Explore the vast range of titles available.

Background Gastric subepithelial lesions (SELs) measuring <20 mm without high‐risk features are typically managed with periodic surveillance, while surgical resection is recommended for gastrointestinal stromal tumors (GISTs) per the Japanese guideline. Recent advancements in endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) needles have improved tissue collection, but few studies have assessed the utility of EUS‐TA for SELs <20 mm. This study aimed to evaluate the usefulness of EUS‐TA for gastric SELs <20 mm. Methods We retrospectively analyzed patients who underwent EUS‐TA for SELs at Tonan Hospital between June 2012 and March 2025. Variables including needle type, number of passes, histological diagnosis, and diagnostic accuracy were compared between SELs <20 and ≥20 mm. Rapid On‐Site Evaluation (ROSE) was performed for all specimens. Results A total of 163 patients were included: 50 with SELs <20 mm and 113 with SELs ≥20 mm. Median lesion size was 15.5 and 31.7 mm, respectively. The <20 mm group required more passes to obtain adequate samples (2.5 vs. 2.0, p = 0.03). GIST was the most common diagnosis in both groups, with no significant difference (56% vs. 61.9%). Fine needle biopsy did not significantly improve sample adequacy or diagnostic accuracy. Diagnostic accuracy for SELs <20 mm was comparable to that for SELs ≥20 mm (88% vs. 93.8%). Conclusions EUS‐TA with ROSE for gastric SELs <20 mm yields diagnostic accuracy comparable to that for SELs ≥20 mm. Given the high GIST prevalence in small SELs, EUS‐TA may be a valuable diagnostic strategy.

Background Evaluating biomarkers, such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor‐2 (HER2), in pathological specimens is crucial for guiding breast cancer treatment. Since biomarker expression may differ between primary and metastatic lesions, biopsy of metastatic sites is recommended whenever feasible. The liver is a common metastatic site for breast cancer, and percutaneous biopsy has traditionally been the standard approach. Recently, endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) has emerged as an alternative method for sampling focal liver lesions. However, the utility of EUS‐TA in assessing breast cancer biomarkers remains unclear. Aim To evaluate the diagnostic performance of EUS‐TA, including its ability to assess biomarkers in liver metastases from breast cancer. Methods This single‐center, retrospective observational study included patients who underwent EUS‐TA for breast cancer liver metastases between 2016 and 2023. Clinical characteristics and specimen adequacy were analyzed. A pathologist classified the obtained tissue samples into four categories: (A) insufficient for diagnosis, (B) diagnosis possible only at the cytology level, (C) histological evaluation possible, but additional immunostaining for biomarkers not feasible, and (D) histological evaluation and additional immunostaining for biomarkers feasible. Results Fifteen cases were included, with a median patient age of 68 years (all female). The median liver lesion size was 20 mm (range: 8–50 mm). The lesions were located in the left lobe in 12 cases and the right lobe in 3 cases. A 22G needle was used in 14 cases, while a 25G needle was used in 1 case. Specimen adequacy was classified as follows: category A in 1 case (6.6%), B in 2 cases (13.3%), C in 0 cases (0%), and D in 12 cases (80%). Biomarker evaluation was feasible in the majority of cases. No procedure‐related adverse events were observed. Conclusion EUS‐TA is a valuable method for obtaining tissue samples from breast cancer liver metastases, enabling biomarker assessment in most cases.

