title: Endoscopic ultrasound-guided fine needle aspiration: from the past to the future.
abstract: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained through aspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung, etc. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is superior to computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detection of malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist during EUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently the procedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses.
authors.affiliation: Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania.
authors.forename: Mădălin-Ionuț
authors.initials: MI
authors.lastname: Costache
authors.affiliation: Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania.
authors.forename: Sevastița
authors.initials: S
authors.lastname: Iordache
authors.affiliation: Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark.
authors.forename: John Gásdal
authors.initials: JG
authors.lastname: Karstensen
authors.affiliation: Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania ; Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark.
authors.forename: Adrian
authors.initials: A
authors.lastname: Săftoiu
authors.affiliation: Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vilmann
keywords: confocal laser endomicroscopy; endoscopic ultrasound; fine needle aspiration