahid M, et al . Endoscopi c ultrasound fine needle aspirate DNA analysis to differentiate malignant and benign pancreatic masses. Am J Gastroenterol 2006; 101: 2493-500.  Back to cited text no. 103
[PUBMED]    
104.Ogura T, Yamao K, Sawaki A, et al . Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses. Gastrointest Endosc 2012; 75: 769-74.  Back to cited text no. 104
[PUBMED]    
105.Wang X, Gao J, Ren Y, et al . Detection of KRAS gene mutations in endoscopic ultrasound-guided fine-needle aspiration biopsy for improving pancreatic cancer diagnosis. Am J Gastroenterol 2011; 106: 2104-11.  Back to cited text no. 105
[PUBMED]    
106.Khalid A, Dewitt J, Ohori NP, et al . EUS-FNA mutational analysis in differentiating autoimmune pancreatitis and pancreatic cancer. Pancreatology 2011; 11: 482-6.  Back to cited text no. 106
[PUBMED]    
107.Wang Y, Gao J, Li Z, et al . Diagnostic value of mucins (MUC1, MUC2 and MUC5AC) expression profile in endoscopic ultrasound-guided fine-needle aspiration specimens of the pancreas. Int J Cancer 2007; 121: 2716-22.  Back to cited text no. 107
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


This article has been cited by
1 Comparison of modified wet suction technique and dry suction technique in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for solid lesions: study protocol for a randomized controlled trial
Yun Wang,Qian Chen,Jinlin Wang,Xiaoli Wu,Yaqi Duan,Ping Yin,Qiaozhen Guo,Wei Hou,Bin Cheng
Trials. 2018; 19(1)
[Pubmed] | [DOI]
2 How Should Gallbladder Cancer Be Managed?
Teviah E. Sachs,Oluseyi Akintorin,Jennifer Tseng
Advances in Surgery. 2018;
[Pubmed] | [DOI]
3 Delayed Hemorrhage from Gastroduodenal Artery Pseudoaneurysm following Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Head Mass
Young Jae Doo,Seung Goun Hong
The Korean Journal of Pancreas and Biliary Tract. 2018; 23(4): 165
[Pubmed] | [DOI]
4 Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasound-guided fine needle aspiration
Dong Kee Jang,Sang Hyub Lee,Jun Kyu Lee,Woo Hyun Paik,Kwang Hyun Chung,Ban Seok Lee,Jun Hyuk Son,Jae Woo Lee,Ji Kon Ryu,Yong-Tae Kim,Kyoung-Bun Lee
Hepatobiliary & Pancreatic Diseases International. 2017; 16(4): 418
[Pubmed] | [DOI]
5 Endoscopic ultrasound guided fine-needle aspiration: What variables influence diagnostic yield?
Sambit K. Mohanty,Dinesh Pradhan,Shivani Sharma,Anurag Sharma,Niharika Patnaik,Martin Feuerman,Robert Bonasara,Adrienne Boyd,David Friedel,Stavros Stavropoulos,Mala Gupta
Diagnostic Cytopathology. 2017;
[Pubmed] | [DOI]
6 Cytohistological and immunohistochemical characteristics of spindle-shaped mesenchymal neoplasms occurring in the gastrointestinal tract
Antonio Ieni,Valeria Barresi,Luca Reggiani Bonetti,Giovanni Branca,Rosario Alberto Caruso,Giovanni Tuccari
Scandinavian Journal of Gastroenterology. 2017; 52(3): 291
[Pubmed] | [DOI]
7 Comparison of Cytologic Preparation Methods in Endoscopic Ultrasound-Guided Fine Needle Aspiration for Diagnosis of Pancreatic Adenocarcinoma
Kyong Joo Lee,Yong Suk Kang,Mee Yon Cho,Jae Woo Kim
Pancreatology. 2016;
[Pubmed] | [DOI]
8 Phosphoproteome Analysis of Invasion and Metastasis-Related Factors in Pancreatic Cancer Cells
Xiaodong Tan,Peng Liu,Yinpeng Huang,Lei Zhou,Yifan Yang,Huaitao Wang,Boqiang Yu,Xiangli Meng,Xiaobo Zhang,Feng Gao,Dong Wang
PLOS ONE. 2016; 11(3): e0152280
[Pubmed] | [DOI]
9 A Case of Intra-abdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration
Cho Rong Oh,Mi-Jin Kim,Kwang Hyuck Lee
The Korean Journal of Gastroenterology. 2015; 66(1): 41
[Pubmed] | [DOI]
10 EUS assisted transmural cholecystogastrostomy fistula creation as a bridge for endoscopic internal gallbladder therapy using a novel fully covered metal stent
Nan Ge,Zhiguo Wang,Siyu Sun,Sheng Wang,Guoxin Wang,Shiwei Sun,Linlin Feng,Fei Yang,Wenzhuang Ma,Shupeng Wang,Xiang Liu,Jintao Guo,Wen Liu
BMC Gastroenterology. 2014; 14(1): 164
[Pubmed] | [DOI]
11 Future Directions in EUS-guided Tissue Acquisition
Pierre H. Deprez
Gastrointestinal Endoscopy Clinics of North America. 2014; 24(1): 143
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  From The Past…
  To the Future
  Conclusions
  Acknowledgments
   References
   Article Figures

 Article Access Statistics
    Viewed2786    
    Printed49    
    Emailed1    
    PDF Downloaded664    
    Comments [Add]    
    Cited by others 11    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]