Detection of unsuspected left hepatic lobe metastases during EUS staging of cancer of the esophagus and cardia.
BACKGROUND
High resolution imaging of the left hepatic lobe can be obtained via endoscopic ultrasound (EUS), allowing for detection of unsuspected metastatic disease during cancer staging. The frequency at which occult liver metastases are detected during EUS staging of cancer of the esophagus and cardia is unknown.


METHODS
Over an 18-month period, 98 patients underwent EUS staging for a new diagnosis of cancer of the esophagus and cardia. Wire-guided dilation was performed if necessary. Standard radial examination was followed by curvilinear evaluation with attention to the left hepatic lobe. All suspicious liver lesions were aspirated under EUS guidance.


RESULTS
The radial and curvilinear echoendoscope were successfully passed to the antrum in 86% and 81% of cases, respectively, without complication. Thirty-two percent of patients required dilation. Lesions suspicious for left hepatic lobe metastases were found in 7% of cases that could be completely evaluated by EUS, all of which underwent EUS-guided fine needle aspiration. All lesions were proven metastases: four true-positive and one false-negative cytologic result.


CONCLUSIONS
Curvilinear EUS examination of the left hepatic lobe in addition to standard radial EUS examination can be performed safely when staging cancer of the esophagus and cardia. Dedicated left hepatic lobe examination should be performed as it avoids unnecessary surgery in a subset of these patients by detection of occult liver metastases.
McGrath
Kevin
K
Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Brody
Debra
D
Luketich
James
J
Khalid
Asif
A
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary*; D002299:Cardia / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*