title: EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases.
abstract: BACKGROUND
  The liver is a common site of metastases for various malignancies. EUS-guided fine needle aspiration (EUS-FNA) of liver masses has only been reported in small series from single centers.
  
  
  METHODS
  A retrospective questionnaire was sent by e-mail to 130 EUS-FNA centers around the world regarding indications, complications, and findings of EUS-FNA of the liver.
  
  
  RESULTS
  Twenty-one centers reported 167 cases of EUS-FNA of the liver. A complication was reported in 6 (4%) of 167 cases including the following: death in 1 patient with an occluding biliary stent and biliary sepsis, bleeding (1), fever (2), and pain (2). EUS-FNA diagnosed malignancy in 23 of 26 (89%) cases after nondiagnostic fine needle aspiration under transabdominal US guidance. EUS localized an unrecognized primary tumor in 17 of 33 (52%) cases in which CT had demonstrated only liver metastases. EUS image characteristics were not predictive of malignant versus benign lesions.
  
  
  CONCLUSIONS
  EUS-guided FNA of the liver appears to be a safe procedure with a major complication rate of approximately 1%. EUS-FNA should be considered when a liver lesion is poorly accessible to US-, or CT-guided FNA should be considered when US- or CT-guided FNA fail to make a diagnosis, when a liver lesion(s) is detected (de novo) by EUS, and for investigation of possible upper GI primary tumors in the setting of liver metastases.
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, Institut Paoli-Calmettes, Marseilles, France.
authors.forename: Jorgen
authors.initials: J
authors.lastname: tenBerge
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Hoffman
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Conny
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authors.lastname: Van Enckevort
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.forename: Richard A
authors.initials: RA
authors.lastname: Erickson
authors.forename: Marc F
authors.initials: MF
authors.lastname: Catalano
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogel
authors.forename: Shawn
authors.initials: S
authors.lastname: Mallery
authors.forename: Douglas O
authors.initials: DO
authors.lastname: Faigel
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Ferrari
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.forename: Larent
authors.initials: L
authors.lastname: Palazzo
authors.forename: Tamir
authors.initials: T
authors.lastname: Ben-Menachem
authors.forename: Paul S
authors.initials: PS
authors.lastname: Jowell
authors.forename: Kevin M
authors.initials: KM
authors.lastname: McGrath
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kowalski
authors.forename: Cuong C
authors.initials: CC
authors.lastname: Nguyen
authors.forename: Wahid Y
authors.initials: WY
authors.lastname: Wassef
authors.forename: Keiji
authors.initials: K
authors.lastname: Yamao
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Greenwald
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.forename: Peter
authors.initials: P
authors.lastname: Vilmann
authors.forename: Luis
authors.initials: L
authors.lastname: Sabbagh
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D001291:Attitude of Health Personnel; D001707:Biopsy, Needle / Q000009:adverse effects*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D019160:Endosonography / Q000009:adverse effects*; D019538:Health Care Surveys; D006801:Humans; D007391:International Cooperation; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity