Impact of EUS-guided FNA on management of gastric carcinoma Disclosure

BackgroundEUS is an integral part of the pretherapeutic evaluation program for patients with upper GI cancer.ObjectiveTo evaluate the impact of EUS-guided FNA on the clinical management of patients with gastric cancer.DesignThe study included patients with confirmed gastric carcinoma who were referred to the Department of Surgical Gastroenterology, Gentofte Hospital, Copenhagen University, Copenhagen, Denmark, during a 6-year period (2001-2007).SettingThe patients underwent standard pretherapeutic evaluation. If no signs of incurability were detected, the patients were offered EUS and EUS-guided FNA. EUS-guided FNA was performed when lymph nodes or lesions were considered to be distant metastases. A board of surgeons was asked to evaluate the management of the patients after the results obtained by EUS-guided FNA were revealed.PatientsThis study involved 234 patients with gastric carcinoma.InterventionEUS-guided FNA.Main Outcome MeasurementsNumber of patients with distant metastasis diagnosed by EUS-guided FNA, with the avoidance of unnecessary surgery.ResultsA total of 81 consecutive patients underwent EUS-guided FNA. Ninety-nine lesions were targeted, and 61 (62%) of these lesions were found to be malignant. In 38 of 81 patients (42%) distant metastases were confirmed by EUS-guided FNA. As judged by the board of surgeons, EUS-guided FNA changed the management plan in 34 of 234 patients (15%).LimitationThe positive EUS-guided FNA diagnoses were not surgically verified.ConclusionEUS-guided FNA is a very important modality and should be integrated as a routine procedure in the preoperative staging algorithm of gastric cancer.