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Shyam Varadarajulu - One of the best experts on this subject based on the ideXlab platform.
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randomized trial comparing the franseen and fork tip needles for eus guided fine needle biopsy sampling of solid Pancreatic Mass lesions
Gastrointestinal Endoscopy, 2018Co-Authors: Ji Young Bang, Shantel Hebertmagee, Udayakumar Navaneethan, Muhammad K Hasan, Robert H Hawes, Shyam VaradarajuluAbstract:Background and Aims Recently, a 3-plane symmetric needle with Franseen geometry and a Fork-tip biopsy needle have been developed for histologic tissue procurement. We compared 22-gauge Franseen and 22-gauge Fork-tip needles in patients undergoing EUS-guided sampling of Pancreatic Masses. Methods Fifty patients underwent sampling using both 22-gauge Franseen and 22-gauge Fork-tip needles, with randomization of needle order. Two dedicated passes were performed using both needles for cell block. Subsequent passes were performed for rapid onsite evaluation (ROSE) using both needles alternately until diagnosis was established. The main outcome was to evaluate for histologic core tissue by comparing area of total tissue, tumor, desmoplastic fibrosis, and rate of retained tissue architecture between cohorts. Other outcomes were rates of diagnostic cell block and diagnostic adequacy at ROSE. Results Final diagnosis was Pancreatic cancer in 44 patients, neuroendocrine tumor in 2, lymphoma in 1, and chronic pancreatitis in 3. There was no significant difference in area of total tissue (median 6.1 [interquartie range {IQR}, 3.5-10.5] vs 8.2 mm 2 [IQR, 4.0-13.0], P = .50), tumor (median .9 [IQR .3-2.8] vs 1.0 mm 2 [IQR .4-2.7], P = .33), desmoplastic fibrosis (median 4.3 [IQR, 2.0-6.7] vs 5.2 mm 2 [IQR, 1.7-6.1], P = .71), retained architecture (100% vs 83%, P = .25), diagnostic cell block (96.0% vs 92.0%, P = .32), and diagnostic adequacy at ROSE (94.0% vs 98.0%, P = .32) between Franseen and Fork-tip needles, respectively. Conclusions There was no significant difference between Franseen and Fork-tip needles in yielding histologic tissue. Given their ability to yield diagnostic cell block in greater than 90% of patients, the new-generation fine-needle biopsy needles may obviate the need for ROSE. (Clinical trial registration number: NCT02910960.)
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randomized trial comparing fanning with standard technique for endoscopic ultrasound guided fine needle aspiration of solid Pancreatic Mass lesions
Endoscopy, 2013Co-Authors: Ji Young Bang, S H Magee, Jayapal Ramesh, Jessica Trevino, Shyam VaradarajuluAbstract:Background and study aims The fanning technique for endoscopic ultrasound-guided fine-needle aspiration (EUS–FNA) involves sampling multiple areas within a lesion with each pass. The aim of this study was to compare the fanning and standard techniques for EUS–FNA of solid Pancreatic Masses.
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randomized trial comparing the 22 gauge aspiration and 22 gauge biopsy needles for eus guided sampling of solid Pancreatic Mass lesions
Gastrointestinal Endoscopy, 2012Co-Authors: Ji Young Bang, Jayapal Ramesh, Jessica Trevino, Shantel Hebertmagee, Shyam VaradarajuluAbstract:Background To overcome limitations of cytology, biopsy needles have been developed to procure histologic samples during EUS. Objective To compare 22-gauge (G) FNA and 22G biopsy needles (FNB) for EUS-guided sampling of solid Pancreatic Masses. Design Randomized trial. Setting Tertiary-care medical center. Patients This study involved 56 patients with solid Pancreatic Masses. Intervention Sampling of Pancreatic Masses by using 22G FNA or 22G FNB devices. Main Outcome Measurements Compare the median number of passes required to establish the diagnosis, diagnostic sufficiency, technical performance, complication rates, procurement of the histologic core, and quality of the histologic specimen. Results A total of 28 patients were randomized to the FNA group and 28 to the FNB group. There was no significant difference in median number of passes required to establish the diagnosis (1 [interquartile range 1-2.5] vs 1 [interquartile range 1-1]; P = .21), rates of diagnostic sufficiency (100% vs 89.3%; P = .24), technical failure (0 vs 3.6%; P = 1.0), or complications (3.6% for both) between FNA and FNB needles, respectively. Patients in whom diagnosis was established in passes 1, 2, and 3 were 64.3% versus 67.9%, 10.7% versus 17.9%, and 25% versus 3.6%, respectively, for FNA and FNB cohorts. There was no significant difference in procurement of the histologic core (100% vs 83.3%; P = .26) or the presence of diagnostic histologic specimens (66.7% vs 80%; P = .66) between FNA and FNB cohorts, respectively. Limitations Only Pancreatic Masses were evaluated. Conclusion Diagnostic sufficiency, technical performance, and safety profiles of FNA and FNB needles are comparable. There was no significant difference in yield or quality of the histologic core between the 2 needle types. (Clinical trial registration number: NCT01394159.)
