• Endoscopic ultrasound
• fine-needle aspiration
• fine-needle biopsy
• retroperitoneal mass

• case report
• inflammatory
• myofibroblastic
• pseudotumor
• surgery

• Endoscopic ultrasound
• lung mass
• transesophageal endobronchial ultrasound
• transesophageal tissue acquisition

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a good alternative and diagnostic tool for gastrointestinal wall thickening with prior negative endoscopic biopsies.

Here we reported a case of a 60-years-old woman admitted with atrophic right kidney and hydronephrosis and intermittent postprandial bloating. Esophagogastroduodenoscopy and small bowel endoscopy revealed wall thickening and stenosis at the junction of the descending and inferior duodenum. Biopsies from endoscopy showed no specific findings. EUS-FNA of the thickened duodenal wall was performed and histopathological examinations revealed poorly differentiated carcinoma. Immunohistochemically staining was positive for pan-cytokeratin, CK7, CK20, and weakly positive for GATA-3 and P63. These results were highly suggestive of metastatic urothelial cancer.

EUS-FNA played an important role in the diagnosis of unexplained gastrointestinal wall thickening and rare metastases to the gastrointestinal wall.

• Duodenal wall thickening
• EUS-FNA
• Metastasis
• Urothelial carcinoma

Endoscopic ultrasound (EUS) gained wide acceptance as the diagnostic and minimally invasive therapeutic approach for intra-luminal and extraluminal gastrointestinal, as well as various non-gastrointestinal lesions. Since its introduction, EUS has undergone substantial technological advances. This multi-centric study is a retrospective analysis of a prospectively maintained database of patients who underwent EUS for the evaluation of lesions located within the gastrointestinal tract and the proximal organs. It aimed to extensively assess in dynamic the dual-center EUS experience over the course of the past 20 years. Hence, we performed a population study and an overall assessment of the EUS procedures. The performance of EUS-FNA/FNB in diagnosing pancreatic neoplasms was evaluated. We also investigated the contribution of associating contrast-enhanced ultrasound imaging (CE-EUS) with EUS-FNA/FNB for differentiating solid pancreatic lesions or cystic pancreatic lesions. A total of 2935 patients undergoing EUS between 2002–2021 were included, out of which 1880 were diagnostic EUS and 1052 EUS-FNA/FNB (80% FNA and 20% FNB). Therapeutic procedures performed included endoscopic transmural drainage of pancreatic fluid collections, celiac plexus block and neurolysis, while diagnostic EUS-like CE-EUS (20%) and real-time elastography (12%) were also conducted. Most complications occurred during the first 7 days after EUS-FNA/FNB or pseudocyst drainage. EUS and the additional tools have high technical success rates and low rates of complications. The EUS methods are safe, cost effective and indispensable for the diagnostic or therapeutic management in gastroenterological everyday practice.

• EUS-guided fine-needle aspiration
• Pancreatic cancer
• endoscopic ultrasonography

• ancillary studies
• endoscopic ultrasound-guided fine-needle aspiration
• rapid on-site evaluation

• Endoscopic ultrasound
• Focal liver lesion
• Hepatocellular carcinoma

• endoscopic ultrasound
• fine-needle aspiration
• gynecologic cancer
• histology

• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Feasibility Studies
• Female
• Gastrointestinal Neoplasms/diagnostic imaging
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Neoplasms/secondary
• Gastrointestinal Tract/diagnostic imaging
• Gastrointestinal Tract/pathology
• Genital Neoplasms, Female/pathology
• Humans
• Middle Aged
• Neoplasms, Second Primary/diagnostic imaging
• Neoplasms, Second Primary/pathology
• Retrospective Studies
• Young Adult

• CA19-9
• Pancreatic cancer
• Para-aortic lymph node

• Aged
• Biliary Tract Surgical Procedures
• CA-19-9 Antigen/blood
• Carcinoma, Pancreatic Ductal/blood
• Carcinoma, Pancreatic Ductal/secondary
• Carcinoma, Pancreatic Ductal/surgery
• Clinical Decision-Making
• Female
• Gastric Bypass
• Humans
• Japan
• Kaplan-Meier Estimate
• Lymph Node Excision/adverse effects
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis
• Male
• Multivariate Analysis
• Pancreatectomy/adverse effects
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Patient Selection
• Predictive Value of Tests
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• FNB, fine-needle biopsy
• MRI, magnetic resonance imaging

• diagnostic accuracy
• endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)
• pelvic masses
• safety

• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/pathology
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/pathology
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Endosonography/methods
• Female
• Flow Cytometry/methods
• Humans
• Immunohistochemistry/methods
• Liver/pathology
• Liver Diseases/diagnosis
• Liver Diseases/pathology
• Liver Neoplasms/diagnosis
• Liver Neoplasms/pathology
• Lymph Nodes/pathology
• Lymphoma/diagnosis
• Lymphoma/pathology
• Male
• Middle Aged
• Retrospective Studies

• Biopsy
• Endoscopic ultrasound
• Meta-analysis
• Pelvic lesion

• Biopsy
• Diagnosis, Differential
• Endoscopy, Gastrointestinal
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/pathology
• Gastrointestinal Neoplasms/diagnosis
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Tract/pathology
• Humans
• Ultrasonography, Interventional

Hepatocellular carcinoma (HCC) is an aggressive tumor and a leading cause of cancer-related deaths globally. The mortality rate remains high despite many advances in treatment. HCC is frequently diagnosed late in its course due to lack of classical symptoms at earlier stages. Endoscopic ultrasound (EUS) has emerged as an important diagnostic tool for the diagnostic evaluation, staging, and treatment of gastrointestinal tract disorders. EUS-guided fine needle aspiration has been a valuable addition to EUS by being able to obtain tissue under direct visualization. Here, we review the potential role of EUS in the diagnosis and management of HCC. EUS seems to be a safe and reliable alternative method for obtaining tissue for diagnosis of liver cancer, especially for lesions that are inaccessible by traditional methods. EUS could play an important role in the diagnosis and management of HCC.

