Clin Endosc.  2021 May;54(3):404-412. 10.5946/ce.2020.065.

Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 22-G Needle for Hepatic Lesions: Single-Center Experience

• Akay E
• Atasoy D
• Altınkaya E
• Koç A
• Ertan T
• Karaman H
• Caglar E

• KMID: 2516321
• DOI: http://doi.org/10.5946/ce.2020.065

Abstract

Background/Aims
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively.
Methods
Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed.
Results
A total of 25 patients (10 females) were included in the study. The mean age was 62.73±15.2 years. The mean size of the masses was 34.50±16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications.
Conclusions
For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates.

Keyword

Clinical management; Diagnostic accuracy; Endoscopic ultrasound; Fine needle aspiration; Liver mass

Figure

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  Fig. 1. Performance of endoscopic ultrasound-guided biopsy from lesions in the right liver lobe. (A) A fat-suppressed T2-weighted magnetic resonance image shows an exophytic, isointense liver mass originating from segment 6. (B) An endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) procedure to a 30 mm hyperechoic mass located in segment 6. (C) Diffusely positive staining is achieved in areas with acinar pattern, and focal staining is noted in thick trabecular areas with HepPar dye (×40). (D) Liver lesions in segment 6, showing intense heterogenous contrast enhancement at the early arterial phase on computed tomography. (E) EUS-FNA procedure to a 25 mm hyperechoic mass located in segment 6. (F) The hepatocellular carcinoma tissues located on the left side of the figure show an increase in capillarization unlike the normal parenchyma on the right side (CD34, ×40).

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  Fig. 2. Macroscopic view of the biopsy material obtained with endoscopic ultrasound guidance.

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  Fig. 3. (A) A well-defined mass with an enhanced capsule in the liver, visualized at the venous phase of a contrast-enhanced, coronal fat-suppressed T1-weighted magnetic resonance image. (B) A 28×34 mm hypo-/iso-echoic mass in segment 6 during the endoscopic ultrasound-guided fine needle aspiration procedure. (C) Monotonous hepatocellular carcinoma cells stained with May–Grunwald–Giemsa (MGG) in the cytological specimen (MGG, ×400). (D) Tumor cells stained with hematoxylin and eosin (×200). (E) Increased capillarization and thick cellular trabeculae in the biopsy obtained under endoscopic ultrasound (CD34, ×200). (F) Alfafetoprotein (AFP) positive stained cells in the endoscopic ultrasound biopsy (AFP, ×200). (G) Macroscopic appearance of the resected tumor.

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  Fig. 4. A cholangiocarcinoma evaluation. (A) An isointense hepatic mass in the left lobe having lobulated contours with infiltrative nature causing segmental intrahepatic bile duct dilatation in coronal T2-weighted 2D fast imaging employing steady-state acquisition (FIESTA) magnetic resonance image. (B) Endoscopic ultrasound-guided fine needle aspiration procedure to a 25 mm × 28 mm hyperechoic mass located in segment 4. (C) Tumor cells showing 3D groupings with Papanicolaou-stained aspiration (×200). (D) Tumor cells showing adenoid structures with CK7 positive staining in the biopsy material (×100). (E) Appearance of the tumor cells with hematoxylin and eosin stain (×200).

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  Fig. 5. Flowchart of the patients with hepatic lesions. EUS, endoscopic ultrasound; HCC, hepatocellular carcinoma; IHC, immunohistochemical; USG, ultrasonography.

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