EUS-FNA for patients with lymphadenopathy suspected of having recurrent malignancy after radical treatment

Introduction: The diagnosis of lymphadenopathy after radical treatment of malignancy is sometimes difficult, especially in patients without local recurrence and without increasing serum levels of related tumor markers. Invasive surgical procedures are sometimes requested to confirm or deny the recurrence; otherwise, patients were followed by imaging tests and a very carefully monitored clinical course. Aims: To evaluate the yield of EUS-FNA in patients with mediastinal, intraabdominal, and pelvic lymphadenopathy after radical treatment of malignancy. Methods: Consecutive patients with mediastinal, intraabdominal, and pelvic lymphadenopathy after radical treatment of malignancy who were referred to our hospital between October 2003 and December 2005 were enrolled in this study. Inclusion criteria were as follows: 1) The lymph nodes (LNs) were located at sites that could be approached from the esophagus, stomach, duodenum, or rectum based on CT imaging, and 2) Local recurrence at the prior lesion was not observed on imaging tests. If patients had other lesions that were approached more easily, for example superficial LNs, these patients were excluded from this study and a sampling was performed at that site. Results: Thirty patients were included, and the locations of the LNs were mediastinum (9), intra-abdominal (19), and pelvic (2). Prior malignancy was gastric (5), lung (5), bile duct (3), uterus (2), breast (2), rectal (2), ovarial (1), colonic (1), renal (1), bladder (1), lingual (1), pancreatic cancer (1), liver cystadenocarcinoma (1), pancreatic endocrine tumor (1), Paget's disease (1), and lymphoma (2). The median period after the treatment was 23 months (range: 3–180 months). A related tumor marker was increased in only one patient (3%). From the pathological findings of the FNA sample, 14 paients were confirmed to have recurrence of a prior malignancy, 9 patients were shown to have no recurrence or other malignancies, and the remaining 6 patients were diagnosed as having different new malignancies as follows: lymphoma (4), LN metastasis from GIST of the small intestine (1), and bile duct cancer (1). One of the 9 patients shown not to have malignancy was diagnosed with recurrence by open laparotomy later. The remaining 8 patients have been observed every 3 months; the median duration of follow-up to date is 12 months (range: 6–22 months), and no increase in size or no other changes have been detected on CT. The sensitivity, specificity, and accuracy were 95%, 100%, and 97%, respectively. EUS-FNA contributed to the decisions about treatment in 29 cases (97%). No serious complications occurred related to the use of EUS-FNA. Conclusions: EUS-FNA in diagnosis of lymphadenopathy after the radical treatment of malignancy is safe, less invasive than surgical procedures, and convenient, and it has a high diagnostic value.