Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy

Choudhary, Narendra S.; Puri, Rajesh; Saigal, Sanjiv; Bhangui, Prashant; Saraf, Neeraj; Shah, Vivek; Nasa, Mukesh; Sarin, Haimanti; Guleria, Mridula; Sud, Randhir; Soin, Arvinder S.

doi:10.1007/s12664-016-0718-0

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…Hepatic macrovesicular steatosis of up to 20% was acceptable. ( 22 ) A graft‐to‐recipient weight ratio (GRWR) of 0.8% was desirable, but as low as 0.6% to 0.7% was accepted in patients with Model for End‐Stage Liver Disease (MELD) scores (without HCC exception points) lower than 19. ( 23 ) The minimum acceptable future liver remnant in the donor was 30% of the total liver volume estimated on CT scan prior to transplant.…”

Section: Methodsmentioning

confidence: 99%

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

et al. 2021

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Conventional selection criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are based on tumour size/number only, and do not consider vital surrogates of tumor biology such as alpha‐fetoprotein (AFP) and tumor [18F]fluorodeoxyglucose positron emission tomography ([18F]FDG PET) avidity. We analyzed survival outcomes, and predictors of HCC recurrence in 405 patients with cirrhosis and HCC (HCC‐cirr) who underwent living donor LT (LDLT) using our expanded selection criteria: no extrahepatic disease or major vascular invasion, irrespective of tumor size/number. Fifty‐one percent patients had tumours beyond Milan, and 43% beyond the University of California San Francisco [UCSF] criteria. The 5‐year overall survival (OS) and recurrence‐free survival (RFS) were 64% and 70%, respectively. Three preoperatively available factors predicted recurrence: pre‐LT AFP ≥100 ng/mL (P = 0.005; hazard ratio [HR], 2.190), tumor burden beyond the UCSF criteria (P = 0.001; HR, 2.640), and [18F]FDG PET avidity (P = 0.004; HR, 2.442). A prognostic model based on the number and combination of the aforementioned preoperative risk factors was developed using a competing‐risk RFS model. Three risk groups were identified: low (none or a single risk factor present, 9.3% recurrence), moderate (AFP ≥100 ng/mL and [18F]FDG PET avidity, or beyond UCSF tumor and [18F]FDG PET avidity, 25% recurrence), and high (AFP ≥100 ng/mL and beyond UCSF, or presence of all 3 risk factors, 46% recurrence). Acceptable long‐term outcomes were achieved using our expanded selection criteria. Our prognostic model to predict recurrence based on preoperative biological and morphological factors could guide pretransplant management (downstaging versus upfront LDLT) with the aim of reducing post‐LDLT recurrence.

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Section: Methodsmentioning

confidence: 99%

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

et al. 2021

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“…The FNA material was adequate in 92% patients, 15 patients (30%) had metastasis precluding transplantation, 4 (8%) received antitubercular therapy in view of granulomatous lymphadenitis, and 27 (54%) had reactive lymphadenitis who underwent liver transplantation. 48…”

Section: Endotransplant Hepatology: Expanding the Horizons Of Eus In ...mentioning

confidence: 99%

Endo-Hepatology: The Buzz Goes Much beyond Liver Biopsy—A Narrative Review

Puri,

Sharma,

Dhampalwar

et al. 2023

Journal of Digestive Endoscopy

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The word endo-hepatology evokes many perceptions. Some believe it to be the emerging new interventional branch and some believe it to be an extension of endoscopy. Nonetheless, it has continued to evolve into an exciting area of active work. With the advent of endoscopic ultrasound (EUS) based procedures, new vistas have opened up. EUS-guided liver biopsies, portal hypertension management, and multiple new procedures are being described. EUS also plays a large role in the management of patients in the peritransplant period. With this review, we present an overview of the role of EUS in the field of hepatology as well as during the peritransplant period and its applications.

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“…They proposed a diagnostic algorithm for evaluating high-risk patients with negative imaging. Choudhary et al[ 21 ] in their prospective study of over 50 patients showed that EUS-FNA of lymph nodes detected in patients with HCC confirmed metastasis and hence precluded transplantation in over a third of the patient cohort.…”

Section: Introductionmentioning

confidence: 99%

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?

Girotra

Soota

Dhaliwal

et al. 2018

WJGE

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Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.

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Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy

Abstract: In patients with HCC and lymphadenopathy, EUS-guided FNA detected metastatic disease and precluded liver transplantation in approximately one third of patients.

Cited by 9 publications

References 9 publications

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

Endo-Hepatology: The Buzz Goes Much beyond Liver Biopsy—A Narrative Review

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?

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