title: Detection of occult liver metastases during EUS for staging of malignancies.
abstract: BACKGROUND
  EUS is commonly used in the staging of GI, thoracic, and other malignancies. Studies suggest EUS can detect occult liver metastases, but the frequency with which this occurs is unknown.
  
  
  METHODS
  Records were reviewed for all patients seen during a 3-year period who underwent EUS of the upper-GI tract for staging of known or suspected malignancy. Patients were included if there was histopathologic evidence of malignancy, they had undergone noninvasive liver imaging within 6 weeks of EUS, and liver surveillance was specifically mentioned in the report of the EUS procedure.
  
  
  RESULTS
  A total of 222 patients were included. Liver lesions were seen in 27 patients, 17 of whom had an abnormal noninvasive liver imaging test. EUS-guided FNA of the liver was performed in 21 patients and was diagnostic of malignancy in 15 (6.8%), 5 of whom (2.3%) had normal noninvasive imaging. In 6 patients, the EUS-guided FNA result was benign. EUS missed liver lesions in 4 patients known to have abnormalities by other imaging modalities.
  
  
  CONCLUSIONS
  EUS can detect occult liver metastases in patients in whom noninvasive hepatic imaging studies are normal, although the frequency at which such lesions are detected is low. Liver surveillance during EUS is worthwhile for patients in whom there is another indication for the procedure; but, at present, EUS should not replace traditional imaging modalities.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina USA.
authors.forename: Priyajit
authors.initials: P
authors.lastname: Prasad
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
authors.forename: Alpesh
authors.initials: A
authors.lastname: Patel
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Wildi
authors.forename: Stacey
authors.initials: S
authors.lastname: Roberts
authors.forename: Radu
authors.initials: R
authors.lastname: Tutuian
authors.forename: Peter
authors.initials: P
authors.lastname: King
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Hoffman
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods; D019160:Endosonography; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology