• Humans
• Adenocarcinoma/pathology
• Adenocarcinoma/diagnostic imaging
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Peritoneal Neoplasms/diagnostic imaging
• Peritoneal Neoplasms/pathology
• Male
• Female
• Middle Aged

• GZK1202214 the Provincial and Ministry Co-constructed National Key Laboratory of Radiological Medicine and Radiation Protection Open Projects

• Endoscopic ultrasonography
• Endoscopy Lower GI Tract
• Endoscopy Upper GI Tract
• Pancreatobiliary (ERCP/PTCD)
• Quality and logistical aspects
• Quality management

• 18f-fdg pet/ct
• eus-fna
• extra-pulmonary tuberculosis

• Diagnosis, Differential
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Endosonography/methods
• Granuloma/diagnosis
• Granuloma/etiology
• Granuloma/pathology
• Humans
• Laparoscopy
• Male
• Mediastinum/diagnostic imaging
• Middle Aged
• Mycobacterium tuberculosis/genetics
• Mycobacterium tuberculosis/isolation & purification
• Polymerase Chain Reaction
• Positron-Emission Tomography
• Tomography, X-Ray Computed/methods
• Tuberculosis, Lymph Node
• Tuberculosis, Miliary/diagnosis

Diagnostic laparoscopy is often a necessary, albeit invasive, procedure to help resolve undiagnosed peritoneal diseases. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, however, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC).

This pilot study aims to prospectively determine the effectiveness of EUS-FNB regarding adequacy of tissue for IHC staining, diagnostic rate and the avoidance rate of diagnostic laparoscopy or percutaneous biopsy in patients with these lesions.

From March 2017 to June 2018, patients with peritoneal or omental lesions identified by CT or MRI at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were prospectively enrolled in the study. All Patients underwent EUS-FNB. For those with negative pathological results of EUS-FNB, percutaneous biopsy or diagnostic laparoscopy was planned. Analysis uses percentages only due to small sample sizes.

A total of 30 EUS-FNB passes were completed, with a median of 3 passes (range 2–3 passes) per case. For EUS-FNB, the sensitivity, specificity, PPV, NPV and accuracy of EUS-FNB from peritoneal lesions were 63.6%, 100%, 100%, 20% and 66.7% respectively. Adequate tissue for IHC stain was found in 25/30 passes (80%). The tissues from EUS results were found malignant in 7/12 patients (58.3%). IHC could be done in 10/12 patients (83.3%). Among the five patients with negative EUS results, two underwent either liver biopsy of mass or abdominal paracentesis, showing gallbladder cancer and adenocarcinoma. Two patients refused laparoscopy due to advanced pancreatic cancer and worsening ovarian cancer. The fifth patient had post-surgical inflammation only with spontaneous resolution. The avoidance rate of laparoscopic diagnosis was 58.3%. No major adverse event was observed.

EUS-FNB from peritoneal lesions provided sufficient core tissue for diagnosis and IHC. Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions.

The online version contains supplementary material available at 10.1186/s12876-021-01953-9.

• Abdominal paracentesis
• Ascites
• Carcinomatosis peritonei
• Endoscopic ultrasound (EUS)
• Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)
• Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB)
• Omental cake
• Omentum
• Peritoneal carcinomatosis
• Peritoneal ligament
• Peritoneal space

• Carcinomatosis
• Endoscopic ultrasonography
• Fine needle biopsy
• Peritoneum

To determine the levels of carcinoembryonic antigen (CEA), proliferating nuclear antigen Ki67 and p53 in pseudomyxoma peritonei (PMP) of appendiceal origin and to correlate the levels with clinicopathological characteristics and overall survival.

This retrospective study collected data on clinicopathological features and immunohistochemical staining of CEA, Ki67 and p53 in patients with PMP of appendiceal origin. Overall survival was evaluated using Kaplan–Meier plots. Median survival time was estimated by Log-rank tests. Potential prognostic factors were evaluated by Cox proportional hazards regression models.

A total of 141 patients with PMP of appendiceal origin were enrolled in the study with a median age of 54 years. Of these, 93 (66.0%) were diagnosed with low-grade mucinous carcinoma, 43 (30.5%) with high-grade mucinous carcinoma and five (3.5%) with high-grade with signet ring cells. CEA exhibited ubiquitous immunopositivity in most cases and was not associated with overall survival. Ki67 labelling index (LI) and p53 status were related to histological grade and overall survival. The main pathological indicators affecting survival included histological grade, lymph node involvement, angiolymphatic invasion, Ki67 LI and p53.

Combined analysis of high Ki67 LI and aberrant p53 may provide the basis for evaluating the biological behaviour of PMP and predicting clinical outcome.

• Pseudomyxoma peritonei
• appendiceal origin
• immunohistochemistry
• peritoneum

Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%–75% for the detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence of obvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC.

Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were included after obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performed through the transgastric route using a linear echoendoscope.

Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspected malignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure was successful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was also negative.

Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC and could be employed during EUS evaluation of malignancies.

• Ascites
• Endoscopic ultrasound
• Endoscopic ultrasound-guided fine needle aspiration
• Omentum
• Peritoneal neoplasms

• adenocarcinoma
• ascites
• endosonography
• pleura
• pleural effusion

• ascites
• peritoneoscopy
• peritonitis carcinomatosa
• tuberculosis

• Adolescent
• Adult
• Aged
• Ascites/diagnosis
• Ascites/etiology
• Ascites/surgery
• Biopsy
• Female
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Peritoneal Diseases/diagnosis
• Peritoneal Diseases/surgery
• Peritoneum/pathology
• Peritoneum/surgery
• Retrospective Studies

• endosonography
• fine-needle aspiration
• malignancy
• peritoneum
• tuberculosis

Transabdominal ultrasound not always allows to determine the nature of ascites based solely on its characteristics.

• ascites
• greater omentum
• tumor implants

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the liver is a safe procedure in the diagnosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modalities of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary stricture is superior to the conventional endoscopic brushing and biopsy.

• Endoscopic ultrasound
• Fine needle aspiration
• Hepatocellular carcinoma
• Bile duct stricture
• Gallbladder
• Cholangiocarcinoma
• Biliary drainage

The evaluation of ascites in patients with known or suspected malignancy is a critical aspect of preoperative staging. Endoscopic evaluation by ultrasound of low volume ascites and sampling of the ascitic fluid by endoscopic ultrasound guided paracentesis (EUS-P) is both a sensitive and specific modality for the determination of peritoneal implants, which is not only an important prognostic indicator but a crucial factor in determining treatment strategy. It is common practice to utilize EUS for gastrointestinal malignancies such as pancreatic or gastric masses, with the performance of paracentesis during the same procedure for the purpose of imaging the abnormality and possibly performing fine needle aspiration for biopsy of the neoplasm itself. However, given the ability of EUS-P to adequately sample even minimal ascites, detecting much smaller volumes than traditional computed tomography or magnetic resonance imaging, EUS-P may be a useful modality for the standard metastatic workup of any newly diagnosed or suspected malignancy. In this “Field of Vision” commentary, we discuss the role of EUS-P, including the article by Suzuki et al reporting their experience with EUS-P using an automated spring-loaded needle device. We also review the utility of EUS-P for non-gastrointestinal malignancies, such as ovarian cancer, which has a high incidence of malignant ascites.

• Ascites
• Malignancy
• Endoscopic ultrasound
• Paracentesis
• Fine needle aspiration

• Abdominal Neoplasms/complications
• Abdominal Neoplasms/pathology
• Ascites/diagnosis
• Ascites/diagnostic imaging
• Ascites/etiology
• Ascites/pathology
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography/instrumentation
• Equipment Design
• Humans
• Needles
• Paracentesis/instrumentation
• Predictive Value of Tests
• Prognosis

• Adequacy
• diagnostic performance
• endoscopic ultrasound-guided fine-needle aspiration
• lymph nodes
• pancreas
• rapid on-site evaluation
• sample quality
• sub-mucosal tumor

Routine examinations have a low specificity and a low positive rate for the diagnosis of peritoneal lesions. This study aimed to evaluate the diagnostic value and safety of ultrasound-guided percutaneous peritoneal lesion biopsies in patients with ascites and/or abdominal distension with unclear causes.

A retrospective analysis was performed in 153 consecutive patients with ascites and/or abdominal distension with unclear causes. All of the patients showed abnormalities of the peritoneum or greater omentum after ultrasonography, and underwent ultrasound-guided percutaneous biopsies using a Bard auto-biopsy gun with 18- or 16-gauge biopsy needles.

The success rate of the procedures was 100% (153/153) and the satisfaction rate of the tissue specimens in the biopsy was 91.5% (140/153). A specific histopathological diagnosis was made in 142 out of 153 patients, with an overall diagnostic accuracy of 92.8%. Among the diagnosed patients, 62 were peritoneal metastatic adenocarcinoma, 49 were peritoneal tuberculosis, 11 were peritoneal malignant mesothelioma, 8 were chronic peritoneal infections, 7 were pseudomyxoma peritonei, and 5 were primary peritoneal lymphoma. Only 11 patients did not get a pathologic diagnosis due to the lack of sufficient tissue specimen. No serious complications occurred.

Ultrasound-guided percutaneous biopsy could be a simple, safe and accurate diagnostic method in patients with ascites and/or abdominal distension with unclear causes.

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

• Ascites/diagnostic imaging
• Biopsy, Fine-Needle
• Endoscopy
• Endosonography
• Esophageal and Gastric Varices/therapy
• Gastroenterology
• Humans
• Liver Diseases/diagnosis
• Liver Diseases/diagnostic imaging
• Liver Diseases/therapy
• Paracentesis/methods
• Ultrasonography, Interventional