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⁎4588 Endoscopic ultrasound as a first-line diagnostic and staging test after ct in patients with suspected or proven lung cancer: yield in 122 consecutive patients.
*4586 DUPLEX DOPPLER ENDOSONOGRAPHY: A NEW GOLD STANDARD FOR THE DIAGNOSIS OF PORTAL VEIN THROMBOSIS. Paul Castellani, Christophe Carrere, Emmanuel Debono, Thierry Constant, Marc Giovannini, Yves Patrice le Treut, Andre Gerolami, Andre Gauthier, Danielle Botta-Fridlund, La Conception, Marseille, France; Inst Paoli-Calmettes, Marseille, France. Objective: to determine the feasibility, the diagnostic value and the therapeutic impact of EUS in the diagnosis of portal vein thrombosis. Subjects and methods : 71 patients , mean age 52 years (24-84 years) with portal hypertension were studied retrospectively with EUS for suspicion of portal vein thrombosis (Duplex sonography or CT). EUS was compared to the sonography (US) results, then to angiography (ACM) and to surgery (considered as gold standards). Results : In 59 US, a diagnosis was made in 55,9% of cases. In 44,1%, the diagnostic was uncertain, particularly on spleno-mesenteric confluence. In 71 EUS, achieved without mortality nor morbidity, a diagnosis was made in 97,2% with diagnostic doubt in 2,8% of cases. 49 portal thrombosis were diagnosed by EUS ( 19/49 were partial thrombosis, never specified by the ACM). In 26 cases on 49, agreement between EUS and ACM was found. In 6 cases on 49, EUS corrected the diagnosis of ACM. 17 cases on 49 had no ACM, but a surgery (liver transplantation or derivation) was only decided on EUS. It existed 2 false positive diagnosis in EUS, these two patients have been transplanted. The diagnostic value of EUS is excellent (Fisher s exact test : p < 0.01), sensitivity 100%, specificity 81,8%, positive predictive value of 94,6%, negative predictive value of 100%. Conclusion : 1) EUS is a reliable way for the diagnosis of portal vein thrombosis, higher than ACM. 2) EUS is a noninvasive exam witch have the advantage of avoiding the use of contrast agents in cirrhotic patients. 3) EUS gives a direct vision of vessels, permitting a detailed analysis (thickness of walls of the vessels, partial or nonocclusive thrombosis, flow inside the portal vein, perigastric collaterals). 4) In our experience, EUS, influenced directly the treatment, permitting a liver transplantation when the confluence was free, guiding the derivation according to the position of the thrombus or indicating a TIPS in case of partial thrombosis complicated of ascites or refractory variceal bleeding.
*4587 EUS-GUIDED FINE NEEDLE ASPIRATION OF OCCULT PLEURAL AND ASCITIC FLUID SUSPECTED OF MALIGNANT ORIGIN. Marc F. Catalano, Shahid H. Sial, Walter J. Hogan, Rajeev Nayar, Joseph E. Geenen, St Luke’s Med Ctr, Milwaukee, WI; Med Coll of Wisconsin, Milwaukee, WI. EUS-guided FNA in the evaluation of malignancy has been established with regards to lesions of the pancreas(solid, cystic), suspicious lymph nodes, suspected leiomyosarcomas as well as non-GI lesions (renal, adrenal, lung, etc..). The growing role of EUS in the evaluation of abdominal pain and weight loss of unknown cause has uncovered occult malignancy in the form of discreet lesions (pancreatic, mediastinal, etc...) and ascitic/pleural fluid. AIM: To determine the diagnostic capability and safety of EUS-guided FNA of suspected occult malignant ascites and pleural effusion. METHOD: 119 patients (78-male, 41-female) over a 6-year-period underwent EUS evaluation of the upper GI tract for abdominal pain and weight loss of unknown origin. All pts had previous exhaustive clinical, laboratory, and radiographic (CT, chest x-ray, US) evaluation without a diagnosis. No evidence of ascites or pleural effusion was noted on CT scan. Presenting symptoms included abdominal pain=102, weight loss=92, chest pain=12, diarrhea=22. RESULTS: 15 patients had either discreet pancreatic lesions (N=7), mediastinal adenopathy (N=2), ascites (N=4), or pleural effusion (N=2). All pts underwent successful FNA. All pts undergoing FNA of the pancreatic lesions had diagnosis of adenocarcinoma. Both patients with mediastinal adenopathy had malignant disease diagnosed by EUS FNA (lymphoma=1, non-small-cell lung CA=1). Three of four patients with ascites had adenocarcinoma while both patients with pleural effusion had non-small-cell lung CA by cytopathology. CONCLUSION: EUS-guided FNA in patients with unexplained abdominal pain and weight loss can assist in establishing occult malignancy when previous standard imaging has been non-diagnostic. Unsuspected pancreatic masses and lymph nodes provide target lesions that may assist in establishing a diagnosis.