A 73‐year‐old woman with a history of rheumatoid arthritis treated with methotrexate (MTX) for the last 10 years was referred to our hospital for a pancreatic tumor examination. Contrast‐enhanced abdominal computed tomography revealed a 20‐mm‐diameter hypovascular tumor in the pancreatic tail. A hypoechoic mass with heterogeneous internal echo was found on an endoscopic ultrasound (EUS). An EUS‐guided fine‐needle biopsy (EUS‐FNB) was performed with a 22‐gauge Franseen‐tip needle. Histologic examination of EUS‐FNB specimens from the pancreatic tumor revealed the proliferation of atypical spindle cells. Immunohistochemical staining for CD20 and Ki‐67 was positive in the atypical cells. Immunohistochemical staining for CD3 was partially positive in the atypical cells. Epstein–Barr virus‐encoded RNA in situ hybridization showed positive staining. MTX‐related lymphoproliferative disorder (MTX‐LPD) with Epstein‐Barr virus infection was diagnosed. MTX treatment was immediately discontinued, and treatment was initiated by a hematologist. However, her condition rapidly deteriorated, and she died of multiple organ failure 4 weeks after diagnosis. MTX‐LPD can complicate gastrointestinal lesions. However, most lesions are localized in the stomach and rarely complicate pancreatic lesions. MTX‐LPD is classified as an “iatrogenic” LPD. Therefore, immediate action, such as MTX discontinuation, is necessary. In conclusion, endoscopists should be aware that MTX‐LPD lesions can occur in the pancreas and gastrointestinal tract. Moreover, EUS‐FNB can be useful in the diagnosis of this rare pancreatic tumor.

BackgroundThere are limited studies on the results of comprehensive genomic profiling testing for pancreatic cancer tissue specimens by endoscopic ultrasound-guided tissue acquisition (EUS-TA). This study aimed to evaluate the proportion of specimens obtained by EUS-TA using a 19-gauge (G) fine-needle biopsy (FNB) needle for unresectable pancreatic cancer (UR-PC) that met the OncoGuide™ NCC Oncopanel System (NOP) analysis suitability criteria.MethodsIn this single-arm, prospective, phase II study, EUS-TA was performed using a 19G FNB biopsy needle in patients with suspected UR-PC based on a contrast-enhanced computed tomography scan. The primary endpoint was the proportion of patients who met the NOP analysis suitability criteria, with a threshold, expected value, α-error, and power of 40%, 70%, 0.025, and 0.9, respectively, and the planned number of enrolled patients was 33. The NOP analysis suitability criteria were defined as tumor cell content ≥ 20% and tissue size ≥ 4 mm2.ResultsThirty-three patients were enrolled. The procedural success rate was 100%, and the cytodiagnosis of class V was observed in all patients. The proportion of patients meeting the NOP analysis suitability criteria was 63.6% (95% CI 47.22–80.05), which satisfied the predefined criteria to be considered valid. Adverse events occurred in 9.0% of the patients.ConclusionsThe proportion of patients with UR-PC who met the NOP analysis suitability criteria for EUS-TA using a 19G FNB needle was effective for achieving the primary endpoint, making it a valid test method. Adverse events occurred at a higher rate than that previously reported.

BackgroundRecently, a novel 22-gauge needle with three symmetric needle points and crown-shaped cutting heels, known as a Franseen needle, has been developed for endoscopic ultrasound-guided fine needle biopsy (EUS-FNB).AimTo assess the histological material acquisition rate and histological diagnostic capability of the 22-gauge Franseen needle (AC22) during EUS-FNB for solid lesions.MethodsThis study was designed as an open-label, multicenter, prospective, single-arm pilot study of EUS-FNB using AC22 for the diagnosis of solid lesions. Three passes of FNB using AC22 were performed for all lesions. The primary endpoints were the histological material acquisition rate and histological diagnostic capability. The secondary endpoints were the technical success rate, quality of histological samples, number of passes for diagnosis, and safety.ResultsBetween September 2017 and May 2018, 75 patients were enrolled. The final diagnoses were malignancy in 65 and benign in 10. Three passes of FNB were technically successful in all patients. The sensitivity, specificity, and accuracy for the malignancy of histological analyses were 92.3% (60/65), 100% (10/10), and 93.3% (70/75), respectively, for the first pass and 95.4% (62/65), 100% (10/10), and 96% (72/75), respectively, for combined three passes. The diagnostic yield plateaued after the second pass. Sufficient tissue samples for histological interpretation were obtained in 96% (72/75) and 100% (75/75) patients for the single pass and combined three passes, respectively. Two patients (2.7%) developed mild pancreatitis as an adverse event.ConclusionEUS-FNB using AC22 showed high histological diagnostic capability with the high first pass yield.Clinical Trials RegistryUMIN Clinical Trials Registry (UMIN ID: UMIN000036641).

