• Clinical Endoscopy
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• 제57권3호
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• pp.384-392
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• 2024

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC. Methods: CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022. Results: Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy. Conclusions: EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

• Korean Journal of Radiology
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• 제22권4호
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• pp.596-603
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• 2021

Objective: To evaluate the feasibility and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology and core-needle biopsy (US-FNAC/CNB) for the diagnosis of laryngo-hypopharyngeal masses. Materials and Methods: This was a single-center prospective case series. From January 2018 to June 2019, we initially enrolled 40 patients with highly suspicious laryngo-hypopharyngeal masses on laryngoscopic examinations. Of these, 28 patients with the mass involving or abutting the pre-epiglottic, paraglottic, pyriform sinus, and/or subglottic regions were finally included. These patients underwent US examinations with/without subsequent US-FNAC/CNB under local anesthesia for evaluation of the laryngo-hypopharyngeal mass. Results: Of the 28 patients who underwent US examinations, a laryngo-hypopharyngeal mass was identified in 26 patients (92.9%). US-FNAC/CNB was performed successfully in 25 of these patients (96.2%), while the procedure failed to target the mass in 1 patient (3.8%). The performance of US caused minor subclinical hematoma in 2 patients (7.7%), but no major complications occurred. US-FNAC/CNB yielded conclusive results in 24 (96.0%) out of the 25 patients with a successful procedure, including 23 patients with squamous cell carcinoma (SCC) and 1 patient with a benign mass. In one patient with atypical cells in US-FNAC, additional direct laryngoscopic biopsy (DLB) was required to confirm SCC. Among the 26 patients who received US-FNAC/CNB, the time from first visit to pathological diagnosis was 7.8 days. For 24 patients finally diagnosed with SCC, the time from first visit to the initiation of treatment was 25.2 days. The mean costs associated with US-FNAC/CNB was $272 under the Korean National Health Insurance Service System. Conclusion: US-FNAC/CNB for a laryngo-hypopharyngeal mass is technically feasible in selected patients, providing good diagnostic performance. This technique could be used as a first-line diagnostic modality by adopting appropriate indications to avoid general anesthesia and DLB-related complications.

• 대한의용생체공학회:의공학회지
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• 제41권5호
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• pp.195-202
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• 2020

Needle detection in ultrasound images is sometimes difficult due to obstruction of fat tissues. Accurate needle detection using continuous ultrasound (CUS) images is a vital stage of treatment planning for tissue biopsy and brachytherapy. The main goal of the study is classified into two categories. First, new detection model, i.e. D-Attention Unet, is developed by combining the context information of 3D medical data and CUS images. Second, the D-Attention Unet model was compared with other models to verify its usefulness for needle detection in continuous ultrasound images. The continuous needle images taken with ultrasonic waves were converted into still images for dataset to evaluate the performance of the D-Attention Unet. The dataset was used for training and testing. Based on the results, the proposed D-Attention Unet model showed the better performance than other 3 models (Unet, D-Unet and Attention Unet), with Dice Similarity Coefficient (DSC), Recall and Precision at 71.9%, 70.6% and 73.7%, respectively. In conclusion, the D-Attention Unet model provides accurate needle detection for US-guided biopsy or brachytherapy, facilitating the clinical workflow. Especially, this kind of research is enthusiastically being performed on how to add image processing techniques to learning techniques. Thus, the proposed method is applied in this manner, it will be more effective technique than before.

• Clinical Endoscopy
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• 제55권5호
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• pp.637-644
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• 2022

Background/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs. Methods: In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques. Results: The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis. Conclusions: SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.

• Asian Pacific Journal of Cancer Prevention
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• 제15권7호
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• pp.3087-3091
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• 2014

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen (tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men with lower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serum tPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue were obtained from different areas of the peripheral prostate and examined histopathologically for the nature of the pathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changes with or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) of patients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCa had abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA >20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among 209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: The incidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can be further improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.

• Asian Pacific Journal of Cancer Prevention
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• 제15권7호
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• pp.3179-3183
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• 2014

Background: The purpose of study was to evaluate radiologic or clinical features of breast cancer undergoing ultrasound (US)-guided 14G core needle biopsy (CNB) and analyze the differences between underestimated and accurately diagnosed groups. Materials and Methods: Of 1,898 cases of US-guided 14G CNB in our institute, 233 cases were proven to be cancer by surgical pathology. The pathologic results from CNB were invasive ductal carcinoma (IDC) (n=157), ductal carcinoma in situ (DCIS) (n=40), high-risk lesions in 22 cases, and benign in 14 cases. Among high-risk lesions, 7 cases of atypical ductal hyperplasia (ADH) were reported as cancer and 11 cases of DCIS were proven IDC in surgical pathology. Some 29 DCIS cases and 157 cases of IDC were correctly diagnosed with CNB. The clinical and imaging features between underestimated and accurately diagnosed breast cancers were compared. Results: Of 233 cancer cases, underestimation occurred in 18 lesions (7.7%). Among underestimated cancers, CNB proven ADH (n=2) and DCIS (n=11) were diagnosed as IDC and CNB proven ADH (n=5) were diagnosed at DCIS finally. Among the 186 accurately diagnosed group, the CNB results were IDC (n=157) and DCIS (n=29). Comparison of underestimated and accurately diagnosed groups for BI-RADS category, margin of mass on mammography and US and orientation of lesion on US revealed statistically significant differences. Conclusions: Underestimation of US-guided 14G CNB occurred in 7.7% of breast cancers. Between underestimated and correctly diagnosed groups, BI-RADS category, margin of the mass on mammography and margin and orientation of the lesions on US were different.

