| セッション情報 |
特別講演16
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| タイトル |
SL-16：EUS-guided fine needle aspiration:Present and future
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| 演者 |
Varadarajulu Shyam（Center for Interventional Endoscopy, Florida Hospital, USA） |
| 共同演者 |
Bang Ji Young（Center for Interventional Endoscopy, Florida Hospital, USA） |
| 抄録 |
EUS-guided FNA is an indispensible technique for establishing tissue diagnosis in patients with lesions located in or adjacent to the gastrointestinal tract. There are numerous factors that determine the procedural outcomes of EUS-FNA. Procedure-related factors include（a）experience level of the endosonographer and（b）availability of a cytopathologist to render rapid onsite evaluation（ROSE）. Endosonographers who perform more than 100 FNA cases annually and are assisted by an onsite cytopathologist have a diagnostic yield that exceeds 90%. Technical factors pertaining to EUS-FNA include（a）the appropriate choice of needles and（b）adaptation of evidence-based techniques. The general consensus is that the 25G needle is the accessory of choice for performing pancreatic FNAs, particularly via the transduodenal route. The 22G needle is suitable for all other FNAs and the 19G needle is relegated mainly to the procurement of core biopsies and cyst aspirations. Specially designed core biopsy needles are now commercially available and widely used but there appears to be a“knowledge-disconnect”between their true need and perceived need. More outcome based data are therefore required to validate their routine use in clinical practice. Technique-related factors are several-fold：numerous studies have now shown that the routine use of suction or stylet is not needed as they do not positively impact the diagnostic yield of EUS-FNA. In addition, the“fanning”and“multiple-pass”techniques are more effective in establishing a diagnosis with fewer passes than the standard approach. Despite these improvements, there are several areas that suffer due to lack of clarity：EUS-FNA is limited in its diagnostic capability to evaluate pancreatic cyst lesions and the absence of an onsite cytopathologist to render ROSE limits the diagnostic sensitivity of the technique. The use of molecular markers, application of other ancillary testing and procurement of reliable histological core tissue will be important to overcome these limitations. |
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