title: Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy.
abstract: BACKGROUND
  Diagnosis of metastatic disease is important in patients with cirrhosis and hepatocellular carcinoma (HCC) to prevent futile liver transplantation. Some of these patients have metastatic lymphadenopathy; however, it is difficult to perform percutaneous fine-needle aspiration due to presence of collateral and anatomic location. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of lymph nodes offers several advantages like real-time vision, proximity to target, and avoidance of collaterals.
  
  
  OBJECTIVE
  The aim of this study was to look for metastatic lymphadenopathy by EUS-guided FNA (EUS-FNA) in prospective liver transplant recipients with HCC.
  
  
  METHODS
  A prospective study was conducted from January 2013 to January 2016 at a tertiary care center. All prospective liver transplant recipients with HCC had PET-CT and bone scan to look for metastatic disease. EUS-FNA was done in patients with abdominal or mediastinal lymphadenopathy and no evidence of extrahepatic disease. Data is shown as median (25-75 interquartile range).
  
  
  RESULTS
  EUS-guided FNA was done for 50 patients (42 abdominal and 8 mediastinal lymph nodes), age 57 (53-62) years, Child-Turcotte-Pugh 7 (6-9), and model for end-stage liver disease 10 (7-16). FNA material was adequate in 92% patients, metastasis in 15 (30%), granulomatous lymphadenopathy in 4 (8%), and reactive change in 27 patients (54%). The material was inadequate for diagnosis in 4 (8%) patients. Thus, EUS-guided FNA precluded transplantation in 30% of patients with lymphadenopathy, and 4 (8%) patients received anti-tubercular therapy before liver transplantation.
  
  
  CONCLUSIONS
  In patients with HCC and lymphadenopathy, EUS-guided FNA detected metastatic disease and precluded liver transplantation in approximately one third of patients.
authors.affiliation: Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Choudhary
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, 122 001, India. purirajesh69@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puri
authors.affiliation: Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.affiliation: Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhangui
authors.affiliation: Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Vinit
authors.initials: V
authors.lastname: Shah
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Nasa
authors.affiliation: Department of Cytopathology, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Haimanti
authors.initials: H
authors.lastname: Sarin
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Mridula
authors.initials: M
authors.lastname: Guleria
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Randhir
authors.initials: R
authors.lastname: Sud
authors.affiliation: Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India.
authors.forename: Arvinder S
authors.initials: AS
authors.lastname: Soin
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000556:secondary*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D016031:Liver Transplantation; D000072281:Lymphadenopathy / Q000175:diagnosis* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Endoscopic ultrasound; Fine-needle aspiration; Hepatocellular carcinoma; Liver transplantation; Tuberculosis