• 대한영상의학회지
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• 제82권5호
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• pp.1207-1217
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• 2021

목적 췌장 및 췌장 주위의 주요 혈관에 인접한 병변에 대하여 초음파 유도하 경피적 중심 바늘 생검(ultrasound-guided percutaneous core needle biopsy; 이하 USPCB)의 안전성과 효능을 평가하였다. 대상과 방법 10년 동안 췌장(n = 98), 간문맥 근처 췌장 주위(n = 34), 또는 췌장 갈고리돌기 부위와 십이지장 제3부분과 인접한 대동맥주위(n = 30) 병변에 대하여 USPCB를 시행받은 162명의 환자의 검사 결과를 수집하였다. 초음파 유도하18게이지 바늘을 가진 자동 생검 총을 사용하였고, USPCB 결과는 수술 결과 또는 추적 관찰 영상과 비교하였다. USPCB의 진단 정확도 및 주요 합병증 비율을 계산했으며, 성공적인 생검의 예측을 위한 요인이 무엇인지 단변량 및 다변량 분석을 사용하여 평가하였다. 결과 USPCB에서 조직 병리학 진단은 149명(92%) 환자에서 일치했다. 주요 합병증은 장간막 혈종 4건과 십이지장 벽내혈종 1건이 발생했다(3%). 성공적인 생검을 위한 요인으로는 위 또는 장관을 통과하는 경로보다는 경장간막 경로를 이용할수록, 초음파상 표적 및 생검 경로가 잘 보일수록 등이 포함되었다. 또한 결과적으로 생검에 성공한 경우 생검 횟수가 더 적었다. 결론 USPCB는 주요 혈관에 인접한 췌장 및 간문맥 근처 췌장 주위 병변 또는 췌장 갈고리돌기 부위나 십이지장 제3부분과 인접한 대동맥 주위 병변의 조직학적 진단을 위한 높은 정확도 및 낮은 합병증 비율을 나타냈다.

• 대한기관식도과학회지
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• 제17권1호
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• pp.9-13
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• 2011

Endobronchial ultrasound (EBUS), which enables visualization of lesions beyond the bronchus, broadens the fields of bronchoscopy. Two types of ultrasound, radial and linear, are used for bronchoscopy. Radial EBUS is performed by inserting an ultrasound mini-probe through the working channel of a flexible bronchoscope. Evaluation of the depth of invasion of early endobronchial lung cancers using radial EBUS is useful in deciding endobronchial treatment. A central tumor limited to within the cartilaginous layer is a good indication for endobronchial photodynamic therapy. EBUS-guide sheath (GS) technique is a sampling method assisted by localization of peripheral lesions using EBUS. The diagnostic yield of EBUS-GS method is higher than that of conventional transbronchial biopsy. High diagnostic values of EBSU-GS method are reported even in small (${\leq}2cm$) peripheral tumors. Linear EBUS is used for endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). EBUS-TBNA has high diagnostic yields in mediastinal staging of lung cancer even in patients having radiologically early stage lung cancers with normal CT or PET findings in the mediastinum. EBUS is a valuable method in evaluating early endobronchial tumors and peripheral small lung cancers and as well as in mediastinal staging.

• Journal of Digestive Cancer Research
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• 제5권2호
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• pp.120-124
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• 2017

A-49-year-old male patient with no specific medical history was admitted to the clinic because of persistent epigastric pain radiating to back for 4 months. He had multiple parenchymal tumors in body and tail of pancreas, para-spinal muscle, and mediastinum on abdomen CT image. Cytologic examination of the pancreas which was done by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) showed adenocarcinoma, whereas histological examination of the para-spinal mass showed undifferentiated sarcoma. Histologic examination of the pancreatic mass was made through endoscopic ultrasound guided fine needle biopsy (EUS-FNB) for accurate diagnosis, and the histologic examination of both the pancreas and posterior mediastinal mass showed the same undifferentiated sarcoma. Therefore, we reviewed the cytopathic tissue obtained from the pancreas for the first time, and it was confirmed to be similar to histologic findings in the mediastinal mass.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2673-2678
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• 2016

Background: It is unclear as to whether the size ratio elastographic technique is useful for assessing ultrasound-detected ductal carcinoma-in-situ (DCIS) masses since they commonly lack a significant desmoplastic reaction. The objectives of this study were to determine the accuracy of this elastographic technique in DCIS and examine if there was any histopathological correlation with the grey-scale strain patterns. Materials and Methods: Female patients referred to the radiology department for image-guided breast biopsy were prospectively evaluated by ultrasound elastography prior to biopsy. Histological diagnosis was the gold standard. An elastographic size ratio of more than 1.1 was considered malignant. Elastographic strain patterns were assessed for correlation with the DCIS histological architectural patterns and nuclear grade. Results: There were 30 DCIS cases. Elastographic sensitivity for detection of malignancy was 86.7% (26/30). 10/30 (33.3%) DCIS masses demonstrated predominantly white elastographic strain patterns while 20/30 (66.7%) were predominantly black. There were 3 (10.0%) DCIS masses that showed had a co-existent bull's-eye sign and 7 (23.3%) other masses had a co-existent toothpaste sign, a strain pattern that has never been reported in the literature. Four out of 4/5 comedo DCIS showed a predominantly white strain pattern (p=0.031) while 6/7 cases with the toothpaste sign were papillary DCIS (p=0.031). There was no relationship between the strain pattern and the DCIS nuclear grade. Conclusions: The size ratio elastographic technique was found to be very sensitive for ultrasound-detected DCIS masses. While the elastographic grey-scale strain pattern should not be used for diagnostic purposes, it correlated well with the DCIS architecture.