Remote malignant intravascular thrombi: EUS-guided FNA diagnosis and impact on cancer staging
| Autor: | Bret T. Petersen, Michael J. Levy, Santhi Swaroop Vege, Mark Topazian, Mark J. Truty, Michael B. Farnell, Suresh T. Chari, Ferga C. Gleeson, Prasad G. Iyer, Elizabeth Rajan, Barham K. Abu Dayyeh, Michael L. Kendrick, Tarun Rustagi, Randall K. Pearson, Kenneth K. Wang |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adenocarcinoma Endosonography 03 medical and health sciences 0302 clinical medicine Cytology Biopsy Humans Medicine Radiology Nuclear Medicine and imaging Thrombus Endoscopic Ultrasound-Guided Fine Needle Aspiration Aged Neoplasm Staging Retrospective Studies Cancer staging Aged 80 and over medicine.diagnostic_test business.industry Gastroenterology Retrospective cohort study Magnetic resonance imaging Middle Aged Neoplastic Cells Circulating medicine.disease Magnetic Resonance Imaging Primary tumor Vascular Neoplasms Pancreatic Neoplasms 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Radiology Tomography X-Ray Computed business |
| Zdroj: | Gastrointestinal Endoscopy. 86:150-155 |
| ISSN: | 0016-5107 |
| DOI: | 10.1016/j.gie.2016.10.025 |
| Popis: | Background and Aims Malignant vascular invasion usually results from gross direct infiltration from a primary tumor and impacts cancer staging, prognosis, and therapy. However, patients may also develop a remote malignant thrombi (RMT), defined as a malignant intravascular thrombus located remote and noncontiguous to the primary tumor. Our aim was to compare EUS, CT, and magnetic resonance imaging (MRI) findings of RMT and to explore the potential impact on cancer staging. Methods Patients with RMT were identified from a prospectively maintained EUS database. Retrospective chart review was performed to obtain EUS, CT/MRI, clinical, and outcome data. Results A median of 3 FNAs (range, 1-8) was obtained from RMT in 17 patients (60 ± 14.1 years, 56% men) between April 2003 and August 2016, with the finding of malignant cytology in 12 patients (70.6%; 10 positive, 2 suspicious). CT/MRI detected the RMT in 5 patients (29.4%), 4 of whom had positive or suspicious EUS-FNA cytology. Among the 8 newly diagnosed pancreatic adenocarcinoma (PaC) patients, CT did not detect the RMT in 5 (63%), of whom 3 patients had positive or suspicious intravascular EUS-FNA cytology. For newly diagnosed PaC patients (n = 8), the EUS-FNA diagnosis of a biopsy specimen–proven RMT upstaged 3 patients (37.5%) and converted 2 patients (25%) from CT resectable to unresectable disease. No adverse events were reported. The mean follow-up was 18.9 ± 27.7 months. Conclusions Our study demonstrates the ability and potential safety of intravascular FNA to detect radiographically occult RMT, which substantially impacts cancer staging and resectability. |
| Databáze: | OpenAIRE |
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