ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (Virtual) | February 2023-Kaul_CaseBased Presentations Mediastinal EUS Fiducials Elastography and Contrast Enhanced CE EUS

Kaul_CaseBased Presentations Mediastinal EUS Fiducials Elastography and Contrast Enhanced CE EUS

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This document is a summary of the content from a presentation on various topics related to endoscopic ultrasound (EUS). The presentation covered topics such as mediastinal EUS, EUS-guided fiducial placement, contrast-enhanced EUS (CE-EUS), and EUS elastography.<br /><br />Mediastinal EUS is commonly used for evaluating mediastinal pathology, including adenopathy, metastatic malignancy, primary malignancy, and infectious conditions. It can also be used for staging and obtaining tissue diagnosis. The presentation provided a detailed overview of the anatomical sites that can be assessed using EUS.<br /><br />EUS-guided fiducial placement involves the placement of solid gold markers using EUS to facilitate image-guided radiation therapy (IGRT). The presentation discussed the different types of fiducials, preloaded and reloadable options, and the technical success and migration rates associated with the procedure. It also highlighted the importance of multidisciplinary tumor boards in deciding whether EUS-guided fiducial placement is suitable for patients.<br /><br />CE-EUS and EUS elastography were also discussed in the presentation. CE-EUS is used for the characterization of solid pancreatic masses, tumor staging, and monitoring the response to local ablation. EUS elastography assesses tissue stiffness and can help differentiate benign from malignant tumors. The accuracy and potential applications of CE-EUS and EUS elastography were described, including their role in differentiating pancreatic cancer from chronic pancreatitis and autoimmune pancreatitis.<br /><br />The presentation emphasized that these advanced EUS imaging techniques provide incremental value in certain cases but may not replace tissue sampling for high-risk lesions. The diagnostic accuracy of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) for solid mass lesions is high, but the performance for indeterminate lesions is uncertain. The widespread adoption of these techniques remains a challenge, and further prospective studies are needed.<br /><br />Overall, the presentation provided a comprehensive overview of the different aspects of EUS, including its role in mediastinal evaluation, fiducial placement, and advanced imaging techniques like CE-EUS and EUS elastography.

Keywords

endoscopic ultrasound

mediastinal EUS

EUS-guided fiducial placement

CE-EUS

EUS elastography

tissue diagnosis

fiducials

pancreatic masses

diagnostic accuracy

prospective studies