Endoscopic Ultrasound-Guided Random Omental Fine Needle Aspiration: A Novel Technique for the Diagnosis of Peritoneal Carcinomatosis
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%–75% forthe detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence ofobvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC. Methods: Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were includedafter obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performedthrough the transgastric route using a linear echoendoscope. Results: Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspectedmalignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure wassuccessful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was alsonegative. Conclusions: Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC andcould be employed during EUS evaluation of malignancies.
Abstract
Background/Aims: Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%–75% forthe detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence ofobvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC. Methods: Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were includedafter obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performedthrough the transgastric route using a linear echoendoscope. Results: Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspectedmalignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure wassuccessful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was alsonegative. Conclusions: Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC andcould be employed during EUS evaluation of malignancies.
참고문헌 (14)
- Allen VA, "Assessment of false-negative ascites cytology in epithelial ovarian carcinoma : a study of 313 patients", Am J Clin Oncol, 40, pp.175~177 (2017)
- Decker D, "Benign and malignant cells in effusions : diagnostic value of image DNA cytometry in comparison to cytological analysis", Pathol Res Pract, 194, pp.791~795 (1998)
- Kielhorn E, "Use of magnetic enrichment for detection of carcinoma cells in fluid specimens", Cancer, 94, pp.205~211 (2002)
- Rana SS, "Endoscopic ultrasound-guided fine needle aspiration of peritoneal nodules in patients with ascites of unknown cause", Endoscopy, 43, pp.1010~1013 (2011)
- Runyon BA, "The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites", Ann Intern Med, 117, pp.215~220 (1992)
- Nguyen PT, "EUS in the detection of ascites and EUS-guided paracentesis", Gastrointest Endosc, 54, pp.336~339 (2001)
- Kaushik N, "EUS-guided paracentesis for the diagnosis of malignant ascites", Gastrointest Endosc, 64, pp.908~913 (2006)
- Peter S, "EUS-guided FNA of peritoneal carcinomatosis in patients with unknown primary malignancy", Gastrointest Endosc, 70, pp.1266~1270 (2009)
- Wardeh R, "Endoscopic ultrasound-guided paracentesis of ascitic fluid : a morphologic study with ultrasonographic correlation", Cancer Cytopathol, 119, pp.27~36 (2011)
- Levy MJ, "Detection of peritoneal carcinomatosis by EUS fine-needle aspiration : impact on staging and resectability(with videos)", Gastrointest Endosc, 81, pp.1215~1224 (2015)
- DeWitt J, "Endoscopic ultrasound-guided fine-needle aspiration of ascites", Clin Gastroenterol Hepatol, 5, pp.609~615 (2007)
- Wani S, "Learning curves for EUS by using cumulative sum analysis : implications for American Society for Gastrointestinal Endoscopy recommendations for training", Gastrointest Endosc, 77, pp.558~565 (2013)
- Lee JY, "The role of omentectomy and random peritoneal biopsies as part of comprehensive surgical staging in apparent early-stage epithelial ovarian cancer", Ann Surg Oncol, 21, pp.2762~2766 (2014)
- Franco D, "Portal hypertension after bile duct obstruction : effect of bile diversion on portal pressure in the rat", Arch Surg, 114, pp.1064~1067 (1979)