Background and AimsData on adequacy of EUS guided biopsies using different tissue acquisition techniques and fine needle aspiration needle designs have been inconclusive. Data on newer fine needle biopsy (FNB) needles are scarce. This study compared the performance of 3 acquisition techniques and 2 fine needle biopsy designs in solid pancreatic lesions.MethodsSingle-center, randomized, pilot clinical trial (Trial registration number NCT03264092). Patients undergoing EUS biopsy of pancreatic lesions were randomized to 1 of 3 acquisition techniques (dry suction, wet suction, slow pull) and 1 of 2 22G FNB needle designs. The primary outcome was specimen cellularity. Secondary outcomes included blood contamination and number of passes needed for diagnosis.ResultsA total of 52 (35.3%), 49 (33.3%) and 46 (31.3%) specimens were obtained with slow pull, dry suction and wet suction, respectively. A total of 56 (38%) and 91 (62%) specimens were obtained with each needle, respectively. No difference in cellularity scores was identified by technique (3.28 vs 3.55 vs 2.94; p = 0.081) or needle type (3.45 vs 3.15; p = 0.19). The same was true for blood contamination and diagnostic pass. A diagnosis was reached after 3 passes in 51 patients (93%). Histological diagnosis was possible in 45 specimens (82%). No severe adverse events occurred.ConclusionsCellularity of pancreatic specimens obtained with FNB needles via EUS was not influenced by technique and needle design. Three passes were enough to obtain a histological diagnosis in most patients. Larger clinical trials are required to validate the results of this study.

BackgroundFor non-functioning pancreatic neuroendocrine tumors (pNETs) ≤ 20 mm, most guidelines consider follow-up observations as an option; however, the various treatment strategies are defined by size alone, even though the Ki-67 index is important for malignancy grading. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is the standard for the histopathological diagnosis of solid pancreatic lesions; however, recent results for small lesions remain unclear. Therefore, we examined the efficacy of EUS-TA for solid pancreatic lesions ≤ 20 mm suspected as pNETs or requiring differentiation and the non-increase rate in tumor size in follow-up cases.MethodsWe retrospectively analyzed data of 111 patients (median age = 58 years) with lesions ≤ 20 mm suspected as pNETs or requiring differentiation who underwent EUS-TA. All patients underwent specimen evaluation by rapid onsite evaluation (ROSE).ResultsEUS-TA led to a diagnosis of pNETs in 77 patients (69.4%) and tumors other than pNETs in 22 patients (19.8%). The histopathological diagnostic accuracy of EUS-TA was 89.2% (99/111) overall, 94.3% (50/53) for 10–20 mm lesions, and 84.5% (49/58) for ≤ 10 mm lesions, with no significant difference in diagnostic accuracy (p = 0.13). The Ki-67 index was measurable in all patients with a histopathological diagnosis of pNETs. Among 49 patients with a diagnosis of pNETs who were followed up, one patient (2.0%) showed tumor enlargement.ConclusionsEUS-TA for solid pancreatic lesions ≤ 20 mm suspected as pNETs or requiring differentiation is safe and has adequate histopathological diagnostic accuracy, suggesting that follow-up observations of pNETs with a histological pathologic diagnosis are acceptable in the short term.