VOLUME 51, NO. 4, PART 2, 2000
Demonstrable ascites and pleural effusion should also undergo FNA because of possible malignant origins.
EUS FNA DX
Pt. (No.)
EUS
FNA
Comp. (No.)
DX Benign/Malignant
Panc Mass Med LN Ascites Pleural eff
7 2 4 2
0 0 1 2
7 2 3 0
0 0 0 0
*4588 ENDOSCOPIC ULTRASOUND AS A FIRST-LINE DIAGNOSTIC AND STAGING TEST AFTER CT IN PATIENTS WITH SUSPECTED OR PROVEN LUNG CANCER: YIELD IN 122 CONSECUTIVE PATIENTS. Anand V. Sahai, Neven Hadzijahic, Gerard Silvestri, Andrew N. Pearson, Brenda J. Hoffman, Michael B. Wallace, Carolyn E. Reed, Robert H. Hawes, Med Univ of South Carolina, Charleston, SC. Background: 50% of lung cancer patients have mediastinal lymph node metastases. Proof of ipsilateral node (N2) or contralateral node (N3) involvement contraindictates surgery as primary treatment, but usually requires mediastinoscopy. EUS-guided fine needle aspiration (FNA) provides access to posterior mediastinal nodes and may therefore prevent mediastinoscopy and document surgically incurable disease. Aim: To verify the yield of EUS as a first-line diagnostic and staging modality in patients with suspected or proven lung cancer by CT and/or bronchoscopy. Methods: EUS-FNA was used as a first-line diagnostic and/or staging test in consecutive patients with suspected or proven lung cancer in whom CT showed mediastinal disease accessable for EUS-FNA. Results: 122 consecutive patients had disease that appeared amenable to EUS-FNA: 70 with suspected and 52 with proven lung cancer. Overall, EUS was attempted in 118 (97%) cases: 10 masses and 108 nodes (47% level 7 [AP window]; 32% level 5 [subcarina]; 15% levels 5 & 7; and 6% other node levels). There were no complications. A cytological diagnosis of cancer was obtained in 46/70 (69%) of suspected cancers. The yield for nodal staging was calculated on an “intent to stage” basis. Mediastinal node involvement was documented cytologically in 73/112 (60%) cases where staging was the aim: 37/112 (33%) N2 and 36/112 (32%) N3 nodes. See Table. Conclusions: 1) EUS has a high yield in patients with suspected or proven lung cancer with mediastinal disease by CT. 2) A cytological diagnosis of cancer is obtained in 2/3 patients with suspected cancer. 3) Cytological proof of mediastinal ipsilateral or contralateral disease is obtained in 2/3 patients.
