Abstract
BackgroundDiagnostic laparoscopy is often a necessary, albeit invasive, procedure to help resolve undiagnosed peritoneal diseases. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, however, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC).AimThis pilot study aims to prospectively determine the effectiveness of EUS-FNB regarding adequacy of tissue for IHC staining, diagnostic rate and the avoidance rate of diagnostic laparoscopy or percutaneous biopsy in patients with these lesions.MethodsFrom March 2017 to June 2018, patients with peritoneal or omental lesions identified by CT or MRI at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were prospectively enrolled in the study. All Patients underwent EUS-FNB. For those with negative pathological results of EUS-FNB, percutaneous biopsy or diagnostic laparoscopy was planned. Analysis uses percentages only due to small sample sizes.ResultsA total of 30 EUS-FNB passes were completed, with a median of 3 passes (range 2–3 passes) per case. For EUS-FNB, the sensitivity, specificity, PPV, NPV and accuracy of EUS-FNB from peritoneal lesions were 63.6%, 100%, 100%, 20% and 66.7% respectively. Adequate tissue for IHC stain was found in 25/30 passes (80%). The tissues from EUS results were found malignant in 7/12 patients (58.3%). IHC could be done in 10/12 patients (83.3%). Among the five patients with negative EUS results, two underwent either liver biopsy of mass or abdominal paracentesis, showing gallbladder cancer and adenocarcinoma. Two patients refused laparoscopy due to advanced pancreatic cancer and worsening ovarian cancer. The fifth patient had post-surgical inflammation only with spontaneous resolution. The avoidance rate of laparoscopic diagnosis was 58.3%. No major adverse event was observed.ConclusionsEUS-FNB from peritoneal lesions provided sufficient core tissue for diagnosis and IHC. Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions.
Highlights
Peritoneal or omental lesions including peritoneal thickening, peritoneal mass or nodule, omental cake or mass can result from a variety of diseases
Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions
Eleven of them were excluded with reasons including poor performance status (n = 4), undetectable lesions during Endoscopic ultrasound (EUS) (n = 4), intervening tumor in puncture site (n = 1), uncontrolled infection (n = 1), and esophageal obstruction (n = 1)
Summary
Peritoneal or omental lesions including peritoneal thickening, peritoneal mass or nodule, omental cake or mass can result from a variety of diseases. Lesions are universally referred to as peritoneal lesions in our study. To diagnose etiologies of peritoneal lesions, several modalities including radiological findings, tissue biopsy under radiological guidance, and diagnostic laparoscopy have been used. Cross-sectional imaging findings of peritoneal lesions alone are too non-specific to provide an etiological diagnosis. Often, this method may underestimate peritoneal disease burden, since it has limitations in the detection of a small volume peritoneal implants or ascites [1]. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC)
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