Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute University Medical Center, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands.
Gastrointest Endosc. 2024 Apr;99(4):548-556. doi: 10.1016/j.gie.2023.10.047. Epub 2023 Oct 27.
For a highly selected group of patients with unresectable perihilar cholangiocarcinoma (pCCA), liver transplantation (LT) is a treatment option. The Dutch screening protocol comprises nonregional lymph node (LN) assessment by EUS, and whenever LN metastases are identified, further LT screening is precluded. The aim of this study is to investigate the yield of EUS in patients with pCCA who are potentially eligible for LT.
In this retrospective, nationwide cohort study, all consecutive patients with suspected unresectable pCCA who underwent EUS in the screening protocol for LT were included from 2011 to 2021. During EUS, sampling of a "suspicious" nonregional LN was performed based on the endoscopist's discretion. The primary outcome was the added value of EUS, defined as the number of patients who were precluded from further screening because of malignant LNs.
A total of 75 patients were included in whom 84 EUS procedures were performed, with EUS-guided tissue acquisition confirming malignancy in LNs in 3 of 75 (4%) patients. In the 43 who underwent surgical staging according to the protocol, nonregional LNs with malignancy were identified in 6 (14%) patients. Positive regional LNs were found in 7 patients in post-LT-resected specimens.
Our current EUS screening for the detection of malignant LNs in patients with pCCA eligible for LT shows a limited but clinically important yield. EUS with systematic screening of all LN stations, both regional and nonregional, and the sampling of suspicious lymph nodes according to defined and set criteria could potentially increase this yield.
对于一组特定的无法切除的肝门部胆管癌（pCCA）患者，肝移植（LT）是一种治疗选择。荷兰的筛查方案包括超声内镜（EUS）检查非区域性淋巴结（LN），并且只要发现 LN 转移，就排除进一步的 LT 筛查。本研究的目的是评估 EUS 在可能适合 LT 的 pCCA 患者中的应用价值。
在这项回顾性的全国性队列研究中，纳入了 2011 年至 2021 年间所有接受 LT 筛查方案中 EUS 检查的疑似无法切除的 pCCA 连续患者。在 EUS 检查期间，根据内镜医生的判断对“可疑”非区域性 LN 进行取样。主要结局是 EUS 的附加价值，定义为因恶性 LN 而排除进一步筛查的患者数量。
共纳入 75 例患者，其中 84 例进行了 EUS 检查，3 例（4%）患者的 LN 经 EUS 引导组织采集证实为恶性。在根据方案进行手术分期的 43 例患者中，6 例（14%）患者的非区域性 LN 有恶性。在 LT 切除标本中发现 7 例患者有阳性区域 LN。
目前我们对适合 LT 的 pCCA 患者进行的 EUS 筛查显示出有限但具有临床意义的应用价值。EUS 检查时应系统地筛查所有 LN 站，包括区域性和非区域性 LN，并根据明确和既定的标准对可疑淋巴结进行取样，这可能会提高检测阳性率。
