EUS-FNA of recurrent postoperative extraluminal and metastatic malignancy.
BACKGROUND
EUS-guided FNA is safe and accurate for the diagnosis of benign or malignant neoplasia and lymphadenopathy; however, its role in the diagnosis of recurrent malignancy is not well described.


METHODS
A prospectively updated EUS-guided FNA cytology database was used to identify patients in whom a diagnosis of postoperative, recurrent, extraluminal, or metastatic malignancy was made over a 5-year period. Only patients with a positive EUS-guided FNA were included in the analysis. All had undergone surgery for the primary malignancy and were in clinical and/or radiographic remission before the initial suspicion of tumor recurrence.


RESULTS
Twenty-one patients underwent EUS-guided FNA of 21 lesions (19 masses, 2 lymph nodes) because of a suspicion of recurrent malignancy based on CT (n = 17) or EUS (n = 4) findings. Median time from the initial diagnosis to recurrence was 26 months (range 5-276 months). Lesions were located in the pancreas (9 patients), mediastinum (7), liver (3), perigastric region (1), and liver hilum (1). EUS-guided FNA (mean number of needle passes, 4.5; range 2-8) obtained diagnostic material for recurrent malignancy in all patients as follows: esophageal (6 patients), renal cell (6), pancreatic (2), breast (2), colon (2), bile duct (1), Ewing's sarcoma (1), and lung (1) cancer. No complication was encountered. Transgastric EUS-guided FNA (4 patients), distal, or transesophageal EUS-FNA (2) proximal to a surgical anastomosis was required to confirm recurrence in all 6 patients with esophageal cancer. The initial cytologic diagnosis of recurrent malignancy was made by EUS in 20 of 21 (95%) patients. One patient with recurrent breast cancer had CT-guided FNA of a right lung mass preceding EUS-guided FNA of an AP window lymph node.


CONCLUSIONS
EUS-guided FNA can detect and safely diagnose recurrent malignancy in the mediastinum, retroperitoneum, and liver. When possible, correlation between EUS-guided FNA cytology and original tumor histopathology/cytology, or the use of immunostaining to confirm the diagnosis, is recommended.
Dewitt
John
J
Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Ghorai
Sujoy
S
Kahi
Charles
C
Leblanc
Julia
J
McHenry
Lee
L
Chappo
John
J
Cramer
Harvey
H
McGreevy
Kathleen
K
Chriswell
Melissa
M
Sherman
Stuart
S
D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000368:Aged; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000556:secondary; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000473:pathology; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary