Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: Impact on staging and resectability (with videos)

Michael J. Levy, Barham K. Abu Dayyeh, Larissa L. Fujii, Amy C. Clayton, Jordan P. Reynolds, Tercio L. Lopes, Archana S. Rao, Jonathan E. Clain, Ferga C. Gleeson, Prasad G Iyer, Michael L. Kendrick, Elizabeth Rajan, Mark Topazian, Kenneth Ke Ning Wang, Maurits J. Wiersema, Suresh T Chari

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability. Objective To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability. Design Retrospective study. Setting Single tertiary-care referral center. Patients A prospectively maintained EUS database was reviewed to identify patients who underwent EUS-guided FNA (EUS-FNA) of a peritoneal anomaly. Findings were compared with a strict criterion standard that incorporated cytohistologic, radiologic, and clinical data. Intervention EUS-FNA of a peritoneal anomaly. Main Outcome Measurements Safety and diagnostic yield. Results Of 106 patients, a criterion standard was available in 98 (39 female patients; median age, 65 years). The sensitivity, specificity, and accuracy of EUS-FNA versus CT/magnetic resonance imaging (MRI) was 91% versus 28%, 100% versus 85%, and 94% versus 47%, respectively. In newly diagnosed cancer patients, peritoneal FNA upstaged 17 patients (23.6%). Of 32 patients deemed resectable by pre-EUS CT/MRI, 15 (46.9%) were deemed unresectable based solely on peritoneal FNA. The odds of FNA changing the resectability status remained highly significant after adjustment for cancer type, time between CT/MRI and EUS-FNA, and the quality of CT/MRI. The malignant appearance of the peritoneal anomaly but not the presence of ascites on EUS predicted a positive FNA finding (odds ratio 2.56; 95% confidence interval, 1.23-5.4 and odds ratio 0.83; 95% confidence interval, 0.4-1.8, respectively). There were 3 adverse events among 4 patients. Two of the patients developed abdominal pain and one each hypertensive urgency and pancreatitis. Limitations Retrospective design, single-center, bias toward EUS as a diagnostic test. Conclusion Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.

Original languageEnglish (US)
Pages (from-to)1215-1224
Number of pages10
JournalGastrointestinal Endoscopy
Volume81
Issue number5
DOIs
StatePublished - May 1 2015

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Fine Needle Biopsy
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Carcinoma
Magnetic Resonance Imaging
Neoplasm Staging
Tertiary Care Centers
Odds Ratio
Confidence Intervals
Routine Diagnostic Tests
Ascites
Pancreatitis
Abdominal Pain
Neoplasms
Patient Care
Retrospective Studies
Databases
Safety
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Levy, M. J., Abu Dayyeh, B. K., Fujii, L. L., Clayton, A. C., Reynolds, J. P., Lopes, T. L., ... Chari, S. T. (2015). Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: Impact on staging and resectability (with videos). Gastrointestinal Endoscopy, 81(5), 1215-1224. https://doi.org/10.1016/j.gie.2014.10.028

Detection of peritoneal carcinomatosis by EUS fine-needle aspiration : Impact on staging and resectability (with videos). / Levy, Michael J.; Abu Dayyeh, Barham K.; Fujii, Larissa L.; Clayton, Amy C.; Reynolds, Jordan P.; Lopes, Tercio L.; Rao, Archana S.; Clain, Jonathan E.; Gleeson, Ferga C.; Iyer, Prasad G; Kendrick, Michael L.; Rajan, Elizabeth; Topazian, Mark; Wang, Kenneth Ke Ning; Wiersema, Maurits J.; Chari, Suresh T.

In: Gastrointestinal Endoscopy, Vol. 81, No. 5, 01.05.2015, p. 1215-1224.

Research output: Contribution to journalArticle

Levy, MJ, Abu Dayyeh, BK, Fujii, LL, Clayton, AC, Reynolds, JP, Lopes, TL, Rao, AS, Clain, JE, Gleeson, FC, Iyer, PG, Kendrick, ML, Rajan, E, Topazian, M, Wang, KKN, Wiersema, MJ & Chari, ST 2015, 'Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: Impact on staging and resectability (with videos)', Gastrointestinal Endoscopy, vol. 81, no. 5, pp. 1215-1224. https://doi.org/10.1016/j.gie.2014.10.028
Levy, Michael J. ; Abu Dayyeh, Barham K. ; Fujii, Larissa L. ; Clayton, Amy C. ; Reynolds, Jordan P. ; Lopes, Tercio L. ; Rao, Archana S. ; Clain, Jonathan E. ; Gleeson, Ferga C. ; Iyer, Prasad G ; Kendrick, Michael L. ; Rajan, Elizabeth ; Topazian, Mark ; Wang, Kenneth Ke Ning ; Wiersema, Maurits J. ; Chari, Suresh T. / Detection of peritoneal carcinomatosis by EUS fine-needle aspiration : Impact on staging and resectability (with videos). In: Gastrointestinal Endoscopy. 2015 ; Vol. 81, No. 5. pp. 1215-1224.
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abstract = "Background Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability. Objective To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability. Design Retrospective study. Setting Single tertiary-care referral center. Patients A prospectively maintained EUS database was reviewed to identify patients who underwent EUS-guided FNA (EUS-FNA) of a peritoneal anomaly. Findings were compared with a strict criterion standard that incorporated cytohistologic, radiologic, and clinical data. Intervention EUS-FNA of a peritoneal anomaly. Main Outcome Measurements Safety and diagnostic yield. Results Of 106 patients, a criterion standard was available in 98 (39 female patients; median age, 65 years). The sensitivity, specificity, and accuracy of EUS-FNA versus CT/magnetic resonance imaging (MRI) was 91{\%} versus 28{\%}, 100{\%} versus 85{\%}, and 94{\%} versus 47{\%}, respectively. In newly diagnosed cancer patients, peritoneal FNA upstaged 17 patients (23.6{\%}). Of 32 patients deemed resectable by pre-EUS CT/MRI, 15 (46.9{\%}) were deemed unresectable based solely on peritoneal FNA. The odds of FNA changing the resectability status remained highly significant after adjustment for cancer type, time between CT/MRI and EUS-FNA, and the quality of CT/MRI. The malignant appearance of the peritoneal anomaly but not the presence of ascites on EUS predicted a positive FNA finding (odds ratio 2.56; 95{\%} confidence interval, 1.23-5.4 and odds ratio 0.83; 95{\%} confidence interval, 0.4-1.8, respectively). There were 3 adverse events among 4 patients. Two of the patients developed abdominal pain and one each hypertensive urgency and pancreatitis. Limitations Retrospective design, single-center, bias toward EUS as a diagnostic test. Conclusion Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.",
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T2 - Impact on staging and resectability (with videos)

