• accuracy of sampling
• biopsy technique
• endoscopic ultrasound (EUS)
• fine-needle aspiration (FNA)
• fine-needle biopsy (FNB)
• pancreatic cancer

• Humans
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Endoscopy, Gastrointestinal/methods
• Endoscopy, Gastrointestinal/instrumentation
• Societies, Medical
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Europe
• Endosonography/methods
• Endosonography/instrumentation
• Needles
• Pancreas/pathology
• Pancreas/diagnostic imaging

• Endoscopic ultrasound
• Fine needle aspiration cytology
• Fine needle biopsy
• Macroscopic on-site evaluation
• Rapid on-site evaluation

• biopsy needle
• blood cell contamination
• diagnosis
• endoscopic ultrasound-guided tissue acquisition
• heparin
• histological integrity
• suction technique

• KRAS wild-type
• Pancreatic adenocarcinoma
• genomic alterations
• targeted therapy
• therapeutic targets

• Humans
• Pancreatic Neoplasms/genetics
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/mortality
• Proto-Oncogene Proteins p21(ras)/genetics
• Proto-Oncogene Proteins p21(ras)/antagonists & inhibitors
• Molecular Targeted Therapy/methods
• Mutation
• Biomarkers, Tumor/genetics

• Cultivation optimization strategy
• Drug screening
• Endoscopic ultrasound-guided fine-needle biopsy
• Pancreatic cancer organoid
• Puncture technique

• Humans
• Organoids/pathology
• Female
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/diagnostic imaging
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Male
• Middle Aged
• Aged
• Prospective Studies
• Precision Medicine/methods
• Pancreas/pathology
• Pancreas/diagnostic imaging

• Interventional pulmonology
• bronchoscopy
• combined ultrasound (CUS)
• endobronchial ultrasound (EBUS)
• endobronchial valves
• endoscopic ultrasound-bronchoscopy (EUS-B)
• navigation bronchoscopy
• peripheral pulmonary lesion

• Humans
• Bronchoscopy/instrumentation
• Lung Neoplasms/pathology
• Lung Neoplasms/diagnostic imaging
• Lung Neoplasms/diagnosis
• Endosonography
• Pulmonary Medicine
• Neoplasm Staging
• Predictive Value of Tests

• Biopsy
• Contrast-enhanced endoscopic ultrasound
• Drainage
• Endosonography
• Fine needle aspiration
• Fine needle biopsy
• Pancreas
• Pancreatic fluid collections
• Tissue acquisition

• Humans
• Contrast Media/administration & dosage
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/pathology
• Endosonography/methods
• Pancreas/diagnostic imaging
• Pancreas/surgery
• Pancreas/blood supply
• Pancreas/pathology
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Ultrasonography, Interventional/methods
• Drainage/methods
• Pancreatic Diseases/diagnostic imaging
• Pancreatic Diseases/surgery
• Pancreatic Diseases/pathology

• 19-gauge
• Endoscopic ultrasound-guided fine-needle aspiration
• Franseen needle
• Lymphadenopathy
• Malignant lymphoma

• endoscopic ultrasound
• endoscopic ultrasound-guided fine-needle aspiration
• endoscopic ultrasound-guided fine-needle biopsy
• gastrointestinal stromal tumor
• gastrointestinal subepithelial tumors
• pathology

• Male
• Humans
• Middle Aged
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Retrospective Studies
• Endosonography
• Pancreatic Neoplasms/diagnosis
• Morpholines
• Organoselenium Compounds

• Clinical Medical Research Projects of Wuhan Municipal Health Commission, No. WX16D26.

• EUS
• PDAC
• fine-needle aspiration (FNA)
• fine-needle biopsy (FNB)
• pancreatic carcinoma
• precision medicine

• AMSTAR
• Gastrointestinal endoscopy
• Meta-analysis
• PRISMA
• Quality

• Autoimmune pancreatitis
• International consensus diagnostic criteria
• Pancreatic cancer
• Steroid

• diagnostic value
• endoscopic ultrasound-Guided fine needle aspiration
• endoscopic ultrasound-guided fine needle biopsy
• mediastinal lesions
• ultrasound gastroscopy

We aimed to develop a deep learning-based segmentation system for rapid on-site cytopathology evaluation (ROSE) to improve the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy.

