title: EUS-derived criteria for distinguishing benign from malignant metastatic solid hepatic masses.
abstract: BACKGROUND
  Detection of hepatic metastases during EUS is an important component of tumor staging.
  
  
  OBJECTIVE
  To describe our experience with EUS-guided FNA (EUS-FNA) of solid hepatic masses and derive and validate criteria to help distinguish between benign and malignant hepatic masses.
  
  
  METHODS
  Retrospective study, survey.
  
  
  METHODS
  Single, tertiary-care referral center.
  
  
  METHODS
  Medical records were reviewed for all patients undergoing EUS-FNA of solid hepatic masses over a 12-year period.
  
  
  METHODS
  EUS-FNA of solid hepatic masses.
  
  
  METHODS
  Masses were deemed benign or malignant according to predetermined criteria. EUS images from 200 patients were used to create derivation and validation cohorts of 100 cases each, matched by cytopathologic diagnosis. Ten expert endosonographers blindly rated 15 initial endosonographic features of each of the 100 images in the derivation cohort. These data were used to derive an EUS scoring system that was then validated by using the validation cohort by the expert endosonographer with the highest diagnostic accuracy.
  
  
  RESULTS
  A total of 332 patients underwent EUS-FNA of a hepatic mass. Interobserver agreement regarding the initial endosonographic features among the expert endosonographers was fair to moderate, with a mean diagnostic accuracy of 73% (standard deviation 5.6). A scoring system incorporating 7 EUS features was developed to distinguish benign from malignant hepatic masses by using the derivation cohort with an area under the receiver operating curve (AUC) of 0.92; when applied to the validation cohort, performance was similar (AUC 0.86). The combined positive predictive value of both cohorts was 88%.
  
  
  CONCLUSIONS
  Single center, retrospective, only one expert endosonographer deriving and validating the EUS criteria.
  
  
  CONCLUSIONS
  An EUS scoring system was developed that helps distinguish benign from malignant hepatic masses. Further study is required to determine the impact of these EUS criteria among endosonographers of all experience.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Larissa L
authors: LL
authors: Fujii-Lau
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Barham K
authors: BK
authors: Abu Dayyeh
authors: Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
authors: Marco J
authors: MJ
authors: Bruno
authors: Division of Gastroenterology and Hepatology, University of California Irvine, Orange, California, USA.
authors: Kenneth J
authors: KJ
authors: Chang
authors: Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors: John M
authors: JM
authors: DeWitt
authors: Division of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Paul
authors: P
authors: Fockens
authors: Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: David
authors: D
authors: Forcione
authors: Department of Gastroenterology, Private Hospital Jean Mermoz, Lyon, France.
authors: Bertrand
authors: B
authors: Napoleon
authors: Tracadero Clinic, Paris, France.
authors: Laurent
authors: L
authors: Palazzo
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Mark D
authors: MD
authors: Topazian
authors: Lutheran Medical Group, Fort Wayne, Indiana, USA.
authors: Maurits J
authors: MJ
authors: Wiersema
authors: Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Amitabh
authors: A
authors: Chak
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Jonathan E
authors: JE
authors: Clain
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
authors: Douglas O
authors: DO
authors: Faigel
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Ferga C
authors: FC
authors: Gleeson
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Robert
authors: R
authors: Hawes
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Prasad G
authors: PG
authors: Iyer
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Elizabeth
authors: E
authors: Rajan
authors: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Tyler
authors: T
authors: Stevens
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors: Michael B
authors: MB
authors: Wallace
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Kenneth K
authors: KK
authors: Wang
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors: Michael J
authors: MJ
authors: Levy
mesh_terms: D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies