TY - JOUR
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 D.
AU - Harewood, Gavin C.
AU - Papachristou, Georgios I.
AU - Takahashi, Naoki
AU - Rosen, Charles B.
AU - Gores, Gregory J.
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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U2 - 10.1016/j.gie.2007.07.018
DO - 10.1016/j.gie.2007.07.018
M3 - Article
C2 - 18061597
AN - SCOPUS:39149111656
SN - 0016-5107
VL - 67
SP - 438
EP - 443
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 3
ER -