Impact of EUS-guided FNA on management of gastric carcinoma

Background: EUS is an integral part of the pretherapeutic evaluation program for patients with upper GI cancer.

Objective: To evaluate the impact of EUS-guided FNA on the clinical management of patients with gastric cancer.

Design: The study included patients with confirmed gastric carcinoma who were referred to the Department of Surgical Gastroenterology, Gentofte Hospital, Copenhagen University, Copenhagen, Denmark, during a 6-year period (2001-2007).

Setting: The patients underwent standard pretherapeutic evaluation. If no signs of incurability were detected, the patients were offered EUS and EUS-guided FNA. EUS-guided FNA was performed when lymph nodes or lesions were considered to be distant metastases. A board of surgeons was asked to evaluate the management of the patients after the results obtained by EUS-guided FNA were revealed.

Patients: This study involved 234 patients with gastric carcinoma.

Intervention: EUS-guided FNA.

Main outcome measurements: Number of patients with distant metastasis diagnosed by EUS-guided FNA, with the avoidance of unnecessary surgery.

Results: A total of 81 consecutive patients underwent EUS-guided FNA. Ninety-nine lesions were targeted, and 61 (62%) of these lesions were found to be malignant. In 38 of 81 patients (42%) distant metastases were confirmed by EUS-guided FNA. As judged by the board of surgeons, EUS-guided FNA changed the management plan in 34 of 234 patients (15%).

Limitation: The positive EUS-guided FNA diagnoses were not surgically verified.

Conclusion: EUS-guided FNA is a very important modality and should be integrated as a routine procedure in the preoperative staging algorithm of gastric cancer.