4587 Eus-guided fine needle aspiration of occult pleural and ascitic fluid suspected of malignant origin.

Abstract

EUS-guided FNA in the evaluation of malignancy has been established with regards to lesions of the pancreas(solid, cystic), suspicious lymph nodes, suspected leiomyosarcomas as well as non-GI lesions (renal, adrenal, lung, etc..). The growing role of EUS in the evaluation of abdominal pain and weight loss of unknown cause has uncovered occult malignancy in the form of discreet lesions (pancreatic, mediastinal, etc...) and ascitic/pleural fluid. AIM: To determine the diagnostic capability and safety of EUS-guided FNA of suspected occult malignant ascites and pleural effusion. METHOD: 119 patients (78-male, 41-female) over a 6-year-period underwent EUS evaluation of the upper GI tract for abdominal pain and weight loss of unknown origin. All pts had previous exhaustive clinical, laboratory, and radiographic (CT, chest x-ray, US) evaluation without a diagnosis. No evidence of ascites or pleural effusion was noted on CT scan. Presenting symptoms included abdominal pain=102, weight loss=92, chest pain=12, diarrhea=22. RESULTS: 15 patients had either discreet pancreatic lesions (N=7), mediastinal adenopathy (N=2), ascites (N=4), or pleural effusion (N=2). All pts underwent successful FNA. All pts undergoing FNA of the pancreatic lesions had diagnosis of adenocarcinoma. Both patients with mediastinal adenopathy had malignant disease diagnosed by EUS FNA (lymphoma=1, non-small-cell lung CA=1). Three of four patients with ascites had adenocarcinoma while both patients with pleural effusion had non-small-cell lung CA by cytopathology. CONCLUSION: EUS-guided FNA in patients with unexplained abdominal pain and weight loss can assist in establishing occult malignancy when previous standard imaging has been non-diagnostic. Unsuspected pancreatic masses and lymph nodes provide target lesions that may assist in establishing a diagnosis. Demonstrable ascites and pleural effusion should also undergo FNA because of possible malignant origins. EUS-guided FNA in the evaluation of malignancy has been established with regards to lesions of the pancreas(solid, cystic), suspicious lymph nodes, suspected leiomyosarcomas as well as non-GI lesions (renal, adrenal, lung, etc..). The growing role of EUS in the evaluation of abdominal pain and weight loss of unknown cause has uncovered occult malignancy in the form of discreet lesions (pancreatic, mediastinal, etc...) and ascitic/pleural fluid. AIM: To determine the diagnostic capability and safety of EUS-guided FNA of suspected occult malignant ascites and pleural effusion. METHOD: 119 patients (78-male, 41-female) over a 6-year-period underwent EUS evaluation of the upper GI tract for abdominal pain and weight loss of unknown origin. All pts had previous exhaustive clinical, laboratory, and radiographic (CT, chest x-ray, US) evaluation without a diagnosis. No evidence of ascites or pleural effusion was noted on CT scan. Presenting symptoms included abdominal pain=102, weight loss=92, chest pain=12, diarrhea=22. RESULTS: 15 patients had either discreet pancreatic lesions (N=7), mediastinal adenopathy (N=2), ascites (N=4), or pleural effusion (N=2). All pts underwent successful FNA. All pts undergoing FNA of the pancreatic lesions had diagnosis of adenocarcinoma. Both patients with mediastinal adenopathy had malignant disease diagnosed by EUS FNA (lymphoma=1, non-small-cell lung CA=1). Three of four patients with ascites had adenocarcinoma while both patients with pleural effusion had non-small-cell lung CA by cytopathology. CONCLUSION: EUS-guided FNA in patients with unexplained abdominal pain and weight loss can assist in establishing occult malignancy when previous standard imaging has been non-diagnostic. Unsuspected pancreatic masses and lymph nodes provide target lesions that may assist in establishing a diagnosis. Demonstrable ascites and pleural effusion should also undergo FNA because of possible malignant origins.