Yield of EUS-FNA for suspected and proven lung cancer Suspected Lung Cancer n=70 FNA performed FNA positive N2 nodes positive N3 noded positive
96% 66% 33% 30%
(67) (46) (23) (23)
Proven Lung Cancer n=52 98% 56% 27% 29%
(51) (29) (14) (15)
GASTROINTESTINAL ENDOSCOPY
AB175
*4587 EUS-GUIDED FINE NEEDLE ASPIRATION OF OCCULT PLEURAL AND ASCITIC FLUID SUSPECTED OF MALIGNANT ORIGIN. Marc F. Catalano, Shahid H. Sial, Walter J. Hogan, Rajeev Nayar, Joseph E. Geenen, St Luke’s Med Ctr, Milwaukee, WI; Med Coll of Wisconsin, Milwaukee, WI. EUS-guided FNA in the evaluation of malignancy has been established with regards to lesions of the pancreas(solid, cystic), suspicious lymph nodes, suspected leiomyosarcomas as well as non-GI lesions (renal, adrenal, lung, etc..). The growing role of EUS in the evaluation of abdominal pain and weight loss of unknown cause has uncovered occult malignancy in the form of discreet lesions (pancreatic, mediastinal, etc...) and ascitic/pleural fluid. AIM: To determine the diagnostic capability and safety of EUS-guided FNA of suspected occult malignant ascites and pleural effusion. METHOD: 119 patients (78-male, 41-female) over a 6-year-period underwent EUS evaluation of the upper GI tract for abdominal pain and weight loss of unknown origin. All pts had previous exhaustive clinical, laboratory, and radiographic (CT, chest x-ray, US) evaluation without a diagnosis. No evidence of ascites or pleural effusion was noted on CT scan. Presenting symptoms included abdominal pain=102, weight loss=92, chest pain=12, diarrhea=22. RESULTS: 15 patients had either discreet pancreatic lesions (N=7), mediastinal adenopathy (N=2), ascites (N=4), or pleural effusion (N=2). All pts underwent successful FNA. All pts undergoing FNA of the pancreatic lesions had diagnosis of adenocarcinoma. Both patients with mediastinal adenopathy had malignant disease diagnosed by EUS FNA (lymphoma=1, non-small-cell lung CA=1). Three of four patients with ascites had adenocarcinoma while both patients with pleural effusion had non-small-cell lung CA by cytopathology. CONCLUSION: EUS-guided FNA in patients with unexplained abdominal pain and weight loss can assist in establishing occult malignancy when previous standard imaging has been non-diagnostic. Unsuspected pancreatic masses and lymph nodes provide target lesions that may assist in establishing a diagnosis.
VOLUME 51, NO. 4, PART 2, 2000
Demonstrable ascites and pleural effusion should also undergo FNA because of possible malignant origins.
EUS FNA DX
Pt. (No.)
EUS
FNA
Comp. (No.)
DX Benign/Malignant
Panc Mass Med LN Ascites Pleural eff
7 2 4 2
0 0 1 2
7 2 3 0
0 0 0 0
*4588 ENDOSCOPIC ULTRASOUND AS A FIRST-LINE DIAGNOSTIC AND STAGING TEST AFTER CT IN PATIENTS WITH SUSPECTED OR PROVEN LUNG CANCER: YIELD IN 122 CONSECUTIVE PATIENTS. Anand V. Sahai, Neven Hadzijahic, Gerard Silvestri, Andrew N. Pearson, Brenda J. Hoffman, Michael B. Wallace, Carolyn E. Reed, Robert H. Hawes, Med Univ of South Carolina, Charleston, SC. Background: 50% of lung cancer patients have mediastinal lymph node metastases. Proof of ipsilateral node (N2) or contralateral node (N3) involvement contraindictates surgery as primary treatment, but usually requires mediastinoscopy. EUS-guided fine needle aspiration (FNA) provides access to posterior mediastinal nodes and may therefore prevent mediastinoscopy and document surgically incurable disease. Aim: To verify the yield of EUS as a first-line diagnostic and staging modality in patients with suspected or proven lung cancer by CT and/or bronchoscopy. Methods: EUS-FNA was used as a first-line diagnostic and/or staging test in consecutive patients with suspected or proven lung cancer in whom CT showed mediastinal disease accessable for EUS-FNA. Results: 122 consecutive patients had disease that appeared amenable to EUS-FNA: 70 with suspected and 52 with proven lung cancer. Overall, EUS was attempted in 118 (97%) cases: 10 masses and 108 nodes (47% level 7 [AP window]; 32% level 5 [subcarina]; 15% levels 5 & 7; and 6% other node levels). There were no complications. A cytological diagnosis of cancer was obtained in 46/70 (69%) of suspected cancers. The yield for nodal staging was calculated on an “intent to stage” basis. Mediastinal node involvement was documented cytologically in 73/112 (60%) cases where staging was the aim: 37/112 (33%) N2 and 36/112 (32%) N3 nodes. See Table. Conclusions: 1) EUS has a high yield in patients with suspected or proven lung cancer with mediastinal disease by CT. 2) A cytological diagnosis of cancer is obtained in 2/3 patients with suspected cancer. 3) Cytological proof of mediastinal ipsilateral or contralateral disease is obtained in 2/3 patients.
Yield of EUS-FNA for suspected and proven lung cancer Suspected Lung Cancer n=70 FNA performed FNA positive N2 nodes positive N3 noded positive
96% 66% 33% 30%
(67) (46) (23) (23)
Proven Lung Cancer n=52 98% 56% 27% 29%
(51) (29) (14) (15)
GASTROINTESTINAL ENDOSCOPY
AB175