Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2019 Nov;17(12):2533-2540.e1. doi: 10.1016/j.cgh.2019.03.043. Epub 2019 Apr 3.
BACKGROUND & AIMS: Tumor cells can migrate via diminutive perivascular cuffing to distant sites along blood vessels to form extravascular migratory metastases (EVMM). These metastases usually are identified during surgery or autopsies. We aimed to evaluate the feasibility and safety of endoscopic ultrasound fine-needle aspiration (EUS-FNA) of perivascular soft-tissue cuffs to detect EVMM. We compared findings from EUS with those from noninvasive cross-sectional imaging (reference standard) of patients who underwent EUS-FNA to assess suspected EVMM and studied the effects on pancreatic tumor staging and determination of resectability.
We performed a retrospective analysis of 253 patients (mean age, 62 ± 12 y) who underwent EUS-FNA of 267 vessels for evaluation of suspected EVMM, from April 2001 through May 2018. EUS findings were compared with those from computed tomography (CT) and magnetic resonance imaging (MRI) as the reference standard. Lesions were considered to be malignant based on cytology analysis of FNA samples, histology analyses of surgical or biopsy specimens, or vascular abnormalities detected by CT or MRI that clearly indicate EVMM.
Thirty patients were found to have benign lesions. The remaining 223 patients who had malignancies (166 with pancreatic ductal adenocarcinomas [PDACs]), underwent further analyses. A median of 4 FNAs (range, 1-20 FNAs) were obtained from 4-mm perivascular soft-tissue cuffs (range, 2-20 mm). FNA and cytology analysis showed malignant cells in 163 vessels (69.4%) from 157 patients (70.4%). CT or MRI did not detect EVMM in 44 patients (28%) with malignancies, including 24 patients (24%) with newly diagnosed PDAC. Detection of EVMM by EUS-FNA resulted in upstaging of 15 patients and conversion of 14 patients with PDAC from resectable (based on CT or MRI) to unresectable. No adverse events were reported during a follow-up period of 3.9 months (range, 0-117 mo).
EUS-FNA and cytologic analysis of perivascular soft-tissue cuffs can detect EVMM that were not found in 28% of patients by CT or MRI. Detection of EVMM affects tumor staging and determination of tumor resectability.
肿瘤细胞可以通过微小的血管周围袖套沿血管迁移到远处形成血管外迁移性转移（EVMM）。这些转移通常是在手术或尸检中发现的。我们旨在评估内镜超声细针抽吸（EUS-FNA）对血管周围软组织袖套的可行性和安全性，以检测 EVMM。我们将 EUS 的发现与非侵入性横断面成像（参考标准）进行比较，这些患者接受了 EUS-FNA 以评估疑似 EVMM，并研究了其对胰腺肿瘤分期和可切除性判断的影响。
我们对 2001 年 4 月至 2018 年 5 月期间因疑似 EVMM 接受 EUS-FNA 评估的 267 条血管的 253 名（平均年龄 62±12 岁）患者进行了回顾性分析。将 EUS 结果与 CT 和 MRI 作为参考标准进行比较。根据 FNA 样本的细胞学分析、手术或活检标本的组织学分析，或 CT 或 MRI 检测到的明确提示 EVMM 的血管异常，将病变判定为恶性。
30 名患者被发现患有良性病变。其余 223 名患有恶性肿瘤（166 名患有胰腺导管腺癌 [PDAC]）的患者进行了进一步分析。从 4-mm 血管周围软组织袖套（范围 2-20mm）中获得中位数为 4 次 FNA（范围 1-20 次）。FNA 和细胞学分析显示 157 名患者的 163 个血管（69.4%）中有恶性细胞。CT 或 MRI 未在 44 名恶性肿瘤患者（包括 24 名新诊断的 PDAC 患者）中发现 EVMM，其中包括 24 名新诊断的 PDAC 患者。EUS-FNA 检测到 EVMM 导致 15 名患者的分期升高，14 名 PDAC 患者从可切除（基于 CT 或 MRI）变为不可切除。在 3.9 个月（0-117 个月）的随访期间未报告不良事件。
EUS-FNA 和血管周围软组织袖套的细胞学分析可检测到 CT 或 MRI 未发现的 28%患者的 EVMM。EVMM 的检测影响肿瘤分期和肿瘤可切除性的判断。
