Endoscopic ultrasound—guided fine needle aspiration in the diagnosis of mediastinal masses of unknown origin

The ability of endosonography to diagnose a variety of gastrointestinal pathology has been significantly advanced with the introduction of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy. EUS-FNA technology can also be applied to the evaluation of non-GI disorders. The role of EUS-FNA to establish the diagnosis of unexplained mediastinal masses has not been previously described. The aim of this study was to determine the diagnostic accuracy, impact on subsequent workup, and role of EUS-FNA in treating mediastinal masses of unknown cause. METHODS : A total of 26 patients (15 men and 11 women, mean age 61 yr, range 39–77 yr) underwent EUS-FNA in patients presenting with unexplained mediastinal masses at four tertiary referral centers. Presenting symptoms included: chest pain (10 patients), dysphagia (eight), cough (seven), fever (six), night sweats (three), and no symptoms/abnormal x-ray (five patients). Five of 26 patients had prior history of cancer (three lung, one tracheal, and one esophageal). RESULTS : Final diagnosis using EUS-FNA, surgery, autopsy, other diagnostic study, or long-term follow-up was available in all patients. EUS-FNA results were classified under three disease categories: 1) infectious, 2) benign/inflammatory, and 3) malignant. Final diagnosis included infectious in five patents, benign/inflammatory in nine, and malignant in 12. EUS-FNA was successful in 21 of 26 patients (81%) for all disease categories (infectious 60%, benign/inflammatory 78%, and malignant 92%). EUS-FNA was successful in directing subsequent workup in 77% (20 of 26) and therapy in 73% (19 of 26). Mean EUS-FNA passes for adequate tissue sampling was lower of nonmalignant disease categories (3.0 and 3.4) versus malignant disease (4.4). No complications were seen during the course of this study. CONCLUSIONS : EUS-FNA in patients presenting with idiopathic mediastinal masses establishes the diagnosis in the vast majority of cases, particularly for those with malignant disease. The emergence of transesophageal EUS-FNA of the mediastinum provides the ability to alter subsequent workup and therapy, obviating the need for more invasive diagnostic studies such as thoracotomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72588/1/j.1572-0241.2002.06023.x.pd

This paper is a revision of a paper presented at the SPIE conference on Coherence Domain Optical Methods and Optical Coherence Tomography in Biomedicine VIII

Abstract. Barrett's esophagus ͑BE͒ and associated adenocarcinoma have emerged as a major health care problem over the last two decades. Because of the widespread use of endoscopy, BE is being recognized increasingly in all Western countries. In clinical trials of endoscopic optical coherence tomography ͑EOCT͒, we defined certain image features that appear to be characteristic of precancerous ͑dys-plastic͒ mucosa: decreased scattering and disorganization in the microscopic morphology. The objective of the present work is to develop computer-aided diagnosis ͑CAD͒ algorithms that aid the detection of dysplasia in BE. The image dataset used in the present study was derived from a total of 405 EOCT images ͑13 patients͒ that were paired with highly correlated histologic sections of corresponding biopsies. Of these, 106 images were included in the study. The CAD algorithm used was based on a standard texture analysis method ͑center-symmetric auto-correlation͒. Using histology as the reference standard, this CAD algorithm had a sensitivity of 82%, specificity of 74%, and accuracy of 83%. CAD has the potential to quantify and standardize the diagnosis of dysplasia and allows high throughput image evaluation for EOCT screening applications. With further refinements, CAD could also improve the accuracy of EOCT identification of dysplasia in BE

Optical coherence tomography and microscopy in gastrointestinal tissues

Optical coherence tomography (OCT) and optical coherence microscopy (OCM) are novel techniques for noninvasive biomedical imaging based on low-coherence interferometry. OCT achieves high-spatial resolution ( \u3c 30 μm in three dimensions) and high dynamic range (\u3e 100 dB) in a fiberoptically integrated system which is suitable for application in minimally invasive diagnostics, including endoscopy. The technique of OCM combines the depth-ranging capability of OCT with the micron-scale resolution imaging capability of confocal microscopy to extend the available imaging depth of confocal microscopy up to several hundred micrometers deep in highly scattering tissues. The theoretical and technical bases for OCT and OCM imaging are described. Example OCT images are provided in gastrointestinal (GI) tissues to illustrate contrast between histological layers of the GI mucosa and differentiation of the mucosa from submucosa. Example OCM images revealing cellular-level microstructure up to several hundred micrometers deep in GI tissue are presented for the first time. The potential applications of OCT and OCM imaging in clinical diagnsotic medicine are discussed