Endoscopic Ultrasound-Guided Tissue Sampling for the Cytohistological Diagnosis of Focal Liver Lesions

Abstract

Background: Focal liver lesions (FLL) often require cytohistological evaluation. Endoscopic Ultrasound (EUS)-guided tissue acquisition (EUS-TA) is highly accurate in diagnosing pancreatic and gastrointestinal malignancies. The aim of our study was to evaluate the role of EUS-TA in the characterization of FLL.

Methods: A retrospective analysis of a prospective database of patients who underwent EUS-TA for the evaluation of FLL. Diagnostic yield, adverse events and factors associated with diagnostic yield were evaluated as endpoints. The effect of variables such as needle size, lesion size, rapid on-site evaluation (ROSE) and the use of cytological or histological needles were analyzed.

Results: A total of 114 cases were included (mean age 68.05 ± 11.35 years, 64 male). A correct diagnosis was made using EUS-TA in 100 of the 114 cases (diagnostic yield of 88%). The EUS-TA of additional extrahepatic lesions during the same EUS procedure increased the diagnostic yield to 94%. No adverse events were reported. Multivariate analysis did not identify any factor influencing the diagnostic yield.

Conclusions: EUS-TA is a highly accurate and safe technique for the differential diagnosis of FLL and could be considered as the primary approach in this setting.

Keywords: diagnostic yield; endoscopic ultrasound; focal liver lesions.

Figure 1

EUS-guided tissue sampling from a solid liver lesion, which corresponds to a liver metastasis from colorectal cancer.

Figure 2

The tissue fragments show large cells with anisonucleosis, hyperchromasia, irregular nuclear membranes, and nuclear overlap, indicating high-grade ductal adenocarcinoma (Papanicolau 40×).

Figure 3

Ductal adenocarcinoma. Tissue fragments of neoplastic glandular cells showing irregular nuclei and mucinous cytoplasm with desmoplastic stroma (HE 20×).