de Jong David M, van de Vondervoort Sanne, Dwarkasing Roy S, Thomeer Maarten G J, Doukas Michael, Voermans Rogier P, Verdonk Robert C, Polak Wojciech G, de Jonge Jeroen, Bruno Marco J, Van Driel Lydi M J W, Groot Koerkamp Bas
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Endosc Int Open. 2024 Aug 23;12(8):E998-E1005. doi: 10.1055/a-2366-2592. eCollection 2024 Aug.
Lymph node (LN) involvement is a poor prognostic factor for patients with intrahepatic cholangiocarcinoma (iCCA). The aim of this study was to evaluate the yield and impact on clinical decision making of endoscopic ultrasound with tissue acquisition (EUS-TA) of LNs in patients with potentially resectable iCCA. In this multicenter cohort study, patients with potentially resectable iCCA and preoperative EUS between 2010 and 2020 were retrospectively included. The impact of EUS-TA was defined as the percentage of patients who did not undergo surgical exploration due to pathologically confirmed positive LNs found with EUS-TA. A total of 56 patients underwent EUS, with 91% of patients to target suspicious LNs on imaging. EUS-TA of LNs confirmed malignancy in 21 LNs among 19 patients (34%). In 17 patients (30%), surgical exploration was withheld due to nodal involvement. Finally, 24 patients (43%) underwent surgical exploration among whom positive regional LNs were identified in six patients (25%). In patients with potentially resectable iCCA and suspicious LNs on cross-sectional imaging, EUS-TA confirmed LN involvement in 30% of patients. Surgical exploration was withheld mostly because of extraregional LN involvement and regional LN involvement in patients with high surgical risk.
淋巴结（LN）受累是肝内胆管癌（iCCA）患者预后不良的因素。本研究的目的是评估内镜超声引导下组织获取（EUS-TA）对潜在可切除iCCA患者的淋巴结取材率及其对临床决策的影响。在这项多中心队列研究中，回顾性纳入了2010年至2020年间有潜在可切除iCCA且术前行EUS检查的患者。EUS-TA的影响定义为因EUS-TA发现病理证实的阳性淋巴结而未进行手术探查的患者百分比。共有56例患者接受了EUS检查，91%的患者以影像学上可疑的淋巴结为目标。19例患者的91枚淋巴结行EUS-TA，其中21枚（34%）确诊为恶性。17例患者（30%）因淋巴结受累未进行手术探查。最后，24例患者（43%）接受了手术探查，其中6例患者（25%）发现区域淋巴结阳性。对于潜在可切除的iCCA且横断面成像有可疑淋巴结的患者，EUS-TA证实30%的患者存在淋巴结受累。大多因区域外淋巴结受累以及手术风险高的患者存在区域淋巴结受累而未进行手术探查。
