Ian Storch

Evaluation of Fine Needle Aspiration vs. Fine Needle Capillary Sampling on Specimen Quality and Diagnostic Accuracy in Endoscopic Ultrasound–Guided Biopsy

OBJECTIVE To compare percutaneous and endoscopic ultrasound (EUS)-guided biopsy techniques. STUDY DESIGN From July 2005 to February 2006, all patients referred for EUS-guided fine needle aspiration (FNA) were considered. If inclusion criteria were met, the first 2 biopsy passes were performed without suction (fine needle capillary [FNC] sampling). Two additional passes were performed using the same needle with 10 mL of applied suction (FNA). A single blinded pathologist later retrospectively evaluated each set of slides. Fifty-three patients met inclusion criteria. The study group comprised pancreatic masses (23), lymph nodes (26), subepithelial masses (3) and liver lesion (1). There were 38 malignant and 15 benign lesions. RESULTS No statistically significant differences were found with the scoring systems considered in the study. In the subgroups of patients with pancreatic masses, lymph nodes, benign disease and malignant disease, no statistically significant outcomes were noted. CONCLUSIONS No difference exists between quality and diagnostic accuracy of specimens obtained from EUS-guided tissue acquisition via FNC and FNA. The decision to use FNC or FNA should be left to the discretion of the individual endosonographer.

Hepatocellular Carcinoma (HCC) with Portal Vein Invasion, Masquerading as Pancreatic Mass, Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA)

Hepatocellular carcinoma (HCC) is a common cause of death among patients with cirrhosis, with epidemiologic data suggesting that the mortality rate in the United States is on the rise [1]. Although screening for HCC ultrasound and AFP every 6 months in patients with cirrhosis is recommended for early detection, small lesions are often missed. Portal vein thrombosis secondary to HCC invasion often results in clinical decompensation and is a contraindication to resection or liver transplantation [2]. As portal vein thrombosis secondary to clot is common among patients with cirrhosis, determination of a clear etiology is important in these patients. We report a case of HCC with portal vein thrombosis mimicking pancreatic cancer. The diagnosis was made by endoscopic ultrasound (EUS) and the presence of tumor thrombus in the portal vein was confirmed by fine needle aspiration (FNA).