Endoscopic ultrasound‐guided paracentesis of ascitic fluid

Abstract

BACKGROUND:Endoscopic ultrasound (EUS)‐guided fine needle aspiration (FNA) has been widely used for the diagnosis of primary and metastatic gastrointestinal (GI) and non‐GI malignancies. Few studies have been published to evaluate the accuracy and the cytologic features of EUS‐guided paracentesis in the diagnosis and staging of malignant neoplasms.METHODS:All EUS‐guided paracenteses of ascitic fluid performed at the University of California Irvine Medical Center (UCIMC) from January 2003 to February 2006 were retrospectively retrieved. Corresponding EUS findings, cytology and histology slides, and follow‐up information were reviewed.RESULTS:One hundred one (101) cases were found. Two smears were submitted in 11 cases because of the scanty amount of fluid aspirated. In the remaining cases, 5 mL or less of fluid were aspirated in 56 patients, and, of 9 who had prior computed tomography (CT), ascitic fluid was not seen in 6. The cytologic diagnoses were as follows: 17 were positive for adenocarcinoma, 1 positive for metastatic small‐cell carcinoma of the lung, 1 positive for diffuse large‐cell lymphoma, 3 suspicious for adenocarcinoma, 1 suspicious for plasmacytoma, 4 atypical epithelial cells, and 74 negative. Cell block was available in 80 cases and immunohistochemical stains were performed in 71 cases to confirm the diagnosis. Six patients had peritoneal biopsy. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were 80%, 100%, 100%, 95%, and 96%, respectively.CONCLUSIONS:EUS‐guided paracentesis is a valuable aid in the cytologic diagnosis of malignant ascites. It is particularly useful when no abnormality is identified by CT. Cancer (Cancer Cytopathol) 2010;. © 2010 American Cancer Society.

How good is fine needle aspiration? What results should you expect?

“…It showed a diagnostic accuracy for peritoneal carcinomatosis of 96% and a sensitivity of 80%, including presence of neoplastic cells in samples of small volume. [63]…”

Endoscopic ultrasound-guided fine-needle aspiration from ascites and peritoneal nodules: A scoping review

“…For the EUS-guided paracentesis, we included 5 reports that described the utility of EUS-guided paracentesis [ Table 1 ]. [ 11 12 13 14 15 ] These reports were from USA (4) and Japan (1). For EUS-guided FNA of peritoneal nodules, we included 4 case series [Tables 2 and 3 ].…”

“…However, being retrospective studies and the common denominator being the inclusion of patients with EUS directed paracentesis or FNA of nodules, there may be a selection/inclusion bias as only successful cases would be included in such an analysis. [ 11 ] While the eventual diagnosis in most patients with EUS-FNA of peritoneal nodules was peritoneal carcinomatosis; in some of the reports, other diagnoses such as tuberculosis and lymphoma were also reported. [ 16 17 18 ]…”

Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions

“…EUS-guided paracentesis is valuable in the cytologic diagnosis and staging of malignant ascites [28,29] . EUS frequently identifies ascites missed by other imaging modalities and may identify malignancy [30] .…”

“…EUS-FNA can be performed safely for therapeutic paracentesis [32] . In a retrospective single center study that evaluated 101 patients who underwent EUS-guided paracentesis, the specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy were 100%, 80%, 100%, 95% and 96%, respectively [29] . Furthermore, EUS-FNA can be used effectively and safely to obtain tissue from the peritoneum for diagnosis of tuberculous peritonitis [33] .…”