Interventionelle Methoden in der Endokrinologie: Untersuchungen zur endosonographisch gesteuerten transluminalen Feinnadelpunktion, endoskopischen farbkodierten Duplexsonographie und transiliakalen Knochenbiopsie

Interventionelle Untersuchungsmethoden kommen in der Endokrinologie selten zur Anwendung. Zur Beurteilung der Qualität, Relevanz, Komplikationsrate und Tolerabilität erfolgte die retrospektive Untersuchung endosonographisch gesteuerter transluminaler Feinnadelpunktionen der Nebennieren und anderer p...

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Bibliographic Details
Main Author: Meyer, Silke
Contributors: Kann, Peter Herbert (Prof. Dr.) (Thesis advisor)
Format: Dissertation
Published: Philipps-Universität Marburg 2006
Innere Medizin
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Table of Contents: Interventional methods are rarely used in endocrinology. In order to investigate quality, relevance, complication rate and tolerability of these methods, endosonographically-guided transluminal fine-needle aspiration biopsies of the adrenals and other paraintestinal organs (a), endoscopic color-coded duplex sonography of adrenal lesions (b) and transiliacal bone biopsies of unclear metabolic bone diseases were retrospectively examined. (a) Endoscopic ultrasound (EUS) enables the visualization of paraintestinal organs with the option of the diagnostic technique of the endosonographically-guided transluminal fine-needle aspiration biopsy (EUS-FNA). The aim was to evaluate specimen quality and complication rate of EUS-FNA of the adrenals and other paraintestinal organs. EUS-FNA was performed using a PENTAX FG 32 UA endosonoscope in combination with a needle system type Hancke-Vilmann. 72 EUS-FNA specimens of 44 EUS-FNAs in 41 patients (pancreas: n=13; adrenals: n=9; abdominal lesions: n= 6; mediastinum: n=13) were evaluated about their specimen quality and contamination with tissue from the needle pathway. 16 vs. 11 of 34 histopathologic and 38 cytologic specimens were classified excellent, 7 vs. 10 sufficient, 7 vs. 13 poor and 4 vs. 4 failed. Analysis of contamination with tissue from the needle pathway showed 4 vs. 2 specimens highly, 3 vs. 14 clearly, 8 vs. 19 slightly and 19 vs. 3 not contaminated. Specimens classified excellent were less contaminated (p=0,037). EUS-FNA identified 35 benign and 24 malignant masses. Definite diagnosis failed in 13 specimens. One non-fatal complication (asymptomatic bleeding) occurred. Specimen classification was possible in 64 of 72 specimens (89%). Poor specimen quality was accompanied by contamination with tissue from the needle pathway. EUS-FNA expands the possibility of diagnosing difficult positioned masses especially in endocrinologic cases. (b) Tumor classification of adrenal masses by endosonomorphological critera is difficult. Here, the aim was to evaluate the perfusion pattern of endosonographically localized adrenal lesions and to classificate these semiquantitatively to the surrounding tissue. Endoscopic color-coded duplex sonography was performed using an endosonoscope Pentax FG 32 UA and Hitachi EUS 525 ultrasound system. Perfusion pattern of 46 histologically confirmed adrenal masses (adenoma: n=20; nodular hyperplasia: n=11; pheochromocytoma: n=15) of 38 patients were classificated as not (n=24), slightly (n=12), moderate (n=4) or highly (n=6) hypervascularized. Pheochromocytomas showed a significant higher grade of perfusion compared to adrenal adenomas (p=0,003) or nodular hyperplasia (p=0,047). There was no significant relationship between grade of hypervascularisation and tumor echogeneity, echostructure, malignancy or tumor size. Endoscopic color-coded duplex sonography seems to be an additional tool for endosonographic classification of adrenal masses, especially in detecting pheochromocytomas. Nevertheless, a wide variance of perfusion patterns between the tumor groups were found and forbid a classification only by endosonographic criteria. (c) The relevance of bone biopsy as a diagnostic procedure in metabolic bone disease has been topic of recent controversial discussions. The aim was to evaluate its role, tolerability and complication rate in routine use. A total of 99 transiliac bone biopsies over a time period of 14 years because of an osteological indication in one single centre were analysed, which reflects that bone biopsy followed about 0,003% of patients` consultations. Bone biopsies were indicated for osteoporotic males (n=63) and premenopausal osteoporotic females (n=18) without endocrine abnormality, suspected systemic/malignant disease (n=16) and decreasing bone density in spite of use of anti-osteoporotic medication (n=2). In most cases (82/99), bone biopsy led to consequences in medical treatment. 16 patients did not receive any anti-osteoporotic treatment. In six patients further diagnostic procedures were initiated because of bone biopsy. Bone biopsy was well tolerated and complications were rare and mild. The transiliacal bone biopsy remains in a small selected patients` collective a relevant diagnostic procedure in differential diagnosis of metabolic bone disease. In conclusion, these interventional methods often supply in selected cases important differential-diagnostic informations for further therapeutic treatment despite of the progress in non-invasive diagnostic procedures.