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Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy

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Abstract

Background

Diagnosis of metastatic disease is important in patients with cirrhosis and hepatocellular carcinoma (HCC) to prevent futile liver transplantation. Some of these patients have metastatic lymphadenopathy; however, it is difficult to perform percutaneous fine-needle aspiration due to presence of collateral and anatomic location. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of lymph nodes offers several advantages like real-time vision, proximity to target, and avoidance of collaterals.

Aim

The aim of this study was to look for metastatic lymphadenopathy by EUS-guided FNA (EUS-FNA) in prospective liver transplant recipients with HCC.

Methods

A prospective study was conducted from January 2013 to January 2016 at a tertiary care center. All prospective liver transplant recipients with HCC had PET-CT and bone scan to look for metastatic disease. EUS-FNA was done in patients with abdominal or mediastinal lymphadenopathy and no evidence of extrahepatic disease. Data is shown as median (25–75 interquartile range).

Results

EUS-guided FNA was done for 50 patients (42 abdominal and 8 mediastinal lymph nodes), age 57 (53–62) years, Child-Turcotte-Pugh 7 (6–9), and model for end-stage liver disease 10 (7–16). FNA material was adequate in 92% patients, metastasis in 15 (30%), granulomatous lymphadenopathy in 4 (8%), and reactive change in 27 patients (54%). The material was inadequate for diagnosis in 4 (8%) patients. Thus, EUS-guided FNA precluded transplantation in 30% of patients with lymphadenopathy, and 4 (8%) patients received anti-tubercular therapy before liver transplantation.

Conclusion

In patients with HCC and lymphadenopathy, EUS-guided FNA detected metastatic disease and precluded liver transplantation in approximately one third of patients.

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Acknowledgements

The authors want to express their heartfelt gratitude to the following people: Mr. Yogesh Saini, Ms. Payal Arora (research coordinators), and Mr. Mansih K Singh (biostatistician at Medanta).

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Authors and Affiliations

  1. Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, 122 001, India

    Narendra S. Choudhary, Sanjiv Saigal, Prashant Bhangui, Neeraj Saraf & Arvinder S. Soin

  2. Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, 122 001, India

    Rajesh Puri, Vinit Shah, Mukesh Nasa, Mridula Guleria & Randhir Sud

  3. Department of Cytopathology, Medanta-The Medicity, Gurgaon, 122 001, India

    Haimanti Sarin

Authors
  1. Narendra S. Choudhary
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  2. Rajesh Puri
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  3. Sanjiv Saigal
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  4. Prashant Bhangui
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  5. Neeraj Saraf
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  6. Vinit Shah
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  7. Mukesh Nasa
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  8. Haimanti Sarin
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  9. Mridula Guleria
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  10. Randhir Sud
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  11. Arvinder S. Soin
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Corresponding author

Correspondence to Rajesh Puri.

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Conflict of interest

NSC, RP, SS, PB, NS, VS, MN, HS, MG, RS, and ASS declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning Informed Consent as shown on Springer.com.

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Choudhary, N.S., Puri, R., Saigal, S. et al. Impact of endoscopic ultrasound-guided fine-needle aspiration in prospective liver transplant recipients with hepatocellular carcinoma and lymphadenopathy. Indian J Gastroenterol 35, 465–468 (2016). https://doi.org/10.1007/s12664-016-0718-0

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  • DOI: https://doi.org/10.1007/s12664-016-0718-0

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