title: Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: impact on staging and resectability (with videos).
abstract: BACKGROUND
  Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability.
  
  
  OBJECTIVE
  To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Single tertiary-care referral center.
  
  
  METHODS
  A prospectively maintained EUS database was reviewed to identify patients who underwent EUS-guided FNA (EUS-FNA) of a peritoneal anomaly. Findings were compared with a strict criterion standard that incorporated cytohistologic, radiologic, and clinical data.
  
  
  METHODS
  EUS-FNA of a peritoneal anomaly.
  
  
  METHODS
  Safety and diagnostic yield.
  
  
  RESULTS
  Of 106 patients, a criterion standard was available in 98 (39 female patients; median age, 65 years). The sensitivity, specificity, and accuracy of EUS-FNA versus CT/magnetic resonance imaging (MRI) was 91% versus 28%, 100% versus 85%, and 94% versus 47%, respectively. In newly diagnosed cancer patients, peritoneal FNA upstaged 17 patients (23.6%). Of 32 patients deemed resectable by pre-EUS CT/MRI, 15 (46.9%) were deemed unresectable based solely on peritoneal FNA. The odds of FNA changing the resectability status remained highly significant after adjustment for cancer type, time between CT/MRI and EUS-FNA, and the quality of CT/MRI. The malignant appearance of the peritoneal anomaly but not the presence of ascites on EUS predicted a positive FNA finding (odds ratio 2.56; 95% confidence interval, 1.23-5.4 and odds ratio 0.83; 95% confidence interval, 0.4-1.8, respectively). There were 3 adverse events among 4 patients. Two of the patients developed abdominal pain and one each hypertensive urgency and pancreatitis.
  
  
  CONCLUSIONS
  Retrospective design, single-center, bias toward EUS as a diagnostic test.
  
  
  CONCLUSIONS
  Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Michael J
authors: MJ
authors: Levy
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Barham K
authors: BK
authors: Abu Dayyeh
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Larissa L
authors: LL
authors: Fujii
authors: Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Amy C
authors: AC
authors: Clayton
authors: Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Jordan P
authors: JP
authors: Reynolds
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Tercio L
authors: TL
authors: Lopes
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Archana S
authors: AS
authors: Rao
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Jonathan E
authors: JE
authors: Clain
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Ferga C
authors: FC
authors: Gleeson
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Prasad G
authors: PG
authors: Iyer
authors: Department of Surgery, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Michael L
authors: ML
authors: Kendrick
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Elizabeth
authors: E
authors: Rajan
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Mark D
authors: MD
authors: Topazian
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Kenneth K
authors: KK
authors: Wang
authors: Lutheran Medical Group, Fort Wayne, Indiana, USA.
authors: Maurits J
authors: MJ
authors: Wiersema
authors: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Suresh T
authors: ST
authors: Chari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed