Endoscopic Ultrasound Guided Fine Needle Aspiration Biopsy Of The Pelvic Lesions

Part I. The effect of Endoscopic ultrasound guided fine needle aspiration biopsy on pelvic solid lesionsObjectiveEndoscopic ultrasound guided fine needle aspiration biopsy(EUS-FNA) was performed for diagnosis of the pelvic solid lesions and the safety of this method were evaluated.MethodsPatients referred for EUS-FNA of pelvic lesions from March2009to June2012in the Affiliated Hospital of Hubei University of Arts and Science were studied retrospectively. A total of42patients with pelvic solid masses discovered by B-ultrasound, CT or MRI had been referred for EUS-FNA. Some patients verified by surgical pathologic examination or clinical follow-up after2months. EUS-FNA was performed using the curved linear array echoendoscope (PENTAX EG-3630U) and Hitachi EUB5500ultrasound workstation. In all cases19-gauge and22-gauge needles with stylet were utilized (OLYMPUSNA-10J-1or COOK ECHO-1-2, COOK ECHO-19).All patients took the left lateral decubitus position, the right lateral or supine position. The probe was placed in the rectum which observed the the size, shape, location, and echo intensity of pelvic masses. Endoscopic ultrasound images prompted to select the appropriate puncture position and avoid the blood vessels by using color Doppler function. The needle was advanced into the lesion under real time endosonographic visualization and inserted into the mass, with a maximum depth of penetration of50mm. The needle stylet was then removed from the assembly. When the needle tip was seen to lie within the lesion, continuous suction was applied with0ml～10ml negative pressures. At the same time, the needle was moved back and forth within the lesion with3-5mm movements, while observing on the ultrasound console screen. Various parts were punctured2to5times, each repeated lifting and thrusting from10to30. If first suction has too much liquid bleeding subject and less tissue lines, you should not sucked in negative pressure until get enough specimens. Suction was then released, and the needle was withdrawn. The contents of the needle were expressed onto a glass slide or pushed into liquid-based cytology preservative fluid and slide forming tissue strips, if any, were fixed in10%formalin solution. Tissues were examined by pathology and cytology. Repeated puncture2～5times if necessary. Follow up the results of pathology and cytology. Postoperative complications such as abdominal pain, fever, blood in the stool were observed. Hospitalized patients were given metronidazole or tinidazole injection for two days to prevent infection. The outpatients took Norfloxacin capsules two days. Hospitalized patients were followed up after three days. Outpatients were examined when they came to hospital next time for pathological inspection report. If suffered from abdominal pain, fever and other complications, patients should look doctor at any time.ResultsAll patients were performed fine needle biopsy of the pelvic lesions. Among the42solid lesions, cytology and pathology demonstrated malignant tumors in28patients,3cases of malignant stromal tumors,3cases of Inflammatory mass cases,2cases of lymphoma,1case of dermoid cyst,5cases of other. Diagnosis rates of samples for immunohistology remained similar between22gauge and19gauge needles (P>0.05). There were no abdominal pain, fever, bloody stool and other complications after the procedures.ConclusionEUS-guided FNA is minimally invasive, a safe and accurate method for diagnosis of pelvic solid lesions. Part Ⅱ. The effect of Endoscopic ultrasound guided fine needle aspiration biopsy on pelvic cystic lesionsObjective Endoscopic ultrasound guided fine needle aspiration biopsy(EUS-FNA) was performed for diagnosis and treatment of the pelvic cystic lesions and purulent lesions were lavaged with Metronidazole repeatedly. The safety of this method was evaluated.MethodsPatients referred for EUS-FNA of pelvic lesions from March2009to June2012in the Affiliated Hospital of Hubei University of Arts and Science were studied retrospectively. A total of10patients with pelvic cystic masses discovered by B-ultrasound, CT or MRI had been referred for EUS-FNA. EUS-FNA was performed using the curved linear array echoendoscope (PENTAX EG-3630U) and Hitachi EUB5500ultrasound workstation. In all cases19-gauge and22-gauge needles with stylet were utilized (OLYMPUSNA-10J-1or COOK ECHO-1-2, COOK ECHO-19). All patients took the left lateral decubitus position, the right lateral or supine position. The probe was placed in the rectum which observed the the size, shape, location, and echo intensity of pelvic masses. Endoscopic ultrasound images prompted to select the appropriate puncture position and avoid the blood vessels by using color Doppler function. The needle was advanced into the cystic lesion under real time endosonographic visualization and inserted into the mass. The needle stylet was then removed from the assembly. When the needle tip was seen to lie within the lesion, continuous suction was applied with5ml～10ml negative pressure and repeated2～5times. The pelvic cystic lesions were drained1～2times and then2-3times for solid portions. Purulent lesions were lavaged with Metronidazole repeatedly. Suction was then released, and the needle was withdrawn. The contents of the needle were expressed onto a glass slide or pushed into liquid-based cytology preservative fluid and slide forming tissue strips, if any, were fixed in10%formalin solution. To send pathology and cytology. Follow up the results of pathology and cytology. Postoperative complications such as abdominal pain, fever, blood in the stool were observed. Hospitalized patients were given metronidazole or tinidazole injection for two days to prevent infection. The outpatients took Norfloxacin capsules two days. Hospitalized patients were followed up after three days. Outpatients were examined when they came to hospital next time for pathological inspection report. If suffered from abdominal pain, fever and other complications, patients should look doctor at any time.ResultsAll patients were performed fine needle biopsy of the pelvic lesions. Among the52lesions, there were10cystic lesions. In cystic lesions,2cases of serous cystadenoma, perirectal abscess in8cases.6purulent lesions were lavaged with Metronidazole repeatedly. Amony them, purulent lesions in3cases disappeared after1～2months examined by EUS. During the operation,8cases of perirectal abscess patients have different degree of pain. There were no other complications after the procedures except that one patient suffered from fever.ConclusionEUS-FNA is minimally invasive, a safe and accurate method for diagnosis of pelvic cystic lesions. EUS-FNA can lavage abscess which make some patients avoid operation.