The evolving role of EUS-guided tissue acquisition

Area of Science:

• Gastroenterology
• Endoscopic Ultrasound (EUS)
• Diagnostic Endoscopy

Background:

• Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revolutionized tissue acquisition from inaccessible gastrointestinal sites.
• While cytological diagnosis shows excellent performance, limitations exist, including procedural inefficiencies and the need for histology in specific cases.

Purpose of the Study:

• To review the evolution of endoscopic ultrasound-guided tissue acquisition techniques.
• To highlight advancements in needles, imaging, and the role of histology and molecular analysis in modern diagnostics.
• To explore the potential of artificial intelligence in enhancing EUS-guided procedures.

Main Methods:

• Review of technological advancements in endoscopic ultrasound (EUS) and biopsy needles.
• Discussion of the evolving role of cytology versus histology in gastrointestinal diagnosis.
• Exploration of adjunctive imaging techniques like contrast harmonic EUS and EUS elastography.
• Consideration of artificial intelligence applications in EUS.

Main Results:

• Newer EUS-FNA needles have improved tissue acquisition for histology.
• Advanced imaging techniques (contrast harmonic EUS, elastography) aid in challenging biopsies.
• Histology, immunohistochemistry, and molecular analysis are increasingly vital for personalized medicine.

Conclusions:

• Despite advancements, challenges in EUS-guided tissue acquisition persist.
• A shift towards histology-based diagnosis is evident, driven by personalized medicine needs.
• Artificial intelligence shows promise in improving EUS diagnostic accuracy and clinical decision-making, especially for non-diagnostic biopsies.