Percutaneous biopsy remains the gold standard for diagnosing focal liver lesions; however, endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) has recently emerged as a promising alternative. Although its diagnostic performance is favorable, most available evidence has focused on epithelial tumors, and reports on mesenchymal tumors are rare. Herein, we report five cases of hepatic mesenchymal tumors diagnosed using EUS‐TA. The cohort comprised four male and one female patient, with a median age of 70 years (range, 63–88). The median targeted lesion size was 30 mm (range, 22–61 mm), predominantly located in the left lateral hepatic segments. Four cases underwent transgastric biopsy and one transduodenal biopsy, using either a 22‐gauge aspiration or biopsy needle. All procedures were technically successful, and no procedure‐related adverse events occurred. Histopathological examination established definitive diagnoses of leiomyosarcoma (n = 2), angiosarcoma (n = 1), epithelioid hemangioendothelioma (n = 1), and metastatic gastrointestinal stromal tumor (n = 1). Subsequent management included chemotherapy in three patients and best supportive care in two. This case series demonstrates that EUS‐TA is a feasible diagnostic modality for hepatic mesenchymal tumors, providing sufficient tissue for histological and immunohistochemical evaluation.

Tissue sampling in biliary tract cancer (BTC) is generally performed through transpapillary biopsy (TPB) or endoscopic ultrasound-guided tissue acquisition (EUS-TA). For the first time, we compared the suitability of specimens obtained using TPB and EUS-TA to determine the optimal tissue-sampling method for comprehensive genome profiling (CGP) analysis in patients with unresectable BTC (UR-BTC). Pathology precheck criteria for CGP analysis comprised the OncoGuide NCC Oncopanel System (NCCOP) and FoundationOne CDx (F1CDx). Seventy-eight patients with UR-BTC (35 TPB and 43 EUS-TA) were included. The NCCOP analysis suitability achievement rate was higher in EUS-TA specimens than in TPB specimens (34.9% vs. 8.6%, p = 0.007), whereas that of F1CDx was 0% in both groups. EUS-TA was identified as an independent factor that contributed to the suitability of the NCCOP analysis. The suitability of the NCCOP analysis of EUS-TA specimens showed a tendency to be higher for mass lesions (43.8% vs. 9.1%, p = 0.065), especially for target size ≥ 18.5 mm, and lower for perihilar cholangiocarcinoma (0% vs. 41.7%, p = 0.077). In TPB, papillary-type lesions (66.7% vs. 3.2%, p = 0.016) and peroral cholangioscopy-assisted biopsies (50.0% vs. 3.3%, p = 0.029) showed better potential for successful NCCOP analysis. EUS-TA is suitable for NCCOP analysis in UR-BTC and may be partially complemented by TPB.

Abdominal tuberculosis (TB) is uncommon in Taiwan and frequently mimics malignancy or other infectious diseases due to nonspecific clinical manifestations, often leading to delayed diagnosis. We report a 72‐year‐old man who presented with fever, anorexia, weight loss, and epigastric discomfort. Esophagogastroduodenoscopy (EGD) revealed a subepithelial lesion (SEL) on the posterior wall of the upper gastric body. Contrast‐enhanced computed tomography (CE‐CT) demonstrated mass‐like lesions involving the liver and upper gastrointestinal tract with enlarged abdominal lymph nodes (LNs), raising concern for malignancy. Endoscopic ultrasound–guided fine‐needle biopsy (EUS‐FNB) was performed on the gastric wall, hepatic lesion, and enlarged LNs. Histopathology revealed necrotizing granulomatous inflammation in all specimens, and tuberculosis polymerase chain reaction (PCR) confirmed Mycobacterium tuberculosis infection. Anti‐tuberculosis therapy resulted in marked clinical improvement and significant radiologic regression. This case highlights a rare presentation of extrapulmonary tuberculosis (EPTB) involving multiple digestive organs and underscores the diagnostic value of endoscopic ultrasound–guided tissue acquisition (EUS‐TA). Key Clinical Message (KCM) Gastrointestinal tuberculosis can closely mimic malignancy, presenting as mass‐like lesions. Integrating clinical context with characteristic endoscopic ultrasound findings and endoscopic ultrasound–guided tissue acquisition, particularly fine‐needle biopsy, facilitates timely diagnosis, appropriate therapy, and favorable clinical outcomes.