EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma

Ferga C. Gleeson, Elizabeth Rajan, Michael J. Levy, Jonathan E. Clain, Mark Topazian, Gavin C. Harewood, Georgios I. Papachristou, Naoki Takahashi, Charles B. Rosen, Gregory James Gores

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Abstract

Background: The clinical impact of EUS-guided FNA (EUS-FNA) in regional lymph-node staging in patients with unresectable hilar cholangiocarcinoma before liver transplantation has yet to be determined. Objectives: To determine the frequency of regional lymph-node detection, identify EUS features predictive of benign or malignant lymph nodes, compare EUS lymph-node detection rates to CT/magnetic resonance imaging and exploratory laparotomy, and evaluate the impact of EUS-FNA on patient selection for liver transplantation. Design: Retrospective case series. Setting: Tertiary referral EUS unit. Patients: Clinical, radiographic, EUS, cytologic, and surgical data of 47 patients with unresectable hilar cholangiocarcinoma before liver transplantation were evaluated. Interventions: EUS-FNA. Main Outcome Measurements: Lymph-node morphology and echo features. Results: EUS identified lymph nodes in all patients. FNA of 70 lymph nodes identified metastases in 9 nodes of 8 patients (17%), who were then precluded from transplantation before a staging laparotomy. Identified lymph nodes, irrespective of malignant involvement, were typically oval and geographic in shape, of mixed echogenicity, with a hypoechoic border. There were no morphologic criteria or echo features to correlate with nodal malignancy. The EUS finding of absent regional lymph-node metastases was confirmed in 20 of 22 by a subsequent exploratory staging laparotomy. Limitations: Single institution, retrospective analysis. Conclusions: EUS identified lymph nodes in all patients, and confirmation of malignant lymph nodes detected by FNA precluded 17% of patients from transplantation. EUS-FNA of visualized lymph nodes irrespective of appearance is advised because morphology and echo features do not predict malignant involvement.

Original languageEnglish (US)
Pages (from-to)438-443
Number of pages6
JournalGastrointestinal Endoscopy
Volume67
Issue number3
DOIs
StatePublished - Mar 2008

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Klatskin Tumor
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Lymph Nodes
Liver Transplantation
Laparotomy
Transplantation
Neoplasm Metastasis

ASJC Scopus subject areas

  • Gastroenterology

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EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. / Gleeson, Ferga C.; Rajan, Elizabeth; Levy, Michael J.; Clain, Jonathan E.; Topazian, Mark; Harewood, Gavin C.; Papachristou, Georgios I.; Takahashi, Naoki; Rosen, Charles B.; Gores, Gregory James.

In: Gastrointestinal Endoscopy, Vol. 67, No. 3, 03.2008, p. 438-443.

Research output: Contribution to journalArticle

Gleeson, FC, Rajan, E, Levy, MJ, Clain, JE, Topazian, M, Harewood, GC, Papachristou, GI, Takahashi, N, Rosen, CB & Gores, GJ 2008, 'EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma', Gastrointestinal Endoscopy, vol. 67, no. 3, pp. 438-443. https://doi.org/10.1016/j.gie.2007.07.018
Gleeson, Ferga C. ; Rajan, Elizabeth ; Levy, Michael J. ; Clain, Jonathan E. ; Topazian, Mark ; Harewood, Gavin C. ; Papachristou, Georgios I. ; Takahashi, Naoki ; Rosen, Charles B. ; Gores, Gregory James. / EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. In: Gastrointestinal Endoscopy. 2008 ; Vol. 67, No. 3. pp. 438-443.
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abstract = "Background: The clinical impact of EUS-guided FNA (EUS-FNA) in regional lymph-node staging in patients with unresectable hilar cholangiocarcinoma before liver transplantation has yet to be determined. Objectives: To determine the frequency of regional lymph-node detection, identify EUS features predictive of benign or malignant lymph nodes, compare EUS lymph-node detection rates to CT/magnetic resonance imaging and exploratory laparotomy, and evaluate the impact of EUS-FNA on patient selection for liver transplantation. Design: Retrospective case series. Setting: Tertiary referral EUS unit. Patients: Clinical, radiographic, EUS, cytologic, and surgical data of 47 patients with unresectable hilar cholangiocarcinoma before liver transplantation were evaluated. Interventions: EUS-FNA. Main Outcome Measurements: Lymph-node morphology and echo features. Results: EUS identified lymph nodes in all patients. FNA of 70 lymph nodes identified metastases in 9 nodes of 8 patients (17{\%}), who were then precluded from transplantation before a staging laparotomy. Identified lymph nodes, irrespective of malignant involvement, were typically oval and geographic in shape, of mixed echogenicity, with a hypoechoic border. There were no morphologic criteria or echo features to correlate with nodal malignancy. The EUS finding of absent regional lymph-node metastases was confirmed in 20 of 22 by a subsequent exploratory staging laparotomy. Limitations: Single institution, retrospective analysis. Conclusions: EUS identified lymph nodes in all patients, and confirmation of malignant lymph nodes detected by FNA precluded 17{\%} of patients from transplantation. EUS-FNA of visualized lymph nodes irrespective of appearance is advised because morphology and echo features do not predict malignant involvement.",
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T1 - EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma

