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Review
. 2018 May-Jun;7(3):141-160.
doi: 10.4103/eus.eus_19_18.

A quarter century of EUS-FNA: Progress, milestones, and future directions

Irina Mihaela Cazacu  1 , Adriana Alexandra Luzuriaga Chavez  2 , Adrian Saftoiu  3 , Peter Vilmann  4 , Manoop S Bhutani  2
Affiliations
Review

A quarter century of EUS-FNA: Progress, milestones, and future directions

Irina Mihaela Cazacu et al. Endosc Ultrasound. 2018 May-Jun.

Abstract

Tissue acquisition using EUS has considerably evolved since the first EUS-FNA was reported 25 years ago. Its introduction was an important breakthrough in the endoscopic field. EUS-FNA has now become a part of the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of the organs in its proximity, including lung diseases. This review aims to present the history of EUS-FNA development and to provide a perspective on the recent developments in procedural techniques and needle technologies that have significantly extended the role of EUS and its clinical applications. There is a bright future ahead for EUS-FNA in the years to come as extensive research is conducted in this field and various technologies are continuously implemented into clinical practice.

Keywords: EUS; EUS-FNA; tissue acquisition.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
The history of EUS-guided fine-needle aspiration
Figure 2
Figure 2
(a) The BNX system with 19-gauge (G), 22G, and 25G needles allows multiple needle exchanges through the outer sheath (Image courtesy of Beacon Endoscopic and used with permission). (b) The Echo Tip ProCore needle has a reverse bevel design for acquiring a tissue specimen. The 22G and 25G needles are shown. (c) A close-up view of the tip of the ProCore 25G needle (Image courtesy of Cook Medical and used with permission). (d) The nitinol-based Expect Flex 19G fine aspiration needle is more flexible than its stainless steel predecessors and appears more promising for use in the duodenum. (e) An extreme close-up view of the expect 19G needle (Image courtesy of Boston Scientific and used with permission). (f) The clear view EUS-guided fine aspiration needle. The distal 2 cm of the needle are laser-etched to enhance visibility (Image courtesy of ConMed Endoscopic Technologies and used with permission)
Figure 3
Figure 3
EUS-FNA of a pancreatic mass (re-used with permission)
Figure 4
Figure 4
Patient with a history of colon cancer with aorto-caval lymph node on computed tomography positron emission tomography, underwent EUS-FNA for pathological diagnosis. (a) Hypoechoic, irregular, oval-shaped lymph node between the aorta and inferior vena cava; (b) close-up view of the lymph node; (c) EUS-FNA of the lymph node using a 25-gauge needle. Cytology: metastatic carcinoma. IVC: Inferior vena cava, SMA: Superior mesenteric artery, SMV: Superior mesenteric vein, L. node: Lymph node, PANC: Pancreas
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