Impact of Endoscopic Ultrasound in Unresectable Perihilar Cholangiocarcinoma patients in Liver Transplantation work-up

Aims For a highly selected group of patients with unresectable perihilar cholangiocarcinoma (pCCA) liver transplantation (LT) is a treatment option. The Dutch screening protocol comprises lymph node (LN) assessment by endoscopic ultrasound (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.

Methods 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 2010-2021. During EUS, sampling of a ‘suspicious’ LN was performed based on the endosonographist’s discretion. The primary outcome was the added value of EUS, defined as number of patients who were precluded from further screening due to malignant LN ([Table 1]).

Table 1

Results In 75 patients (characteristics in Table) a total of 84 EUS procedures were performed. In 18 patients (24%), 31 suspicious non-regional LN were identified with tissue acquisition in 28 (90%). In two patients LN biopsy confirmed malignancy and further screening was precluded. Finally, 44 (59%) underwent surgical staging and positive LN were identified in 6 patients (14%). In an additional 6 patients (21%) positive regional LN were identified in the liver explant.

Conclusions Our current EUS screening for the detection of malignant LN in patients with pCCA eligible for LT shows a limited but clinically important yield. EUS with systematic screening of all LN stations and sampling of ‘suspicious’ lymph nodes according to defined and set criteria (size, shape, homogeneity, etc) could potentially increase this yield.

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Artikel online veröffentlicht:
14. April 2023