EUS-Guided FNA: Tips and Tricks

Abstract

<jats:title>Abstract</jats:title><jats:p>The development of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) technique has been proved to be a great armamentarium to gastroenterologists and other branches including surgery, oncology, hepatology, pulmonary medicine, and internal medicine. EUS-FNA is quite safe and allows tissue acquisition from difficult anatomical locations like retroperitoneum, pancreas, and mediastinum. The current review discusses basic techniques steps of EUS-FNA including tips and tricks. Also, false negative FNA and EUS-FNA in difficult locations are discussed. We also discussed about EUS-guided fine needle biopsy. </jats:p>

Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma

“…The stylet slow-pull technique has shown comparable results to conventional suction techniques with a mean of two passes for solid pancreatic lesions [ 77 , 78 , 79 ]. For cirrhotic patients and in the presence of coagulopathy, suction is usually avoided as it increases contamination in blood [ 80 ]. Keeping the stylet provides a few additional advantages by increasing the stiffness of the needle and helping remove material obtained from gastrointestinal wall punctures [ 80 ].…”

“…For cirrhotic patients and in the presence of coagulopathy, suction is usually avoided as it increases contamination in blood [ 80 ]. Keeping the stylet provides a few additional advantages by increasing the stiffness of the needle and helping remove material obtained from gastrointestinal wall punctures [ 80 ]. In a recent network meta-analysis of 16 studies ( n = 2048), these techniques were compared (including no suctioning and the wet suction, dry suction, and stylet slow-pull techniques), and no difference among the various suction techniques was found in terms of their tissue adequacy, diagnostic accuracy, and moderate-to-high levels of cellularity.…”

“…EUS TA is minimally invasive and the risk of complications is minimal, which includes abdominal pain, pancreatitis, bleeding, perforation, infection, and needle track seeding (NTS) with an overall frequency ranging from 0 to 3% [ 80 , 126 ]. The majority of complications are mild and can be managed conservatively.…”

Liver biopsy guided by endoscopic ultrasound

“…Immunohistochemical – estrogen positive cells 90%, HER 2 score 2, progesterone negative, Ki67 about 30%. Diagnosis: Metastasis of primary breast cancer 1 2 3 4 5 6 .…”