title: Impact of preoperative endoscopic ultrasound-guided fine needle aspiration on postoperative recurrence and survival in cholangiocarcinoma patients.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is frequently performed for suspected biliary tumors for diagnosis and staging but carries a theoretical risk of needle-track seeding. We aimed to evaluate the impact of preoperative EUS-FNA on long-term outcomes for patients with cholangiocarcinoma (CCA).
  
  
  METHODS
  In a retrospective single-center study of consecutive patients with CCA with preoperative EUS-FNA, main outcome measures were overall survival and progression-free survival.
  
  
  RESULTS
  In 150 patients with confirmed CCA, 61 underwent preoperative FNA. Median overall survival was 18.5 months (95% confidence limits [CL] 15.4, 25.7): 111 patients died and 39 survived. Of the 150 patients, 119 underwent curative-intent surgical resection, with median progression-free survival of 17.8 months (95% CL 14.5, 22.8); 89/119 patients had tumor recurrence or died, and 30/119 remained alive and disease-free. On multivariable analysis, overall survival was associated with: undergoing curative-intent surgery (hazard ratio [HR] 5.79, P = 0.001), lack of lymph node involvement (HR 1.89, P = 0.011), younger age (HR 1.51 for every 10 years, P < 0.0015), and small tumor size (HR 1.11 for every 1 cm, P = 0.029). For patients undergoing curative-intent surgery, on multivariable analysis, improved progression-free survival was associated with: lack of lymph node involvement (HR 1.88, P = 0.010), smaller tumor size (HR 1.16 for every 1 cm smaller, P = 0.003), and younger age (HR 1.53 for every 10 years, P < 0.001). Number of needle passes showed no statistically significant impact on overall survival.
  
  
  CONCLUSIONS
  Preoperative EUS-FNA in patients with CCA does not appear to adversely affect overall or progression-free survival.
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University, Indianapolis, United States.
authors.forename: Abdul Hamid
authors.initials: AH
authors.lastname: El Chafic
authors.forename: John
authors.initials: J
authors.lastname: Dewitt
authors.forename: Julia Kim
authors.initials: JK
authors.lastname: Leblanc
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.forename: Gregory
authors.initials: G
authors.lastname: Cote
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Cynthia
authors.initials: C
authors.lastname: Johnson
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mohamadnejad
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Haddad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome