Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Focal Liver Lesions: The Expanding Light Over the Shadow

Abstract

Endoscopic ultrasound (EUS) has enabled detailed observation of lesions around the upper intestine, as well as aided the acquisition of pathological samples using fine-needle aspiration (FNA) under real-time EUS image guidance from the within the intestine. EUS is a highly sensitive imaging technique, and EUS-FNA is a reliable and safe biopsy procedure used in daily clinical practice. 1,2 Moreover, both are commonly used for evaluating pancreatic lesions since the pancreas is located in the deep abdomen, making percutaneous imaging and biopsy difficult. On the other hand, abdominal ultrasound is a well-established modality for the evaluation of liver lesions, which is followed by percutaneous biopsy when necessary; however, the indications for EUS have also recently expanded to liver lesions.A study in 1999 by Nguyen et al. 3 provided an initial report of EUS-FNA for liver lesions. They reported that EUS revealed the presence of focal liver lesions in 14 of 574 (2.4%) patients with a history or with suspicion of malignancy, whereas previous computed tomography scans depicted the liver lesions in only 3 out of 14 (21%) patients. EUS-FNA using a 22-gauge needle was subsequently performed for these liver lesions