Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: impact on staging and resectability (with videos)

Michael J Levy; Barham K Abu Dayyeh; Larissa L Fujii; Amy C Clayton; Jordan P Reynolds; Tercio L Lopes; Archana S Rao; Jonathan E Clain; Ferga C Gleeson; Prasad G Iyer; Michael L Kendrick; Elizabeth Rajan; Mark D Topazian; Kenneth K Wang; Maurits J Wiersema; Suresh T Chari

doi:10.1016/j.gie.2014.10.028

Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: impact on staging and resectability (with videos)

Gastrointest Endosc. 2015 May;81(5):1215-24. doi: 10.1016/j.gie.2014.10.028. Epub 2015 Feb 7.

Authors

Michael J Levy¹, Barham K Abu Dayyeh¹, Larissa L Fujii¹, Amy C Clayton², Jordan P Reynolds², Tercio L Lopes¹, Archana S Rao¹, Jonathan E Clain¹, Ferga C Gleeson¹, Prasad G Iyer¹, Michael L Kendrick³, Elizabeth Rajan¹, Mark D Topazian¹, Kenneth K Wang¹, Maurits J Wiersema⁴, Suresh T Chari¹

Affiliations

¹ Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³ Department of Surgery, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Lutheran Medical Group, Fort Wayne, Indiana, USA.

PMID: 25660979
DOI: 10.1016/j.gie.2014.10.028

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.

Design: Retrospective study.

Setting: Single tertiary-care referral center.

Patients: 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.

Intervention: EUS-FNA of a peritoneal anomaly.

Main outcome measurements: 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.

Limitations: Retrospective design, single-center, bias toward EUS as a diagnostic test.

Conclusion: Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.

Publication types

Video-Audio Media

MeSH terms

Aged
Aged, 80 and over
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging / methods
Peritoneal Neoplasms / diagnosis*
Peritoneal Neoplasms / diagnostic imaging
Peritoneal Neoplasms / pathology
Retrospective Studies
Tomography, X-Ray Computed