EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma.
BACKGROUND
The clinical impact of EUS-guided FNA (EUS-FNA) in regional lymph-node staging in patients with unresectable hilar cholangiocarcinoma before liver transplantation has yet to be determined.


OBJECTIVE
To determine the frequency of regional lymph-node detection, identify EUS features predictive of benign or malignant lymph nodes, compare EUS lymph-node detection rates to CT/magnetic resonance imaging and exploratory laparotomy, and evaluate the impact of EUS-FNA on patient selection for liver transplantation.


METHODS
Retrospective case series.


METHODS
Tertiary referral EUS unit.


METHODS
Clinical, radiographic, EUS, cytologic, and surgical data of 47 patients with unresectable hilar cholangiocarcinoma before liver transplantation were evaluated.


METHODS
EUS-FNA.


METHODS
Lymph-node morphology and echo features.


RESULTS
EUS identified lymph nodes in all patients. FNA of 70 lymph nodes identified metastases in 9 nodes of 8 patients (17%), who were then precluded from transplantation before a staging laparotomy. Identified lymph nodes, irrespective of malignant involvement, were typically oval and geographic in shape, of mixed echogenicity, with a hypoechoic border. There were no morphologic criteria or echo features to correlate with nodal malignancy. The EUS finding of absent regional lymph-node metastases was confirmed in 20 of 22 by a subsequent exploratory staging laparotomy.


CONCLUSIONS
Single institution, retrospective analysis.


CONCLUSIONS
EUS identified lymph nodes in all patients, and confirmation of malignant lymph nodes detected by FNA precluded 17% of patients from transplantation. EUS-FNA of visualized lymph nodes irrespective of appearance is advised because morphology and echo features do not predict malignant involvement.
Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Ferga C
FC
Gleeson
Elizabeth
E
Rajan
Michael J
MJ
Levy
Jonathan E
JE
Clain
Mark D
MD
Topazian
Gavin C
GC
Harewood
Georgios I
GI
Papachristou
Naoki
N
Takahashi
Charles B
CB
Rosen
Gregory J
GJ
Gores
D000328:Adult; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic; D044963:Biopsy, Fine-Needle / Q000379:methods*; D018281:Cholangiocarcinoma / Q000473:pathology*; D015331:Cohort Studies; D019160:Endosonography; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted