Department of Medicine, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, AR, USA.
Department of Internal Medicine, CHI St. Vincent Infirmary, Little Rock, AR, USA.
Endosc Ultrasound. 2016 Jul-Aug;5(4):254-7. doi: 10.4103/2303-9027.187886.
Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes.
After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis.
Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications.
Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure.
凸面弯曲超声支气管镜(EUS-B)在食管中对纵隔结构进行细针抽吸活检的有效性已得到充分描述。相比之下,对于通过 EUS-B 进入膈下结构的方法,报道却很少。我们多年来一直在使用 EUS-B 进入膈下部位。本综述记录了我们使用 EUS-B 对肝脏、左肾上腺和腹腔淋巴结进行活检的经验。
在获得机构审查委员会的批准后,对 2013 年 7 月至 2015 年 6 月间进行的所有介入性肺病的超声内镜检查进行了回顾。然后选择进行膈下部位活检的病例进行分析。
在研究期间,45 例膈下活检(25 例左肾上腺、7 例肝脏和 13 例腹腔淋巴结)均采用 EUS-B 进行。在所有病例中,细胞充足,样本足够大,可用于免疫组化和任何相关的辅助研究。转移性恶性肿瘤在 58%的病例中得到证实,16%的病例包含良性诊断结果,27%的病例记录为正常器官组织。没有发生并发症。
对于在气道和食管中都能熟练操作支气管内超声探头的操作者来说,当存在膈下异常时,可以积极寻找并成功进行活检,从而增加该操作的诊断价值。