AU - Levy, Michael J.

AU - Abu Dayyeh, Barham K.

AU - Fujii, Larissa L.

AU - Clayton, Amy C.

AU - Reynolds, Jordan P.

AU - Lopes, Tercio L.

AU - Rao, Archana S.

AU - Clain, Jonathan E.

AU - Gleeson, Ferga C.

AU - Iyer, Prasad G

AU - Kendrick, Michael L.

AU - Rajan, Elizabeth

AU - Topazian, Mark

AU - Wang, Kenneth Ke Ning

AU - Wiersema, Maurits J.

AU - Chari, Suresh T

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability. Objective To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability. Design Retrospective study. Setting Single tertiary-care referral center. Patients A prospectively maintained EUS database was reviewed to identify patients who underwent EUS-guided FNA (EUS-FNA) of a peritoneal anomaly. Findings were compared with a strict criterion standard that incorporated cytohistologic, radiologic, and clinical data. Intervention EUS-FNA of a peritoneal anomaly. Main Outcome Measurements Safety and diagnostic yield. Results Of 106 patients, a criterion standard was available in 98 (39 female patients; median age, 65 years). The sensitivity, specificity, and accuracy of EUS-FNA versus CT/magnetic resonance imaging (MRI) was 91% versus 28%, 100% versus 85%, and 94% versus 47%, respectively. In newly diagnosed cancer patients, peritoneal FNA upstaged 17 patients (23.6%). Of 32 patients deemed resectable by pre-EUS CT/MRI, 15 (46.9%) were deemed unresectable based solely on peritoneal FNA. The odds of FNA changing the resectability status remained highly significant after adjustment for cancer type, time between CT/MRI and EUS-FNA, and the quality of CT/MRI. The malignant appearance of the peritoneal anomaly but not the presence of ascites on EUS predicted a positive FNA finding (odds ratio 2.56; 95% confidence interval, 1.23-5.4 and odds ratio 0.83; 95% confidence interval, 0.4-1.8, respectively). There were 3 adverse events among 4 patients. Two of the patients developed abdominal pain and one each hypertensive urgency and pancreatitis. Limitations Retrospective design, single-center, bias toward EUS as a diagnostic test. Conclusion Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.

AB - Background Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability. Objective To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability. Design Retrospective study. Setting Single tertiary-care referral center. Patients A prospectively maintained EUS database was reviewed to identify patients who underwent EUS-guided FNA (EUS-FNA) of a peritoneal anomaly. Findings were compared with a strict criterion standard that incorporated cytohistologic, radiologic, and clinical data. Intervention EUS-FNA of a peritoneal anomaly. Main Outcome Measurements Safety and diagnostic yield. Results Of 106 patients, a criterion standard was available in 98 (39 female patients; median age, 65 years). The sensitivity, specificity, and accuracy of EUS-FNA versus CT/magnetic resonance imaging (MRI) was 91% versus 28%, 100% versus 85%, and 94% versus 47%, respectively. In newly diagnosed cancer patients, peritoneal FNA upstaged 17 patients (23.6%). Of 32 patients deemed resectable by pre-EUS CT/MRI, 15 (46.9%) were deemed unresectable based solely on peritoneal FNA. The odds of FNA changing the resectability status remained highly significant after adjustment for cancer type, time between CT/MRI and EUS-FNA, and the quality of CT/MRI. The malignant appearance of the peritoneal anomaly but not the presence of ascites on EUS predicted a positive FNA finding (odds ratio 2.56; 95% confidence interval, 1.23-5.4 and odds ratio 0.83; 95% confidence interval, 0.4-1.8, respectively). There were 3 adverse events among 4 patients. Two of the patients developed abdominal pain and one each hypertensive urgency and pancreatitis. Limitations Retrospective design, single-center, bias toward EUS as a diagnostic test. Conclusion Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.

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