A retrospective, multicenter, diagnostic study was conducted using 5345 cytopathological slide images from 194 patients who underwent EUS-FNA. These patients were from Nanjing Drum Tower Hospital (109 patients), Wuxi People's Hospital (30 patients), Wuxi Second People's Hospital (25 patients), and The Second Affiliated Hospital of Soochow University (30 patients). A deep convolutional neural network (DCNN) system was developed to segment cell clusters and identify cancer cell clusters with cytopathological slide images. Internal testing, external testing, subgroup analysis, and human–machine competition were used to evaluate the performance of the system.

The DCNN system segmented stained cells from the background in cytopathological slides with an F1-score of 0·929 and 0·899–0·938 in internal and external testing, respectively. For cancer identification, the DCNN system identified images containing cancer clusters with AUCs of 0·958 and 0·948–0·976 in internal and external testing, respectively. The generalizable and robust performance of the DCNN system was validated in sensitivity analysis (AUC > 0·900) and was superior to that of trained endoscopists and comparable to cytopathologists on our testing datasets.

The DCNN system is feasible and robust for identifying sample adequacy and pancreatic cancer cell clusters. Prospective studies are warranted to evaluate the clinical significance of the system.

Jiangsu Natural Science Foundation; Nanjing Medical Science and Technology Development Funding; National Natural Science Foundation of China.

• Deep convolutional neural network
• EUS-FNA
• Pancreatic mass
• Rapid on-site cytopathology evaluation

• Deep Learning
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Humans
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Prospective Studies
• Retrospective Studies

Gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas are the most common gastric subepithelial tumors (GSETs) with similar endoscopic findings. Preoperative prediction of GSETs is difficult. This study analyzed and predicted GSET diagnosis through a retrospective review of 395 patients who underwent surgical resection of GISTs, leiomyomas, and schwannomas measuring 2–10 cm. GSETs were divided by size (group 2–5, >2 and ≤5 cm; group 5–10, >5 and ≤10 cm) for analysis. Demographics, clinical symptoms, and images were analyzed. A recursive partitioning analysis (RPA) was used to identify optimal classifications for specific GSET diagnoses. GIST patients were relatively older than other patients. Both groups had higher proportions of UGI bleeding, lower hemoglobin (Hb) levels, and a higher ratio of necrosis on their computed tomography (CT) scans. The RPA tree showed that (a) age ≤ 55, Hb ≥ 10.7, and CT necrosis; (b) age ≤ 55 and Hb < 10.7; (c) age >55 and Hb < 12.9; and (d) age >55 and CT hetero-/homogeneity can predict high GIST risk in group 2–5. Positive or negative CT necrosis, with age >55, can predict high GIST risk in group 5–10. GIST patients were older and presented with low Hb levels and tumor necrosis. In RPA, the accuracy reached 85% and 89% in groups 2–5 and 5–10, respectively.

We aimed to develop a new artificial intelligence (AI)-based method for evaluating endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) specimens in pancreatic diseases using deep learning and contrastive learning. We analysed a total of 173 specimens from 96 patients who underwent EUS-FNB with a 22 G Franseen needle for pancreatic diseases. In the initial study, the deep learning method based on stereomicroscopic images of 98 EUS-FNB specimens from 63 patients showed an accuracy of 71.8% for predicting the histological diagnosis, which was lower than that of macroscopic on-site evaluation (MOSE) performed by EUS experts (81.6%). Then, we used image analysis software to mark the core tissues in the photomicrographs of EUS-FNB specimens after haematoxylin and eosin staining and verified whether the diagnostic performance could be improved by applying contrastive learning for the features of the stereomicroscopic images and stained images. The sensitivity, specificity, and accuracy of MOSE were 88.97%, 53.5%, and 83.24%, respectively, while those of the AI-based diagnostic method using contrastive learning were 90.34%, 53.5%, and 84.39%, respectively. The AI-based evaluation method using contrastive learning was comparable to MOSE performed by EUS experts and can be a novel objective evaluation method for EUS-FNB.

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death and lacks effective treatment options. Diagnostic endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies represent an appealing source of material for molecular analysis to inform targeted therapy, as they are often the only available tissue for patients presenting with PDAC irrespective of disease stage. However, EUS-FNA biopsies are typically not used to screen for precision medicine studies due to concerns about low tissue yield and quality. Epidermal growth factor receptor (EGFR) inhibition has shown promise in clinical trials of unselected patients with advanced pancreatic cancer, but has not been prospectively tested in KRAS wild-type patients. Here, we examine the clinical utility of EUS-FNA biopsies for molecular screening of KRAS wild-type PDAC patients for targeted anti-EGFR therapy to assess the feasibility of this approach.

