Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Lesions Within the Liver and the Porta Hepatis (Liver Hilum). A Single Center Report of 67 Lesions in 59 Patients

Abstract

Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is increasingly being used in gastrointestinal oncology. The liver and the porta hepatis constitute a common site of primary tumors or metastasis, sometimes difficult to be non-surgically accessible. Therefore EUS-FNA of liver and hilar lesions is of paramount importance. The aim of the study was to report the indications, cytological diagnosis, diagnostic effectiveness, safety, and clinical impact of EUS-FNA of liver (LL) and hilar (HL) lesions in our tertiary facility center. Methods: Between May, 2003, and October, 2005, a total of 59 patients with 67 different LL and HL were enrolled in this study. Demographic data of patients as well as indications, complications and findings of EUS-FNA were collected and reviewed. Results: EUS-FNA was performed on 43 LL and 24 HL (in total 67) in 59 patients (43 male and 16 female with a mean age of 61 ± 12 years). Of these 59 patients, 35 had only LL, 18 only HL and 6 had both LL and HL. The main indication for the procedure was previous imaging of a liver mass in 14 out of 59 patients (23,7%), a pancreatic mass in 13 (22%), or abnormal pancreatobiliary tree findings in 10 patients (16,9%). On average 1,5 ± 0,6 needle passes were performed through each of the 67 lesions. No complications occured. Of these 67 lesions, 45 (67,2%) were cytologically diagnosed as malignant (36 LL and 9 HL), 18 (26,9%) benign (4 LL and 14 HL) and 4 (5,9%) were nondiagnostic (3 LL and 1 HL). A total of 18 out of 22 nonmalignant lesions were confirmed as negative by follow up. Regarding malignancy, EUS-FNA had a sensitivity of 91,8%, specificity of 100%, yielding a negative predictive value of 81,8% and a positive predictive value of 100%. Among patients with malignancy (40 out of 59) the most common cytological diagnosis was metastatic adenocarcinoma from the pancreas in 16 of them (40%), followed by cholangiocarcinoma in 8 patients (20%). Of the 41 patients with liver lesions, at least 17 (41,5%) had normal previous noninvasive imaging, in 14 of whom (34,1%) malignancy was diagnosed. EUS-FNA had a positive impact on patient management in 82,4% of subjects with cytology positive for malignancy. Conclusions: EUS-FNA is a safe and effective procedure for determining the malignant potential of lesions in the liver and the porta hepatis. It can have major impact on clinical management revealing undiagnosed lesions, upstaging tumors, obtaining tissue for diagnosis in patients with inoperable disease and avoiding surgery. Our experience suggests that having a pathologist present in the endoscopy unit provides optimal amount of tissue for correct cytological diagnosis.