• endoscopic ultrasound
• fine needle aspiration
• hepatocellular carcinoma
• hepatoma

• Endoscopic ultrasound–guided fine-needle aspiration
• Rectal/perirectal EUS-FNA

Gastric carcinoma (GC) is one of the most common causes of cancer-related death worldwide. Surgical resection is the only cure available and is dependent on the GC stage at presentation, which incorporates depth of tumor invasion, extent of lymph node and distant metastases. Accurate preoperative staging is therefore essential for optimal surgical management with consideration of preoperative and/or postoperative chemotherapy. Multidetector computed tomography (MDCT) with its ability to assess tumor depth, nodal disease and metastases is the preferred technique for staging GC. Endoscopic ultrasonography is more accurate for assessing the depth of wall invasion in early cancer, but is limited in the assessment of advanced local or stenotic cancer and detection of distant metastases. Magnetic resonance imaging (MRI), although useful for staging, is not proven to be effective. Positron emission tomography (PET) is most useful for detecting and characterizing distant metastases. Both MDCT and PET are useful for assessment of treatment response following preoperative chemotherapy and for detection of recurrence after surgical resection. This review article discusses the usefulness of imaging modalities for detecting, staging and assessing treatment response for GC and the potential role of newer applications including CT volumetry, virtual gastroscopy and perfusion CT in the management of GC.

Introduction. Thorough quality control (QC) study with systemic monitoring and evaluation is crucial to optimizing the effectiveness of EUS-FNA. Methods. Retrospective analysis was composed of investigating consecutive patient files that underwent EUS-FNA. QC specifically focused on diagnostic accuracy, impacts on preexisting diagnoses, and case management. Results. 268 patient files were evaluated. EUS-FNA cytology helped establish accurate diagnoses in 92.54% (248/268) of patients. Sensitivity, specificity, PPV, NPV, and accuracy were 83%, 100%, 100%, 91.6%, and 94%, respectively. The most common biopsy site was the pancreas (68%). The most accurate location for EUS-FNA was the esophagus, 13/13 (100%), followed by the pancreas (89.6%). EUS-FNA was least informative for abdominal lymph nodes (70.5%). After FNA and followup, eight false negatives for tumors were found (3%), while 7.5% of samples still lacked a definitive diagnosis. Discussion. QC suggests that the diagnostic accuracy of EUS-FNA might be improved further by (1) taking more FNA passes from suspected lesions, (2) optimizing needle selection (3) having an experienced echo-endoscopist available during the learning curve, and (4) having a cytologist present during the procedure. QC also identified remediable reporting errors. In conclusion, QC study is valuable in identifying weaknesses and thereby augmenting the effectiveness of EUS-FNA.

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

• Endoscopic ultrasonography
• Endoscopic ultrasonography-guided fine-needle biopsy
• Complications
• Contraindications
• Risk
• Safety
• Perforation
• Bleeding
• Infection
• Acute pancreatitis

Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects were two males and one female, ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors. However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes. Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 indexes were 3%-15%, 2%-3%, and 3%, respectively. No case showed any signs of malignancy. As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated no enlargement and no change in characteristics. Schwannomas are almost always benign and can be observed following diagnosis by EUS-FNA.

• Schwannoma
• Endoscopic ultrasonography
• Fine-needle aspiration
• Retroperitoneal tumor
• S100 proteins
• Ki-67 index

Isolated extragonadal germ cell tumors can be primary in nature or metastatic from a burned out testicular cancer. Accurate diagnosis is critical as appropriate therapy can be highly curative. We present the case of an isolated extragonadal germ cell tumor in the retroperitoneum diagnosed by endoscopic ultrasound-guided fine needle aspiration. This case underscores the importance of considering germ cell tumors in the differential diagnosis of an unexplained retroperitoneal mass, particularly since immunophenotypic staining may be necessary to establish the diagnosis.

• Germ cell tumor
• Endoscopic ultrasound
• Fine needle aspiration

Standard-of-care requires the availability of an efficient, economical and accurate on-site fine needle aspiration (FNA) service. Presence of a trained individual during the procedure ensures an improved patient care. Appropriate selection of the equipment, interaction with the clinicians and compliance with the various regulations during the procedure is essential. This is often done by an on-site FNA service. Organization and implementation of such a system in a large academic center is challenging.

we reviewed the ambulatory care needs in the new Perelman Center for Advanced Medicine (PeCAM). Multiple (9) FNA sites have been established keeping in view the patient's convenience, clinic demands, various regulatory requirements and laboratory staff. Each location has dedicated FNA station with microscopes and supplies. In addition, state- ofthe -art technologies including a mobile FNA cart (Penn-A- Cart), remote specimen evaluation (TeleCyP) have been incorporated.

The new set up is extremely efficient and much valued by the patients and the clinicians. It has improved patient care.

With necessary investments and resources a point-of-care FNA service has been created which has improved patient care. This, albeit with certain modifications may serve as a model for FNA service.

• FNA
• Penn-A-Cart
• TeleCyP
• on-site
• point-of-care

Squamous cell carcinoma of the pancreas has been sparsely described since the 1940s, and generally has a poor prognosis. Herein, we present a case of primary squamous cell carcinoma of the pancreas with liver metastasis, both confirmed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). To the best of our knowledge, this is the first case report in literature utilizing EUS-FNA for a cell-type specific diagnosis of primary pancreatic squamous cell carcinoma with a liver metastasis.

• Computed tomography
• Cytology
• Endoscopic ultrasound