Fresh frozen EUS-FNA or surgical biopsies from PDAC patient tumours were used to screen for KRAS mutations. Eligible patients with recurrent, locally advanced, or metastatic KRAS wild-type status who had received at least one prior line of chemotherapy were enrolled in a pilot study (ACTRN12617000540314) and treated with panitumumab at 6mg/kg intravenously every 2 weeks until progression or unacceptable toxicity. The primary endpoint was 4-month progression-free survival (PFS).

275 patient biopsies were screened for KRAS mutations, which were detected in 88.3% of patient samples. 8 eligible KRAS wild-type patients were enrolled onto the interventional study between November 2017 and December 2020 and treated with panitumumab. 4-month PFS was 14.3% with no objective tumour responses observed. The only grade 3/4 treatment related toxicity observed was hypomagnesaemia.

This study demonstrates proof-of-principle feasibility to molecularly screen patients with pancreatic cancer for targeted therapies, and confirms diagnostic EUS-FNA biopsies as a reliable source of tumour material for molecular analysis. Single agent panitumumab was safe and tolerable but led to no objective tumour responses in this population.

• KRAS
• endoscopic ultrasound
• molecular analysis
• pancreatic cancer
• precision medicine

• EUS-LB, EUS-guided liver biopsy
• FNB, fine-needle biopsy

• EUS-guided tissue acquisition
• biopsy
• diagnostic accuracy
• endoscopic ultrasound
• image-guided biopsy

Recently, a three-plane symmetric needle with Franseen geometry was developed for endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). In this retrospective study, tissue acquisition per pass was compared between 22-gauge Franseen FNB and standard fine needle aspiration (FNA) needles in patients with solid pancreatic lesions.

Consecutive patients who underwent EUS-FNA or EUS-FNB for solid pancreatic lesions between October 2014 and March 2018 were retrospectively studied. The tissue acquisition rate and the diagnostic performance per session, per pass, and at first pass were compared.

A total of 663 passes (300 by the FNB needle and 363 by the standard FNA needle) were performed in 154 patients (71 FNB and 83 FNA). The tissue acquisition rate per session and at first pass in the FNB and FNA groups was 100% and 95% (p=0.13) and 87% and 69% (p=0.007), respectively. The multivariate analysis revealed that among the patients, EUS-FNB (odds ratio, 3.07; p=0.01) was associated with a higher first-pass tissue acquisition rate. While the tissue acquisition rate reached a plateau after the 4th pass with FNA, it reached a plateau after the 2nd pass with FNB. Among the 129 malignant cases, the histological tissue acquisition rate per session was similar (100% and 94%), but the sensitivity by histology alone per session was higher for FNB than for FNA (93% and 73%, p<0.01).

The results of our retrospective analysis indicated that compared with a standard FNA needle, a 22-gauge Franseen FNB needle was associated with a higher first-pass tissue acquisition rate.

• Endoscopic ultrasonographyguided fine-needle biopsy
• Endoscopic ultrasound
• Endoscopic ultrasoundguided fine needle aspiration
• Histology
• Pancreatic neoplasms

• 19-gauge
• 22-gauge
• Franseen needle
• endoscopic ultrasound-guided fine-needle biopsy
• pancreatic cancer

Pancreatic cancer is one of the leading causes of cancer-related mortality in western countries. Early diagnosis of pancreatic cancers plays a key role in the management by identification of patients who are surgical candidates. The advancement in the radiological imaging and interventional endoscopy (including endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography and endoscopic enteral stenting techniques) has a significant impact in the diagnostic evaluation, staging and treatment of pancreatic cancer. The multidisciplinary involvement of radiology, gastroenterology, medical oncology and surgical oncology is central to the management of patients with pancreatic cancers. This review aims to highlight the diagnostic and therapeutic role of EUS in the management of patients with pancreatic malignancy, especially pancreatic ductal adenocarcinoma.

