Dewitt John, Ghorai Sujoy, Kahi Charles, Leblanc Julia, McHenry Lee, Chappo John, Cramer Harvey, McGreevy Kathleen, Chriswell Melissa, Sherman Stuart
Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Gastrointest Endosc. 2003 Oct;58(4):542-8. doi: 10.1067/s0016-5107(03)01872-8.
EUS-guided FNA is safe and accurate for the diagnosis of benign or malignant neoplasia and lymphadenopathy; however, its role in the diagnosis of recurrent malignancy is not well described.
A prospectively updated EUS-guided FNA cytology database was used to identify patients in whom a diagnosis of postoperative, recurrent, extraluminal, or metastatic malignancy was made over a 5-year period. Only patients with a positive EUS-guided FNA were included in the analysis. All had undergone surgery for the primary malignancy and were in clinical and/or radiographic remission before the initial suspicion of tumor recurrence.
Twenty-one patients underwent EUS-guided FNA of 21 lesions (19 masses, 2 lymph nodes) because of a suspicion of recurrent malignancy based on CT (n = 17) or EUS (n = 4) findings. Median time from the initial diagnosis to recurrence was 26 months (range 5-276 months). Lesions were located in the pancreas (9 patients), mediastinum (7), liver (3), perigastric region (1), and liver hilum (1). EUS-guided FNA (mean number of needle passes, 4.5; range 2-8) obtained diagnostic material for recurrent malignancy in all patients as follows: esophageal (6 patients), renal cell (6), pancreatic (2), breast (2), colon (2), bile duct (1), Ewing's sarcoma (1), and lung (1) cancer. No complication was encountered. Transgastric EUS-guided FNA (4 patients), distal, or transesophageal EUS-FNA (2) proximal to a surgical anastomosis was required to confirm recurrence in all 6 patients with esophageal cancer. The initial cytologic diagnosis of recurrent malignancy was made by EUS in 20 of 21 (95%) patients. One patient with recurrent breast cancer had CT-guided FNA of a right lung mass preceding EUS-guided FNA of an AP window lymph node.
EUS-guided FNA can detect and safely diagnose recurrent malignancy in the mediastinum, retroperitoneum, and liver. When possible, correlation between EUS-guided FNA cytology and original tumor histopathology/cytology, or the use of immunostaining to confirm the diagnosis, is recommended.
超声内镜引导下细针穿刺活检术（EUS-guided FNA）对于诊断良性或恶性肿瘤及淋巴结病安全且准确；然而，其在复发性恶性肿瘤诊断中的作用尚未得到充分描述。
前瞻性更新的EUS引导下FNA细胞学数据库用于识别在5年期间被诊断为术后、复发、腔外或转移性恶性肿瘤的患者。分析仅纳入EUS引导下FNA结果为阳性的患者。所有患者均接受过原发性恶性肿瘤手术，且在最初怀疑肿瘤复发前处于临床和/或影像学缓解状态。
21例患者因基于CT（n = 17）或EUS（n = 4）检查结果怀疑复发性恶性肿瘤，对21个病变（19个肿块、2个淋巴结）进行了EUS引导下FNA。从初始诊断到复发的中位时间为26个月（范围5 - 276个月）。病变位于胰腺（9例患者）、纵隔（7例）、肝脏（3例）、胃周区域（1例）和肝门（1例）。EUS引导下FNA（平均穿刺针数4.5；范围2 - 8）在所有患者中均获取了用于诊断复发性恶性肿瘤的材料，具体如下：食管癌（6例患者）、肾细胞癌（6例）、胰腺癌（2例）、乳腺癌（2例）、结肠癌（2例）、胆管癌（1例）、尤因肉瘤（1例）和肺癌（1例）。未发生并发症。所有6例食管癌患者均需经胃EUS引导下FNA（4例患者）或手术吻合口远端或经食管EUS - FNA（2例）近端来确认复发。21例患者中有20例（95%）通过EUS做出了复发性恶性肿瘤的初始细胞学诊断。1例复发性乳腺癌患者在对主动脉肺动脉窗淋巴结进行EUS引导下FNA之前，对右肺肿块进行了CT引导下FNA。
EUS引导下FNA可检测并安全诊断纵隔、腹膜后和肝脏的复发性恶性肿瘤。建议在可能的情况下，将EUS引导下FNA细胞学结果与原始肿瘤组织病理学/细胞学结果进行对比，或使用免疫染色来确诊。
