- Gastrointestinal Tumor Detection and Staging
- Fine Needle Aspiration Cytology: A Non-Invasive Method of Diagnosing and Staging Non-Small Cell Lung Cancer, Discovered Only Five Years Ago
 inthrop-University Hospital, nestled among suburban trees and comfortable homes in Mineola, may outwardly resemble a community hospital - but its medical and technological expertise equal and even surpass any major medical center in the United States.
For example, there is Endoscopic Ultrasound, an ambulatory procedure known as "EUS." There are only 25 specialists in the United States who are fully trained in EUS, and Winthrop has on its team of specialists one of the foremost experts in this elite group - Frank Gress, MD, Director of Winthrop's Endoscopy and Endoscopic Ultrasound Center, with the Division of Gastroenterology, Hepatology, and Nutrition.
Additionally, only three American medical centers can offer fine
needle aspiration (FNA) biopsy,
combined with EUS for staging lung tumors - and Winthrop is one of them. FNA with EUS is an accurate, non-invasive method of diagnosing and staging non-small cell lung cancer - that is, determining whether the lymph nodes in the chest cavity have become malignant. The procedure has only been practiced for the past five years, and is helpful in confirming a diagnosis in ambiguous cases.
While FNA with EUS cannot eradicate a diagnosis of lung cancer, it can save a suffering patient from diagnostic surgery.
Frank Gress, MD, Director of Endoscopy and Endoscopic Ultrasound, with the Division of Gastroenterology, Hepatology, and Nutrition.
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EUS can save your life...by allowing the thorough visualization of a pancreatic tumor and its surrounding structures early enough to detect cancerous invasion into the lymph nodes and local blood
vessels. This is crucial - because
by the time most patients consult
a specialist, the tumor has spread, becoming inoperable.
Through EUS, diagnosis and treatment are also available for disorders affecting the esophagus, stomach, pancreas, gallbladder, bile duct, rectum, and lungs.
EUS can exceed the accuracy
of CT Scanning
Contemporary society is primed to believe that advanced technology has all the answers. That's why it's so hard to believe that sometimes, pancreatic tumors can outwit Computerized Tomography (CT) Scanning - but they can. Now, EUS can overcome the potential of these tumors to "play possum."
EUS is a safe, high-tech diagnostic procedure that utilizes ultrasound in a unique way, to evaluate and diagnose disorders of the gastrointestinal tract, with minimal risk. EUS also facilitates several
therapeutic procedures.
EUS is typically recommended for patients who have undergone CT Scanning or transabdominal ultrasound, and have been given a clean bill of health - although they are still suffering with inexplicable
persistent pain and other
abdominal symptoms.
Unique Instrumentation Allows a More Unobstructed View
Sometimes, bowel gas can obstruct the images which are
visualized with CT Scanning or other modalities. When further investigation of the gastrointestinal tract is necessary, EUS instrumentation - with its two-part scope - can be helpful. Its ultrasound capability images the inner wall layers of the gastrointestinal tract, and its endoscopic capability provides maneuverability. Together, the instrumentation escalates tumor staging accuracy to 90%, exceeding the accuracy of Computed Tomography (CT) for GI tract malignancies.
EUS eliminates poor imaging problems because its ultrasound transducer is situated on top of a standard endoscope, which can be introduced into either the mouth or rectum to produce clear imaging of the layers of the various organs of the digestive system.
EUS staging accuracy correlates 89-90% with surgical findings and can exceed the accuracy of Computed Tomography (CT) for GI tract
malignancies.
Moreover, the transducer can be placed adjacent to specific internal structures for study - the gut wall, liver, spleen, pancreas, gallbladder, and bile ducts.
High Tech Viewing Leads to Earlier Diagnosis
Through EUS, more precise diagnosis and staging of pancreatic, biliary, and gastrointestinal tumors are now possible. EUS can view five distinct layers of the gastrointestinal tract wall, known as its "normal architecture." The growth of a mass would appear as a dense, dark, irregular structure, which could penetrate several layers, and the depth of this penetration - the most serious obstacle to successful surgical removal - can be determined with great accuracy.
"EUS is particularly valuable - and accurate - in imaging lesions and tiny pancreatic tumors, less than one centimeter in size," Dr. Gress notes.
EUS also helps to identify advanced esophageal cancer patients who would most benefit from the esophageal stent - a flexible wire artificial esophagus, resembling a child's "Slinky" toy, to reinforce a cancerous, weakened, and narrowed esophagus. Placement of this stent can allow patients to eat again, by forcing open and keeping open the esophagus.
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EUS can diagnose other conditions, too
EUS is invaluable in the detection of pancreatic and biliary diseases, including choledocholithiasis, gallstones, microlithiasis, and pancreatitis - pancreatic inflammation without a discernible cause. EUS is also excellent at detecting and staging chronic pancreatitis. Once diagnosed, physicians will attempt to relieve the pain of chronic pancreatitis through medication, pancreatic enzyme supplements, or EUS-guided celiac nerve block.
Diagnosis of Lung Cancer
When introduced into the
esophagus, excellent imaging can be obtained of the esophagus, lungs, surrounding lymph nodes, duodenum, pancreas, bile duct,
and chest.
This is tremendously helpful in staging non-small cell lung cancers, and in identifying lymph node metastasis throughout the chest
cavity. (Nearly one-half of all patients afflicted with this disease exhibit this type of metastasis.) EUS is also cost-effective when compared to a CT Scan.
EUS-Guided Fine Needle Aspiration - for Cytology/Biopsy
EUS is also utilized for fine needle aspiration (FNA) for tissue sampling. With EUS guidance, the biopsy needle is introduced into the appropriate area of the tissue, and samples are withdrawn for evaluation by cytologists. Appropriate clinical decisions can then be made.
Relief of Chronic Abdominal Pain Through EUS Nerve Blocks
Approximately 50% of inoperable terminal pancreatic cancer patients may find some relief through EUS-guided celiac plexus block, which also helps many patients with chronic pancreatitis.
Using a fine needle, a topical anesthetic is applied directly on the nerve center causing the pain.
Do you think that EUS could help you, or someone you know? Why not contact Dr. Frank Gress at Winthrop's EUS Center, at 516/663-8977.
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