Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology of Porta Hepatis Lesions: A Retrospective Study

Abstract

Objective: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has recently been used for the evaluation of various lesions arising in the porta hepatis. The purpose of this study is to evaluate the diagnostic yield of this increasingly utilized approach to porta hepatis lesions. Study Design: A retrospective study of 72 consecutive samples of porta hepatis lesions obtained via EUS-FNA between 2004 and 2015 was conducted. Clinical histories and endoscopic findings were available prior to the diagnostic interpretation. The diagnosis of each lesion was based on its cytologic features on smears, its histologic features on cell block, a comparison with any relevant prior specimens, immunohistochemistry and flow cytometric studies when applicable. Results: A total of 72 lesions (59 lymph nodes, 2 cysts and 11 masses) were biopsied in 70 patients. Adequate specimens were obtained in 65/72 cases (90%). Most of the lymph nodes were benign (n = 40, 67%) and most of the masses were malignant or suspicious (n = 8, 73%). A variety of diagnoses, primary and metastatic, were made, including hepatocellular carcinoma, cholangiocarcinoma and lymphoma. In addition, we have noted a significant increase in the number of EUS-FNAs in recent years. Conclusion: EUS-FNA is an effective and increasingly utilized diagnostic approach for the evaluation of multiple types of lesions in the porta hepatis.

Initial investigation on ultrasound-guided percutaneous biopsy of lesions in the first hepatic hilum with fusion of ultrasound and multimodal imaging cognitive guidance

“…Among 100 hepatocellular carcinomas, 18% were well-differentiated, 26% and 56% were moderate-differentiated and poor-differentiated, respectively. Biopsies of hepatocellular carcinomas were performed with large needles in 45% (45/100) and with small needles in 55% (55/100) (18).In comparison, the diagnostic success rate of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), as reported by Krister Jones et al, stands at 32% (19). PUS-CNB significantly outperforms cytology-based biopsy methods (8)(9)(10)(11).…”

Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report

“…In cases where cholecystectomy was performed with suspicion of cholelithiasis and acute or chronic cholecystitis reveals infiltration by lymphoma or leukemia, blood tests (leukocytosis, abnormal liver function tests, raised CA 19-9), bone marrow aspirate, fine needle aspiration cytology (FNAC) of abdominal fluid for malignant cells, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for evaluation of lymph nodes in porta hepatic region should be carried out. In addition, abdominal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scan should be performed to investigate systemic involvement [ 24 ].…”

Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging?

“…However, when combined with FNA, EUS had accuracy of 94% in comparison to 69% with CT scan[ 19 ]. EUS was able to detect significantly more lesions in the left lobe of the liver, sample hilar nodes (non-feasible by traditional imaging methods)[ 20 ] and characterize lesions that were too small and indeterminate for HCC on a CT scan. They proposed a diagnostic algorithm for evaluating high-risk patients with negative imaging.…”