Citations

Abstract Endoscopic ultrasound (EUS) has evolved from a purely diagnostic procedure to one with therapeutic capabilities. One of the most challenging therapeutic intervention for endosonographers is EUS‐guided pancreatic drainage. The development of this technique has allowed access and drainage of the main pancreatic duct after failed endoscopic retrograde pancreatography and can avoid invasive procedures such as surgical and percutaneous interventions. This review discusses the indications, technique, challenges, and an algorithmic approach to EUS‐guided pancreatic drainage.

Acute hemorrhage related to gastric varices (GV) is more severe and often more difficult to immediately treat upon detection, leading to a poorer patient prognosis, as compared to esophageal variceal bleeding. Currently, the recommended treatment of bleeding GV is endoscopic cyanoacrylate injection and transjugular intrahepatic portosystemic shunt placement for endoscopic failures. Newer endoscopic (e.g. hemospray) and endosonographic (e.g. coil injection, glue obliteration, or combined coil and glue injection) techniques have been developed to offer an alternative treatment and improve patient outcome. The present article serves to review the endoscopic, endosonographic, and interventional radiological techniques used to treat GV and their clinical applications.

BACKGROUNDMultigene molecular testing to guide personalized therapy for oncology patients is of increasing clinical relevance. Molecular testing of fine‐needle aspiration samples is underused, but when acquired with minimally invasive techniques could become the standard of care to obtain theranostic specimens. The aims of the current study were to identify key cytology specimen selection criteria suitable for next‐generation sequencing (NGS) and to determine the prevalence and spectrum of pathogenic alterations in a cohort of patients with AJCC stage IV lung cancer.METHODSA total of 70 adrenal gland cytology specimens with direct smears were screened to identify 56 patients with a single slide containing at least 300 total cells and 20% tumor nuclei. After DNA extraction, the NGS protocols were used to simultaneously detect mutations in >2800 exonic regions in 50 key cancer genes.RESULTSA total of 28 specimens produced acceptable NGS results. Specimens with a combined critical cell mass (>5000 viable cells) and a DNA concentration >5 ng/µL resulted in a 95% chance of successful sequencing. A total of 37 pathogenic alterations were identified in 10 genes and in 25 patients (85%). A pathogenic alteration (≥1) linked to available or developing targeted therapies was revealed in 50% of cases.CONCLUSIONSThe data from the current study demonstrate that theranostic NGS can be applied to adrenal gland metastasis using routine cytologic smear specimens. The characteristics of such smears could be evaluated during onsite adequacy assessment by cytopathology professionals. This model greatly augments the opportunity for customized genotype‐directed therapy from minimally invasive techniques. Cancer (Cancer Cytopathol) 2014;122:822–832. © 2014 American Cancer Society.

ABSTRACTBackgroundDobutamine stress echocardiography (DSE) is commonly used to risk stratify patients in the cardiac evaluation prior to orthotopic liver transplantation (OLT). Data remain limited regarding the accuracy to predict obstructive coronary artery disease (CAD) using this approach.HypothesisWe hypothesize that DSE may have limitations in the investigation of underlying CAD in patients with end‐stage liver disease.MethodsA retrospective chart review of all patients who underwent OLT at Mayo Clinic in Florida between 1998 and 2010 was performed. Sixty‐six underwent invasive coronary angiography (ICA) within 1 year of DSE and were included in our study. Based on DSE results, patients were stratified into 1 of 3 groups: nonischemic, ischemic, and indeterminate. The relationship between DSE, ICA, and death from all cause and cardiac‐related cause with a minimum 3‐year follow‐up period were analyzed.ResultsA total of 66 patients were included in our cohort. There was no difference in age, gender, severity of liver disease, and echocardiographic findings among the groups. Forty‐three percent of patients (n = 12) with an abnormal result on DSE were found to have moderate or severe obstructive CAD on cardiac catheterization, whereas 49% of patients (n = 17) with a normal finding on DSE had moderate or severe CAD. Of 5 patients who died from a documented cardiac etiology, 3 had normal stress test results, 1 had abnormal findings, and 1 had an indeterminate DSE result. When compared with ICA, our study demonstrated that DSE has a sensitivity of 41.4% (95% confidence interval [CI]: 0.24‐0.61), specificity of 47.1% (95% CI: 0.30‐0.65), positive predictive value of 40.0% (95% CI: 0.23‐0.59), and negative predictive value of 48.0% (95% CI: 0.31‐0.66) in identification of underlying CAD.ConclusionsAlthough widely used, DSE may not always accurately reflect the severity of obstructive CAD in patients undergoing OLT.