• endoscopic procedures
• endoscopic ultrasonography
• pancreatic cancer
• pancreatic disorders
• pancreato-biliary disorders

• biomarker
• chemotherapy
• endoscopic ultrasound-guided fine needle aspiration
• endoscopic ultrasound-guided fine needle biopsy
• endoscopic ultrasound-guided tissue acquisition
• next-generation sequencing
• pancreatic cancer
• precision medicine
• targeted genome sequencing

• Endoscopic ultrasound
• Fine-needle aspiration
• Fine-needle biopsy
• Pancreatic cancer
• Personalised medicine

• Endoscopic ultrasound
• Histological core tissue
• Immunohistochemistry
• Pancreas
• ProCore needles

• EUS-guided sampling
• pancreatic cancer
• patient-derived organoid
• precision medicine

• JP19K07739 JSPS KAKENHI

The diagnostic work-up of lymphadenopathy is challenging but important to determine the correct therapy. Nevertheless, few studies have addressed the topic of endosonography (EUS)-guided tissue acquisition in lymphadenopathy. Therefore, we aimed to evaluate the accuracy and safety of EUS-guided fine-needle biopsy sampling (EUS-FNB) in intrathoracic and intraabdominal lymphadenopathy.

In a tertiary care center, patients with lymphadenopathy referred for EUS-guided sampling were included prospectively from 2014 to 2019 (NCT02360839). In all cases, EUS-FNB (22 gauge) and EUS-guided fine-needle aspiration (EUS-FNA) (25 gauge) were performed. The patients were randomized to the first needle pass with FNB or FNA. Study outcomes were the diagnostic accuracy and adverse event rate.

Forty-eight patients were included (median age: 69 years [interquartile range, 59–76]; 24/48 females [50%]). The final diagnoses were metastasis (n=17), lymphoma (n=11), sarcoidosis (n=6), and inflammatory disease (n=14). The diagnostic performance of the two modalities was comparable, including a high sensitivity for metastatic nodes (EUS-FNB: 87% vs. EUS-FNA: 100%, p=0.5). The sensitivity for lymphoma was borderline superior in favor of EUS-FNB (EUS-FNB: 55% vs. EUS-FNA: 9%, p=0.06). No adverse events were recorded.

In lymphadenopathy, both EUS-FNB and EUS-FNA are safe and highly sensitive for metastatic lymph node detection. Lymphoma diagnosis is challenging regardless of the needle used.

• Endoscopic ultrasound-guided fine needle aspiration
• Endosonography
• Fine needle biopsy
• Lymphadenopathy

• endoscopic ultrasound
• interventional EUS
• pancreaticobiliary malignancy

The histological diagnosis of autoimmune pancreatitis (AIP) by an endoscopic ultrasound (EUS)-guided approach is still challenging.

We investigated the utility of the 21-gauge Menghini-type biopsy needle with the rolling method for the histological diagnosis of AIP, in comparison with conventional 22-gauge needles. Among total 28 patients, rate of definitive histological diagnosis, acquired sample area of tissue, rate of histopathological diagnosis of AIP, and adverse events were retrospectively analyzed.

Definitive histological diagnoses were successfully accomplished in all 14 patients (100%) treated with a Menghini-type needle, and in 57% of cases (8/14) treated with conventional 22-gauge needles (P < 0.001). The median sample area of the tissue, except for blood contamination, was remarkably larger by the Menghini-type needle than by conventional-type needles (6.2 [IQR, 4.5–8.8] versus 0.7 [IQR, 0.2–2.0] mm², P < 0.001), and the area per punctures was approximately 4 times larger (1.4 [IQR: 0.9–2.9] versus 0.3 [IQR: 0.1–0.6] mm²/puncture, P < 0.001). Based on the International Consensus Diagnostic Criteria, lymphoplasmacytic infiltration, abundant IgG4-postive cells, storiform fibrosis, and obliterative phlebitis were found in 86%/29%, 64%/0%, 36%/0%, and 7%/0% patients who were treated with the Menghini-type needle and conventional-type needles, respectively. Consequently, histopathological diagnosis with type 1 AIP (lever 1 or 2) was achieved in 9 patients (64%) treated with the Menghini-type needle and in no patient treated with conventional-type needles (P < 0.001). Two patients who had mild post-procedural pancreatitis improved with conservative treatment, and no bleeding occurred in patients treated with the Menghini-type needle.

EUS-guided rolling method with the 21-gauge Menghini-type biopsy needle is useful for the histopathological diagnosis of AIP, due to its abundant acquisition of good-quality tissue from the pancreas.