AU - Gleeson, Ferga C.

AU - Rajan, Elizabeth

AU - Levy, Michael J.

AU - Clain, Jonathan E.

AU - Topazian, Mark

AU - Harewood, Gavin C.

AU - Papachristou, Georgios I.

AU - Takahashi, Naoki

AU - Rosen, Charles B.

AU - Gores, Gregory James

PY - 2008/3

Y1 - 2008/3

N2 - Background: The clinical impact of EUS-guided FNA (EUS-FNA) in regional lymph-node staging in patients with unresectable hilar cholangiocarcinoma before liver transplantation has yet to be determined. Objectives: To determine the frequency of regional lymph-node detection, identify EUS features predictive of benign or malignant lymph nodes, compare EUS lymph-node detection rates to CT/magnetic resonance imaging and exploratory laparotomy, and evaluate the impact of EUS-FNA on patient selection for liver transplantation. Design: Retrospective case series. Setting: Tertiary referral EUS unit. Patients: Clinical, radiographic, EUS, cytologic, and surgical data of 47 patients with unresectable hilar cholangiocarcinoma before liver transplantation were evaluated. Interventions: EUS-FNA. Main Outcome Measurements: Lymph-node morphology and echo features. Results: EUS identified lymph nodes in all patients. FNA of 70 lymph nodes identified metastases in 9 nodes of 8 patients (17%), who were then precluded from transplantation before a staging laparotomy. Identified lymph nodes, irrespective of malignant involvement, were typically oval and geographic in shape, of mixed echogenicity, with a hypoechoic border. There were no morphologic criteria or echo features to correlate with nodal malignancy. The EUS finding of absent regional lymph-node metastases was confirmed in 20 of 22 by a subsequent exploratory staging laparotomy. Limitations: Single institution, retrospective analysis. Conclusions: EUS identified lymph nodes in all patients, and confirmation of malignant lymph nodes detected by FNA precluded 17% of patients from transplantation. EUS-FNA of visualized lymph nodes irrespective of appearance is advised because morphology and echo features do not predict malignant involvement.

AB - Background: The clinical impact of EUS-guided FNA (EUS-FNA) in regional lymph-node staging in patients with unresectable hilar cholangiocarcinoma before liver transplantation has yet to be determined. Objectives: To determine the frequency of regional lymph-node detection, identify EUS features predictive of benign or malignant lymph nodes, compare EUS lymph-node detection rates to CT/magnetic resonance imaging and exploratory laparotomy, and evaluate the impact of EUS-FNA on patient selection for liver transplantation. Design: Retrospective case series. Setting: Tertiary referral EUS unit. Patients: Clinical, radiographic, EUS, cytologic, and surgical data of 47 patients with unresectable hilar cholangiocarcinoma before liver transplantation were evaluated. Interventions: EUS-FNA. Main Outcome Measurements: Lymph-node morphology and echo features. Results: EUS identified lymph nodes in all patients. FNA of 70 lymph nodes identified metastases in 9 nodes of 8 patients (17%), who were then precluded from transplantation before a staging laparotomy. Identified lymph nodes, irrespective of malignant involvement, were typically oval and geographic in shape, of mixed echogenicity, with a hypoechoic border. There were no morphologic criteria or echo features to correlate with nodal malignancy. The EUS finding of absent regional lymph-node metastases was confirmed in 20 of 22 by a subsequent exploratory staging laparotomy. Limitations: Single institution, retrospective analysis. Conclusions: EUS identified lymph nodes in all patients, and confirmation of malignant lymph nodes detected by FNA precluded 17% of patients from transplantation. EUS-FNA of visualized lymph nodes irrespective of appearance is advised because morphology and echo features do not predict malignant involvement.

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