title: EUS for detection of the hepatocellular carcinoma: results of a prospective study.
abstract: BACKGROUND
  Early detection of hepatocellular carcinoma (HCC) and accurate determination of the number of lesions are critical in determining eligibility for liver transplantation or resection. Current diagnostic modalities (CT and magnetic resonance imaging [MRI]) often miss small lesions.
  
  
  OBJECTIVE
  To compare the accuracy of the EUS with CT for the detection of primary tumors of the liver.
  
  
  METHODS
  Prospective single-center study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Subjects at high risk of HCC (hepatitis B, hepatitis C, or alcoholic cirrhosis) were enrolled.
  
  
  METHODS
  US, CT, MRI, and EUS examinations of the liver were performed. Liver lesions identified during EUS underwent EUS-guided FNA (EUS-FNA).
  
  
  RESULTS
  Seventeen patients were enrolled in the study. Nine of these patients had liver tumors (HCC, 8; cholangiocarcinoma, 1). EUS-FNA established a tissue diagnosis in 8 of the 9 cases. The diagnostic accuracy of US, CT, MRI, and EUS/EUS-FNA were 38%, 69%, 92%, and 94%, respectively. EUS detected a significantly higher number of nodular lesions than US (P = .03), CT (P = .002), and MRI (P = .04). For HCC lesions, a trend was observed in favor of EUS for the detection of more lesions than US (8 vs 2; P = .06) and CT (20 vs 8; P = .06). No complications were observed as a result of EUS-FNA.
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  EUS-FNA is a safe and accurate test for the diagnosis of HCC. EUS increases the accuracy of intrahepatic staging of the HCC by delineation of lesions, which are missed by CT and MRI. We recommend EUS for suspected HCC, particularly in cases that are being considered for liver transplantation.
authors.affiliation: Section of Gastroenterology and Hepatology, Central Texas Veterans Health Care System, Scott and White Memorial Hospital, Temple, Texas 76504, USA.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Singh
authors.forename: Richard A
authors.initials: RA
authors.lastname: Erickson
authors.forename: Phalguni
authors.initials: P
authors.lastname: Mukhopadhyay
authors.forename: Shanthi
authors.initials: S
authors.lastname: Gopal
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khan
authors.forename: T
authors.initials: T
authors.lastname: Ulf Westblom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging*; D019160:Endosonography; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional