Endoscopic Ultrasound with Tissue Acquisition of Lymph Nodes in Patients with Resectable Intrahepatic Cholangiocarcinoma

Aims For patients with intrahepatic cholangiocarcinoma (iCCA), median survival after resection is 60 months. However, when regional lymph node (LN) metastases are found, survival drops to 20 months. Our aim was therefore to evaluate the yield of EUS with tissue acquisition (TA) of LN in resectable iCCA patients and determine the impact on clinical decision making.

Methods In this retrospective, multicentre cohort study, patients with potentially resectable iCCA who underwent preoperative EUS for various indications from 2010-2020 were included. The impact of EUS-TA was defined as the percentage of patients who did not undergo surgical exploration due to positive LN found with EUS-TA. Extraregional LN (e.g., aortocaval and celiac trunc) were distinguished from regional LN. EUS was not performed in a standardized manner and TA was performed at the discretion of the endosonographist.

Results A total of 56 patients were included. At EUS a total of 71 LN (29 regional; 42 extraregional) across 46 patients (82%) were described. In 55 LN EUS-TA was indicated and successful, with malignancy confirmed in 21 LN across 19 patients (35%). Fifteen (27%) out of those 19 patients had positive extraregional LN and 4 (9%) had positive regional LN. Surgical exploration was precluded due to positive LN in 17 patients (30%). In the 24 patients (43%) that finally underwent surgical exploration, positive LN that were missed by EUS, were identified in five patients (21%), of which 2 had extraregional LN ([Table 1]).

Fig. 1

Conclusions Preoperative EUS in the setting of resectable iCCA potentially has clinical implications precluding surgical exploration in case of positive LN. A systematic approach by EUS including nodal mapping of all relevant stations with TA could potentially increase this yield.

 

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Conflicts of interest

The other authors have no conflicts of interest to declare.M.J. Bruno received research funding for industry initiated studies from Boston Scientific and Cook Medical. He received research funding for investigator initiated studies from Boston Scientific, Cook Medical, Pentax Medical, Interscope, Mylan and ChiRoStim. He is a consultant to Boston Scientific, Cook Medical, and Pentax Medical. R.P. Voermans received research funding for investigator initiated studies from Boston Scientific and Prion Medical. He is a consultant with speakers fee for Boston Scientific.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023