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yield of eus guided fna of Pancreatic Masses in the presence or the absence of chronic pancreatitis
Gastrointestinal Endoscopy, 2005Co-Authors: Shyam Varadarajulu, Ashutosh Tamhane, Mohamad A EloubeidiAbstract:Background Evaluation of a focal Pancreatic Mass in the setting of chronic pancreatitis (CP) is a diagnostic challenge. The objectives of the study were to compare the diagnostic yield and accuracy of EUS-guided FNA (EUS-FNA) in the evaluation of Pancreatic-Mass lesions in the presence or the absence of CP and to identify predictors of CP before EUS-FNA of Pancreatic-Mass lesions. Methods The study design was analysis of data collected prospectively on all patients with solid Pancreatic-Mass lesions who underwent EUS-FNA at a tertiary referral center. A total of 282 consecutive patients underwent 300 EUS-FNA procedures of Pancreatic-Mass lesions over a 3-year period. The diagnostic yield and the accuracy of EUS-FNA was compared between patients with and without CP. CP was defined by the presence of more than 4 EUS criteria. Results Final diagnosis was adenocarcinoma in 210 (70%), benign disease in 64 (21%), other pathology in 19 (6%), and indeterminate in 4 (2%); 3 patients (1%) were lost to follow-up. CP was noted in 75/300 (25%) patients. A lower sensitivity for EUS-FNA was observed in patients with CP than in those without CP (73.9% vs. 91.3%; p = 0.02). While patients with CP had a higher negative predictive value (88.9% vs. 45.5%; p Conclusions EUS-FNA has a low sensitivity for Pancreatic-Mass lesions in the setting of CP. This decreased sensitivity can be overcome by performing more numbers of passes at FNA, which improves diagnostic accuracy. Demographic features and clinical presentation are predictive of underlying CP in patients with Pancreatic-Mass lesions.
Ji Young Bang - One of the best experts on this subject based on the ideXlab platform.
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randomized trial comparing the franseen and fork tip needles for eus guided fine needle biopsy sampling of solid Pancreatic Mass lesions
Gastrointestinal Endoscopy, 2018Co-Authors: Ji Young Bang, Shantel Hebertmagee, Udayakumar Navaneethan, Muhammad K Hasan, Robert H Hawes, Shyam VaradarajuluAbstract:Background and Aims Recently, a 3-plane symmetric needle with Franseen geometry and a Fork-tip biopsy needle have been developed for histologic tissue procurement. We compared 22-gauge Franseen and 22-gauge Fork-tip needles in patients undergoing EUS-guided sampling of Pancreatic Masses. Methods Fifty patients underwent sampling using both 22-gauge Franseen and 22-gauge Fork-tip needles, with randomization of needle order. Two dedicated passes were performed using both needles for cell block. Subsequent passes were performed for rapid onsite evaluation (ROSE) using both needles alternately until diagnosis was established. The main outcome was to evaluate for histologic core tissue by comparing area of total tissue, tumor, desmoplastic fibrosis, and rate of retained tissue architecture between cohorts. Other outcomes were rates of diagnostic cell block and diagnostic adequacy at ROSE. Results Final diagnosis was Pancreatic cancer in 44 patients, neuroendocrine tumor in 2, lymphoma in 1, and chronic pancreatitis in 3. There was no significant difference in area of total tissue (median 6.1 [interquartie range {IQR}, 3.5-10.5] vs 8.2 mm 2 [IQR, 4.0-13.0], P = .50), tumor (median .9 [IQR .3-2.8] vs 1.0 mm 2 [IQR .4-2.7], P = .33), desmoplastic fibrosis (median 4.3 [IQR, 2.0-6.7] vs 5.2 mm 2 [IQR, 1.7-6.1], P = .71), retained architecture (100% vs 83%, P = .25), diagnostic cell block (96.0% vs 92.0%, P = .32), and diagnostic adequacy at ROSE (94.0% vs 98.0%, P = .32) between Franseen and Fork-tip needles, respectively. Conclusions There was no significant difference between Franseen and Fork-tip needles in yielding histologic tissue. Given their ability to yield diagnostic cell block in greater than 90% of patients, the new-generation fine-needle biopsy needles may obviate the need for ROSE. (Clinical trial registration number: NCT02910960.)
