New Methods to Obtain Better Tissue Samples with EUS-guided FNA

Charles J. Lightdale, MD, Consulting Editor

Endoscopic ultrasound (EUS) started out as primarily an imaging technique, but it soon became clear that EUS-guided fine-needle aspiration (FNA) for tissue acquisition would become a dominant function. Walking past an endoscopy room, one might hear phrases like “dart-throw” or “ice-pick” as we tried to teach GI Fellows how to use various EUS needles more notable for their similarities than their differences.

There was some early hope that computer analysis of ultrasound signals might reveal “signatures” correlating with specific diagnoses. Although some progress has been made, that goal remains elusive. The successful alternative was EUS-guided FNA to obtain cytologic and histologic specimens from imaged abnormalities. The development of electronic linear ultrasound endoscopes, with the ultrasound beam parallel to the instrument channel, allowed EUS-guided FNA to be carried out with great precision. Linear EUS systems and scopes improved rapidly and have been widely adopted by interventional endoscopists with a focus on subepithelial wall lesions, lymph nodes, and especially the pancreas.

Interestingly, it is only in recent years that major improvements have been made to the needles used for EUS-guided FNA. In addition, there has been progress in the development of new techniques for better tissue acquisition in different circumstances. There is some disagreement among specialists on the choice of needles and methods. However, no one disagrees that obtaining adequate tissue to guide new individualized therapies in gastroenterology, surgery, and oncology has become of critical importance.

The Guest Editors for this issue of the Gastrointestinal Endoscopy Clinics of North America on “EUS-guided Tissue Acquisition” are Robert Hawes, a pioneer and world leader in the field of EUS, and his colleague, Shyam Varadarajulu, representing the next generation of endosonographer-interventionalists. They have assembled a group of experts who share their passion to obtain the best possible results from EUS-guided FNA, and they have compiled a volume that covers all the relevant topics and controversies.

The choices in carrying out EUS-guided FNA have become rather complex. There are a variety of needle designs now available that offer different advantages and possibilities. Hitting the target with the needle is obviously central to success, but only the first step in maximizing the likelihood of getting a sufficient specimen for an accurate diagnosis. Everything that you need to know to obtain an optimal sample is in this state-of-the-art volume. If you are performing or learning EUS-guided FNA, this issue of the Gastrointestinal Endoscopy Clinics of North America is a “don’t miss.”

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