Return to Research+Publications On the Outside Looking In Doctors at UCI Medical Center are using a less invasive and more accurate approach to diagnosing certain kinds of cancer. It is called Endoscopic Ultrasound-Guided Fine Needle Aspiration, it combines endoscopic ultrasound and fine-needle aspiration in order to visualize and biopsy tumors.		Dr. Kenneth Chang (L) and Dr. Phuong Nguyen evaluating a patient by endoscopic ultrasound.
The potential result: Tumor detection, biopsy and staging (determining the extent of the tumor) that would have required more invasive methods via conventional surgery. Reduced pain and recovery time. And considerable cost savings, since the procedure reveals whether malignancies are too invasive for surgery to remedy. Quite simply, it puts the physician's eyes and ears inside the patient without surgery. A slender tube is inserted downward through the patient's mouth or upward through the rectum. A microchip television camera embedded in the tip of the tube transmits crisp, clear images to a television monitor. Says Dr. Kenneth Chang, head of gastrointestinal oncology for the Chao Family Clinical Cancer Research Center and developer of this emerging technique, "The addition of ultrasound to the endoscope means that we can now see beyond the membranes that used to limit our view." When endoscopic ultrasound is being used, a second TV monitors displays radar-like shadows that are bounced-back sound waves. These images reveal both organs and lesions within those organs. "Endoscopic Ultrasound-Guided Fine Needle Aspiration Quite simply, it puts the physician's eyes and ears inside the patient without surgery." A Steep Learning Curve While endoscopic ultrasound is still in very limited use across the country, Dr. Chang is already using it to enable an even newer method called fine-needle aspiration. Here, the endoscope tube helps guide a biopsy needle that captures minuscule tissue samples for analysis. Chang estimates that only about 150 hospitals are currently doing endoscopic ultrasound. He adds, "Only about 75 are equipped to do fine needle aspiration and less than half of those are actually doing successful needle biopsies." The bottleneck happens in the training. Dr. Chang has already taught UCI's Dr. Phuong Nguyen the delicate procedure. He says, "The needle is guided with great precision. It's not something that you can take a weekend workshop and go do." A master of understatement, Dr. Nguyen says, "You do have to know your anatomy." It seems that deciphering the ultrasound images is quite a challenge, even for highly trained physicians. It's like being in a long, winding tunnel and knowing at all times where north, south, east and west are. Dr. Chang refers to Dr. Nguyen as his "first clone" and is, with a sense of urgency, teaching others his remarkable new technique. UCI Medical Center is reinforcing its international lead in endoscopic ultrasonography with the construction of an Interventional Endoscopy Center which will be opened later this year.

Scroll up