Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience
Por:
Garcia-Sumalla, A, Subtil, J, de la Serna, C, Maisterra, S, Aparicio, J, Bojorquez, A, Montanes, R, Vazquez-Sequeiros, E and Gornals, J
Publicada:
1 dic 2020
Ahead of Print:
27 nov 2020
Resumen:
Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact.
Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88% (95 % CI, 0.74-0.96), 100% (95 % CI, 0.59-1), and 90% (95 % CI, 0.78-0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88%). Arterial vessel and ASA-III had a trend with incidents (both, P < 0.08). Rapid on-site evlauation was found to be an independent predictor for obtaining a conclusive sample (OR 6.2; 95%CI, 1.06-36.73, P < 0.04). Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.
Filiaciones:
Garcia-Sumalla, A:
Univ Barcelona, Hosp Univ Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
Subtil, J:
Complejo Univ Navarra, Dept Digest Dis, Endoscopy Unit, Pamplona, Spain
de la Serna, C:
Hosp Univ Rio Hortega, Dept Digest Dis, Endoscopy Unit, Valladolid, Spain
Maisterra, S:
Univ Barcelona, Hosp Univ Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
:
Hosp Gen Univ Alicante, Dept Digest Dis, Endoscopy Unit, Alicante, Spain
Bojorquez, A:
Complejo Univ Navarra, Dept Digest Dis, Endoscopy Unit, Pamplona, Spain
Montanes, R:
Hosp Univ Virgen Rocio, Dept Digest Dis, Endoscopy Unit, Seville, Spain
Vazquez-Sequeiros, E:
Hosp Univ Ramon Y Cajal, Dept Digest Dis, Endoscopy Unit, Madrid, Spain
Gornals, J:
Univ Barcelona, Hosp Univ Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Endoscopy Unit,Dept Digest Dis, Barcelona, Catalonia, Spain
Univ Oberta Catalunya, Hlth Sci Dept, Barcelona, Catalonia, Spain
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