Endoscopic ultrasound-guided tissue acquisition for focal liver lesions in patients with a history of multiple primary malignant neoplasms

Abstract

Objective: This study aimed to investigate the usefulness of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing focal liver lesions in patients with a history of multiple primary malignant neoplasms.

Methods: Among patients who underwent EUS-TA for focal liver lesions between 2016 and 2022, those with a history of multiple malignant neoplasms were included. A histologically confirmed malignant tumor within the past 5 years before EUS-TA was defined as a history of malignant neoplasm. The primary outcomes were diagnostic ability and adverse events of EUS-TA.

Results: This study included 16 patients (median age, 73 [33-90] years), the median tumor size was 32 (6-51) mm, 14 had a history of double malignant neoplasms, whereas two had triple malignant neoplasms. Malignant neoplasms were detected histologically or cytologically in all cases. Immunohistochemistry was performed in 75% (12/16), and the final diagnosis of EUS-TA was metastatic liver tumor in 12 patients, and primary malignant liver tumor in four patients. The primary site could be identified in 11 of 12 metastatic tumor cases. The diagnostic yield of EUS-TA was 100% (16/16) for differentiating benign and malignant tumors and 94% (15/16) for confirming the histological type including the primary site of metastatic lesions. No adverse events were associated with the procedure.

Conclusion: EUS-TA is a useful diagnostic modality for focal liver lesions in patients with a history of multiple malignant neoplasms, allowing for the differential diagnosis of primary and metastatic tumors and identification of the primary site of metastatic lesions.

Keywords: endoscopic ultrasound; focal liver lesion; hepatocellular carcinoma; metastatic liver tumor; tissue acquisition.

FIGURE 1

(a) A 77‐year‐old male with concurrent gastric cancer (poorly differentiated adenocarcinoma) and sigmoid colon cancer (well‐differentiated adenocarcinoma). Abdominal computed tomography showed multiple liver tumors in the left lobe, and metastasis from gastric or colorectal cancer was suspected. If the metastasis originated from gastric cancer, hepatic resection was contraindicated. If the metastasis originated from colorectal cancer, aggressive liver resection was recommended. (b) Endoscopic ultrasound‐guided tissue acquisition was performed transgastrically using a 22 G puncture needle. (c) Adenocarcinoma was histologically detected. (d) Immunohistochemistry showed positive for CDX‐2, making the diagnosis of metastasis from colorectal cancer possible. A left hepatectomy was performed. Pathologically, all liver lesions were metastases from colorectal cancer.

FIGURE 2

(a) An 81‐year‐old male with a history of triple malignant neoplasms (extrahepatic bile duct cancer, colorectal cancer, and lung cancer; all were pathologically diagnosed as adenocarcinoma). During follow‐up, contrast‐enhanced magnetic resonance imaging revealed a 15 mm tumor in the lateral area of the liver (arrow). (b) Endoscopic ultrasound‐guided tissue acquisition was performed transgastrically with a 22 G puncture needle. (c) Histologically, adenocarcinoma was observed. (d) Immunohistochemistry showed TTF‐1 positivity, and the patient was then diagnosed with lung cancer metastasis. Thus, chemotherapy for lung cancer was administered.