Improved Access for Internal Solid Tumors, Deep-seated Targets
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Endoscopic ultrasound of a 59-year-old with obstructive jaundice identified a hypoechoic mass in the head of the pancreas causing chronic bile duct obstruction.
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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) allows physicians to collect tissue samples or deliver therapeutic agents, thus enhancing diagnostic and interventional care. EUS-FNA is a less invasive method than percutaneous biopsy or surgery that are used to acquire diagnostic specimens from patients with gastrointestinal (GI), pancreaticobiliary, or thoracic malig-nancies. "Diagnostically speaking, with EUS-FNA, the sky is the limit," says Mohamad A. Eloubeidi, MD, MHS, director of UAB's Endoscopic Ultrasound Program.
Introduced and developed in 2000 by Eloubeidi, the UAB program provides clinicians with diagnostic access to organs and targets formerly accessible only during surgery or with image-guided percutaneous biopsy. UAB clinicians currently perform more than 2000 EUS procedures a year, 40% of which entail fine needle aspiration, making the UAB EUS program one of the busiest in the nation. Eloubeidi and gastroenterologist Shyam Varadarajulu, MD, see patients from across the Southeast 5 days a week.
Introducing the curvilinear echoendoscope used for EUS-FNA through the esophagus or anus lets physicians use the GI tract as a conduit for sample acquisition, avoiding multiple organs. EUS-FNA is suitable for multiple diagnostic applications, "allowing sampling of deep-seated organs and eliminating unnecessary invasive procedures and interventions in patients with unresectable tumors," Eloubeidi says.
In pancreaticobiliary disease, physicians use EUS-FNA to obtain tissue samples from solid pancreatic masses. EUS-FNA findings can distinguish malignant pancreatic masses from benign lesions attributable to chronic pancreatitis, eliminating the need for surgery. A challenging procedure for endosonographers to master, EUS-FNA of solid pancreatic masses is more than 90% accurate at UAB, Eloubeidi says. "For malignancies arising from the GI tract wall, EUS-FNA can assist physicians in staging lesions, evaluating depth of tumor invasion, planning intervention strategies, and determining if chemotherapy or radiation therapy is necessary," he says.
Multidisciplinary Diagnostics
Clinicians also can optimize cancer staging in patients with non-small cell lung cancer by sampling posterior mediastinal lymph nodes via transesophageal EUS-FNA, which, according to a UAB study, is a more effective tool than 18F-flourodeoxy- glucose positron emission tomography or chest tomography.
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EUS-FNA revealed cytologic features consistent with malignancy.
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In the study, EUS-FNA tissue confirmation was 97% accurate and prevented surgical interventions for further staging in 57% of patients (Ann Thorac Surg. 2005;79:263-268). Although the conscious sedation for EUS-FNA carries some risk, the technique avoids the risk of pneumothorax associated with percutaneous lung biopsy. Physicians also can use EUS-FNA to sample abdominal, thoracic, or pancreaticolienal lymph nodes and use this information in conjunction with flow cytometry to diagnose lymphoma.
EUS-FNA improves patient management by facilitating tissue diagnosis of tumors without the need for diagnostic surgery and allows on-site cytopathological interpretation, expediting diagnostic wait times. "EUS-FNA is an integral diagnostic modality at a facility with a large cancer center," Eloubeidi says. "UAB's expansion of this modality to assess multiple conditions promotes and improves integrated patient care."
For more information contact Dr. Mohammad Eloubeidi at 1-800-UAB-MIST or at mist@uabmc.edu