Role of EUS-FNA for gallbladder mass lesions with biliary obstruction: a large single-center experience

Abstract

Background and study aims Although endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) is an established modality for pathological sampling of pancreatic and biliary lesions, limited data are available on the diagnostic value of EUS-FNA for evaluation of gallbladder mass lesions, a common cause of obstructive jaundice. We aimed to evaluate the usefulness of EUS-FNA for diagnosis of gallbladder mass lesions presenting with biliary obstruction. Patients and methods This study was a retrospective analysis of data from patients who had undergone EUS-FNA for gallbladder mass lesions. FNA was performed on either a gallbladder mass, metastatic node or liver lesions. Outcome measures were diagnostic yield of EUS FNA and adverse events. Results From April 2011 to August 2018, 101 patients with gallbladder mass lesions with biliary obstruction underwent EUS-FNA. The final diagnosis was malignancy in 98, benign disease in one, and two patients were lost to follow-up. EUS-FNA confirmed the diagnosis in 89 of 98 patients with malignancy (sensitivity 90.81 %); was false negative in nine of 98 cases with malignancy; and was truly negative in the solitary patient with benign disease (specificity 100 %). Positive predictive value, negative predictive value (NPV), and accuracy were 100 %, 10 %, and 90.90 %, respectively. Two patients had self-limiting pain. Conclusion EUS-FNA is a sensitive tool for evaluation of gallbladder mass lesions presenting with obstructive jaundice. However, because of low NPV, lesions in which FNA is negative should be further evaluated.

The Role of Fine Needle Aspiration Cytology in the Diagnosis of Gallbladder Cancer: A Systematic Review

“…Among them, one article was excluded due to lack of histological data on the patients, two more were excluded due to lack of clear clarification of how the final diagnosis was confirmed for every patient and finally, one article was excluded because it included only six patients. Ultimately, six articles [14][15][16][17][18][19] were selected for inclusion in the qualitive and quantitative analysis (Figure 1). how the final diagnosis was confirmed for every patient and finally, one article was excluded because it included only six patients.…”

Personalized Approach to the Role of Endoscopic Ultrasound in the Diagnosis and Management of Pancreaticobiliary Malignancies

“…Furthermore, one meta-analysis with 284 patients who underwent EUS-biopsy for biliary and gallbladder masses did not observe any complications of seeding, bile leak, or cholangitis [ 28 ]. Similarly, in another study of 101 patients with gallbladder masses who underwent EUS-FNA, there were no complications of procedure-related cholangitis or bile leak in any patient [ 37 ]. However, Johnson et al reported that percutaneous biopsy for pancreatic cancer also did not significantly increase positive peritoneal washings or peritoneal failure rate [ 38 ].…”

The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

“…This technique poses the risk of perforating the gallbladder duct with the guidewire. In contrast, if a gallbladder lesion can be visualized as a tumor by EUS, a pathological diagnosis can be established using EUS-FNA [29].…”