• EUS-FNB
• Good-quality tissue
• ICDC
• Sample area

Type 1 autoimmune pancreatitis (AIP) is histologically characterized by lymphoplasmacytic sclerosing pancreatitis (LPSP). Recently, the diagnostic yield of endoscopic ultrasonography-guided fine needle aspiration/biopsy (EUS-FNA/B) for AIP has been reported. However, its role in the diagnostic flow of AIP is not fully elucidated. We retrospectively reviewed 53 consecutive patients who were suspected with AIP and underwent EUS-FNA/B. We evaluated the contribution of EUS-FNA/B to the diagnosis of AIP before considering response to steroid therapy among patients with diffuse enlargement of the pancreas and those with focal enlargement, respectively. Twenty-two patients showed diffuse pancreatic enlargement and 31 showed focal enlargement. The final diagnosis was definitive AIP in 32 patients, probable AIP in 2, possible AIP in 1, and mass-forming focal pancreatitis in 18. There was no change in diagnosis after EUS-FNA/B among patients with diffuse pancreatic enlargement, while diagnosis changed in 38.7% (12/31) among those with focal enlargement—there was a probable to definitive diagnosis in 4 patients, unspecified to definitive in 3, and unspecified to probable in 5. EUS-FNB provided a significantly higher sensitivity for typical pathological findings of LPSP than EUS-FNA, and 10 patients were diagnosed as pathologically definitive AIP by EUS-FNB, though none were by EUS-FNA (p = 0.002). EUS-FNA/B was useful in the diagnosis of focal type AIP, and steroid therapy could be introduced after the diagnosis was confirmed. Meanwhile, EUS-FNA/B provided no contribution to diagnosis of diffuse type AIP. EUS-FNB showed a higher diagnostic yield than FNA.

• autoimmune pancreatitis
• diagnosis
• endoscopic ultrasonography
• fine needle aspiration/biopsy

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is increasingly utilized to enhance the cytological yield of sampling solid lesions, but its superiority over existing fine-needle aspiration (FNA) platforms has not been clearly demonstrated. The aim of our study was to compare the diagnostic accuracy and procedural outcomes of FNB using a new Franseen-tip needle to that of a traditional FNA in sampling solid lesions under EUS guidance.

Consecutive patients with solid lesions referred for EUS-FNB sampling were included. Procedure-related outcomes were collected prospectively including patient demographics, number of passes performed, diagnostic sample adequacy, adverse events, and recovery time. The Acquire needle was used to sample all lesions in the study group. Consecutive EUS-FNA procedures performed to sample solid lesions using the Expect needle were utilized as controls.

There were 180 patients undergoing EUS-FNB compared to 183 patients undergoing EUS-FNA procedures for solid-lesion sampling. The procedure time was significantly shorter in patients who underwent FNB compared to FNA (mean: 37.4 vs 44.9 minutes, P < 0.001). Significantly fewer passes were performed in the FNB cohort compared to the FNA group (mean: 2.9 vs 3.8, P < 0.001). The cytologic diagnostic yield was significantly higher in the FNB group compared to the FNA group (98.3% vs 90.2%, P = 0.003). No significant difference in the incidence of adverse events was observed between the FNB and FNA groups (1.1% vs 0.5%, P = 0.564).

An FNB-exclusive approach to sampling solid lesions under EUS guidance is safe and feasible, and may result in fewer overall passes, shorter procedure time, and improved diagnostic adequacy. FNB may replace FNA as the primary sampling modality of choice in all solid lesions.

• endoscopic ultrasound
• fine-needle aspiration
• fine-needle biopsy
• pancreatic tumors

Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is useful in the differential diagnosis of solid pancreatic lesions, lymph nodes, and liver lesions, inadequate sampling may result in an incorrect pathological diagnosis. The accuracy of EUS for the evaluation of pancreatobiliary lesions may be increased by image enhancement technologies, including contrast-enhanced harmonic (CH)-EUS and EUS-elastography. These methods can provide information that complement EUS-FNA for the diagnosis and staging of pancreatobiliary cancer, and can help to identify the EUS-FNA target, reducing the requirement for repeat FNA.

• CH-EUS
• EUS-FNA
• EUS-elastography

• EUS-guided tissue sampling
• cytopathology
• smear
• training

The introduction of fine needle biopsies (FNB) to clinical practice presents a changing trend towards histology in the endoscopic ultrasound-guided tissue acquisition (EUS-TA).

To evaluate the clinical performance of a new FNB needle, the 22-gauge (22G) Franseen needle, when sampling pancreatic solid lesions.

Consecutive patients with an indication for EUS-TA for the assessment of pancreatic solid lesions were included in this prospective, single-center, single-arm trial. Each patient underwent a puncture of the lesion two times using the 22G Franseen needle and the obtained samples were directly placed into formalin for histological analysis. The primary study endpoint was the rate of high-quality obtained specimen. Secondary endpoints included the length and diameter of the core specimen, the diagnostic accuracy and the complication rate.