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randomized trial comparing fanning with standard technique for endoscopic ultrasound guided fine needle aspiration of solid Pancreatic Mass lesions
Endoscopy, 2013Co-Authors: Ji Young Bang, S H Magee, Jayapal Ramesh, Jessica Trevino, Shyam VaradarajuluAbstract:Background and study aims The fanning technique for endoscopic ultrasound-guided fine-needle aspiration (EUS–FNA) involves sampling multiple areas within a lesion with each pass. The aim of this study was to compare the fanning and standard techniques for EUS–FNA of solid Pancreatic Masses.
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randomized trial comparing the 22 gauge aspiration and 22 gauge biopsy needles for eus guided sampling of solid Pancreatic Mass lesions
Gastrointestinal Endoscopy, 2012Co-Authors: Ji Young Bang, Jayapal Ramesh, Jessica Trevino, Shantel Hebertmagee, Shyam VaradarajuluAbstract:Background To overcome limitations of cytology, biopsy needles have been developed to procure histologic samples during EUS. Objective To compare 22-gauge (G) FNA and 22G biopsy needles (FNB) for EUS-guided sampling of solid Pancreatic Masses. Design Randomized trial. Setting Tertiary-care medical center. Patients This study involved 56 patients with solid Pancreatic Masses. Intervention Sampling of Pancreatic Masses by using 22G FNA or 22G FNB devices. Main Outcome Measurements Compare the median number of passes required to establish the diagnosis, diagnostic sufficiency, technical performance, complication rates, procurement of the histologic core, and quality of the histologic specimen. Results A total of 28 patients were randomized to the FNA group and 28 to the FNB group. There was no significant difference in median number of passes required to establish the diagnosis (1 [interquartile range 1-2.5] vs 1 [interquartile range 1-1]; P = .21), rates of diagnostic sufficiency (100% vs 89.3%; P = .24), technical failure (0 vs 3.6%; P = 1.0), or complications (3.6% for both) between FNA and FNB needles, respectively. Patients in whom diagnosis was established in passes 1, 2, and 3 were 64.3% versus 67.9%, 10.7% versus 17.9%, and 25% versus 3.6%, respectively, for FNA and FNB cohorts. There was no significant difference in procurement of the histologic core (100% vs 83.3%; P = .26) or the presence of diagnostic histologic specimens (66.7% vs 80%; P = .66) between FNA and FNB cohorts, respectively. Limitations Only Pancreatic Masses were evaluated. Conclusion Diagnostic sufficiency, technical performance, and safety profiles of FNA and FNB needles are comparable. There was no significant difference in yield or quality of the histologic core between the 2 needle types. (Clinical trial registration number: NCT01394159.)
Mohamad A Eloubeidi - One of the best experts on this subject based on the ideXlab platform.
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how good is endoscopic ultrasound guided fine needle aspiration in diagnosing the correct etiology for a solid Pancreatic Mass a meta analysis and systematic review
Pancreas, 2013Co-Authors: Srinivas R Puli, Matthew L Bechtold, James Buxbaum, Mohamad A EloubeidiAbstract:OBJECTIVES: The objective of this study was to evaluate the accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in diagnosing the correct etiology for a solid Pancreatic Mass. METHOD: Data extracted from EUS-FNA studies with a criterion standard (either confirmed by surgery or appropriate follow-up) were selected. Articles were searched in MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Pooling was conducted by both fixed- and random-effects models. RESULTS: Initial search identified 3610 reference articles, of these 360 relevant articles were selected and reviewed. Data were extracted from 41 studies (N = 4766) which met the inclusion criteria. Pooled sensitivity of EUS-FNA in diagnosing the correct etiology for solid Pancreatic Mass was 86.8% (95% confidence interval [CI], 85.5-87.9). Endoscopic ultrasound-guided FNA had a pooled specificity of 95.8% (95% CI, 94.6-96.7). Positive likelihood ratio of EUS was 15.2 (95% CI, 8.5-27.3), and the negative likelihood ratio was 0.17 (95% CI, 0.13-0.21). CONCLUSIONS: Endoscopic ultrasound-guided FNA is an excellent diagnostic tool to detect the correct etiology for solid Pancreatic Masses. When available, EUS-FNA should be strongly considered as the first diagnostic tool for sampling these lesions to optimize patient management.
