EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases.
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.
tenBerge
Jorgen
J
Medical University of South Carolina, Charleston, South Carolina, Institut Paoli-Calmettes, Marseilles, France.
Hoffman
Brenda J
BJ
Hawes
Robert H
RH
Van Enckevort
Conny
C
Giovannini
Marc
M
Erickson
Richard A
RA
Catalano
Marc F
MF
Fogel
Roberto
R
Mallery
Shawn
S
Faigel
Douglas O
DO
Ferrari
Angelo P
AP
Waxman
Irving
I
Palazzo
Larent
L
Ben-Menachem
Tamir
T
Jowell
Paul S
PS
McGrath
Kevin M
KM
Kowalski
Thomas E
TE
Nguyen
Cuong C
CC
Wassef
Wahid Y
WY
Yamao
Keiji
K
Chak
Amitabh
A
Greenwald
Bruce D
BD
Woodward
Timothy A
TA
Vilmann
Peter
P
Sabbagh
Luis
L
Wallace
Michael B
MB
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