Endoscopic ultrasound-guided fine-needle aspiration biopsy in the gastrointestinal tract
- Maurits J Wiersema, MD
Maurits J Wiersema, MD
- Clinical Assistant Professor of Medicine
- Indiana University School of Medicine
Endoscopic ultrasonography (EUS) has evolved from a diagnostic imaging modality to one that can also be used for invasive diagnostic and therapeutic procedures. These advances are largely due to the introduction of linear scanning instruments that can be used to place devices into the ultrasound plane of view, permitting various interventions to be performed. The ability of EUS to guide a biopsy needle into lesions that are too small to be identified by computed tomography or magnetic resonance imaging, or too well encased by surrounding vascular structures to allow percutaneous biopsy, secures its role in a variety of clinical settings.
Indications for EUS-guided fine-needle aspiration (EUS-FNA) include biopsy of mucosal and submucosal lesions in which prior conventional endoscopic biopsies have been nondiagnostic. The procedure is most commonly used to sample peri-intestinal structures such as lymph nodes and masses in the pancreas, liver, adrenal gland, and bile duct. It has also been used to aspirate peritoneal and pleural fluid.
This topic review will summarize experience with EUS-FNA in the gastrointestinal tract. A discussion on EUS-guided trucut biopsy is presented separately. (See "Endoscopic ultrasound-guided trucut biopsy".)
A number of different endoscopic ultrasound (EUS) devices are available. Most are similar to standard endoscopic instruments in that they have biopsy channels and video or fiberoptic endoscopic capability. They differ from normal endoscopes by having sophisticated ultrasound transmission and reception capability at the tip of the instrument.
"Linear" instruments scan in the same plane as the long axis of the endoscope, whereas mechanical "radial" instruments have a rotating mechanical ultrasound probe that scans in a circle at 90 degrees to the long axis of the endoscope. The ultrasound signal is then integrated by a complex processor and transmitted in real time to a video screen. Until recently, electronic (linear) and mechanical (radial) EUS instruments required separate processors, adding significantly to the cost of providing a comprehensive EUS service. However, 360-degree electronic radial echoendoscopes have been developed, allowing for use of a curvilinear array and a radial echoendoscope by a single processor, thus economizing EUS service.
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