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yield of eus guided fna of Pancreatic Masses in the presence or the absence of chronic pancreatitis
Gastrointestinal Endoscopy, 2005Co-Authors: Shyam Varadarajulu, Ashutosh Tamhane, Mohamad A EloubeidiAbstract:Background Evaluation of a focal Pancreatic Mass in the setting of chronic pancreatitis (CP) is a diagnostic challenge. The objectives of the study were to compare the diagnostic yield and accuracy of EUS-guided FNA (EUS-FNA) in the evaluation of Pancreatic-Mass lesions in the presence or the absence of CP and to identify predictors of CP before EUS-FNA of Pancreatic-Mass lesions. Methods The study design was analysis of data collected prospectively on all patients with solid Pancreatic-Mass lesions who underwent EUS-FNA at a tertiary referral center. A total of 282 consecutive patients underwent 300 EUS-FNA procedures of Pancreatic-Mass lesions over a 3-year period. The diagnostic yield and the accuracy of EUS-FNA was compared between patients with and without CP. CP was defined by the presence of more than 4 EUS criteria. Results Final diagnosis was adenocarcinoma in 210 (70%), benign disease in 64 (21%), other pathology in 19 (6%), and indeterminate in 4 (2%); 3 patients (1%) were lost to follow-up. CP was noted in 75/300 (25%) patients. A lower sensitivity for EUS-FNA was observed in patients with CP than in those without CP (73.9% vs. 91.3%; p = 0.02). While patients with CP had a higher negative predictive value (88.9% vs. 45.5%; p Conclusions EUS-FNA has a low sensitivity for Pancreatic-Mass lesions in the setting of CP. This decreased sensitivity can be overcome by performing more numbers of passes at FNA, which improves diagnostic accuracy. Demographic features and clinical presentation are predictive of underlying CP in patients with Pancreatic-Mass lesions.
Glen A Lehman - One of the best experts on this subject based on the ideXlab platform.
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endoscopic ultrasonography guided fine needle aspiration biopsy of suspected Pancreatic cancer
Annals of Internal Medicine, 2001Co-Authors: Frank G Gress, Klaus Gottlieb, Stuart Sherman, Glen A LehmanAbstract:Endoscopic ultrasonography–guided fine-needle aspiration biopsy may be valuable in the evaluation of a Pancreatic Mass when results on other biopsy methods are negative but Pancreatic cancer is sus...
Keiko Sasaki - One of the best experts on this subject based on the ideXlab platform.
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endoscopic ultrasonography guided fine needle aspiration biopsy using 22 gauge needle in diagnosis of autoimmune pancreatitis
Digestive and Liver Disease, 2011Co-Authors: Kenichiro Imai, Hiroyuki Matsubayashi, Katsuhiko Uesaka, Akira Fukutomi, Keiko SasakiAbstract:Abstract Backgrounds The effectiveness of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has not been fully evaluated in the diagnosis of autoimmune pancreatitis (AIP). Aim To evaluate the effectiveness of EUS-FNA using 22-gauge needles in the diagnosis of AIP. Methods EUS-FNA was examined in 85 patients with Pancreatic Mass, including 64 patients with Pancreatic cancer and 21 patients with AIP. We investigated ability of EUS-FNA using 22-gauge needle for the differential diagnosis between AIP and Pancreatic cancer. We also compared the factors concerning FNA procedures (number of needle passes, size of lesion, device, and amount of obtained Pancreatic tissue) between two diseases. Results Tissues obtained from 21 patients with AIP, although none of them demonstrated histology suspicious for malignancy, did not show histological evidence definitive for AIP. The amount of obtained Pancreatic tissue was almost equal between two diseases in each Pancreatic location. Sensitivity, specificity, overall accuracy, and negative predictive value of histological diagnosis of Pancreatic cancer were 92.2%, 100%, 94.1%, and 80.8%, respectively. Conclusion EUS-FNA using 22-gauge needle distinguished benign from malignant Pancreatic Mass with >90% of accuracy, regardless of the location. Hence, it was helpful for the clinical diagnosis of AIP, however not providing satisfactory samples for the histological diagnosis of AIP.
