Harmonic contrast-enhanced endoscopic ultrasound fine-needle aspiration: Fact or fiction?

Abstract

The negative predictive value of endoscopic ultrasonography fine-needle aspiration is relatively low. To achieve the improvement of the diagnostic yield, the following were proposed: a higher number of passes, the presence of the rapid on-site cytopathologist evaluation, the fanning technique, or the repetition of the fine needle biopsy. Harmonic contrast-enhanced endosonography may better identify the targeted area in the lesions by avoiding the inside necrosis and the vessels of fibrosis, so it can guide the fine-needle aspiration. Both techniques are complementary, not competitive, and they can be done in the same session. The combined technique is simple, safe, and requires only a few minutes with minimal extra costs compared to standard fine-needle aspiration. It minimally increases the diagnostic rate, and it permits the decrease of the number of passes. However, we will know its real clinical impact only in the future and whether it will be incorporated into the lesion assessment process.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1

The contrast harmonic endoscopic ultrasonography-fine-needle aspiration of a pancreatic lesion (adenocarcinoma). The pancreatic lesion is hypoenhanced compared to the surrounding tissue, with some vessels inside and a central anechoic necrosis. The needle is inserted into the lesion during the late venous phase (Aloka alpha 7 platform)

Figure 2

The contrast harmonic endoscopic ultrasonography-fine-needle aspiration of a pancreatic lesion (neuroendocrine tumor). The lesion is hyperenhanced in the arterial phase, with fast washout in the venous phase. There are some remains of contrast inside the lesion during the late venous phase. The needle is inserted into the hyperenhanced region, avoiding the hypoenhanced part situated behind the needle (Aloka F75 platform)

Figure 3

The contrast harmonic endoscopic ultrasonography-fine-needle aspiration of a submucosal gastric neoplasm (gastrointestinal stromal tumor). The lesion is hyperenhanced in the arterial phase, with fast washout. The needle is inserted into the lesion during the late venous phase, but very little contrast is still remaining inside (Aloka F75 platform)