EUS-guided FNA for the diagnosis of recurrent bladder cancer through the ileal conduit: a novel approach.
BACKGROUND
Diagnosing local recurrence of tumor after cystectomy and ileal conduit construction for urinary bladder cancer remains a diagnostic challenge. Also, distinction of benign stricture from recurrent tumor at the site of ureteral anastomosis in the ileal conduit is difficult.


OBJECTIVE
A new method is described for performing EUS-guided FNA through the ileal conduit in patients suspected of having local tumor recurrence after complete cystectomy for bladder cancer.


METHODS
Case series, part of a large prospective study on EUS-guided FNA.


METHODS
Three patients who had undergone total cystectomy and ileal conduit construction for bladder cancer underwent EUS-guided FNA through the ileal conduit for evaluation of suspected tumor recurrence at the site of anastomosis of the distal ureter and the ileal conduit.


METHODS
The feasibility, diagnostic accuracy, and safety profile of EUS-guided FNA is assessed.


METHODS
EUS-guided FNA through the ileal conduit was technically feasible in all 3 patients. By EUS, the mass appeared as an irregularly shaped, hypoechoic lesion that was extrinsic to the lumen of the ileum. A diagnosis of recurrent transitional cell cancer was made in 2 patients and anastomotic stricture was found in 1 patient. Both patients with tumor recurrence received palliative chemotherapy, and the patient with an anastomotic stricture was managed by placement of a nephrostomy stent. No complications were encountered.


CONCLUSIONS
Small number of enrolled subjects; short duration of follow-up.


CONCLUSIONS
EUS-guided FNA through the ileal conduit is technically feasible, safe, and establishes diagnosis in patients suspected of tumor recurrence after complete cystectomy for bladder cancer.
Eloubeidi
Mohamad A
MA
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Varadarajulu
Shyam
S
El-Galley
Rizk
R
Bueschen
Anton J
AJ
Eltoum
Isam
I
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D018084:Ultrasonography, Interventional; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014547:Urinary Diversion