EUS-guided FNA for the diagnosis of recurrent bladder cancer through the ileal conduit: a novel approach

BackgroundDiagnosing local recurrence of tumor after cystectomy and ileal conduit construction for urinary bladder cancer remains a diagnostic challenge. Also, distinction of benign stricture from recurrent tumor at the site of ureteral anastomosis in the ileal conduit is difficult.ObjectiveA new method is described for performing EUS-guided FNA through the ileal conduit in patients suspected of having local tumor recurrence after complete cystectomy for bladder cancer.DesignCase series, part of a large prospective study on EUS-guided FNA.PatientsThree patients who had undergone total cystectomy and ileal conduit construction for bladder cancer underwent EUS-guided FNA through the ileal conduit for evaluation of suspected tumor recurrence at the site of anastomosis of the distal ureter and the ileal conduit.Main Outcome MeasurementsThe feasibility, diagnostic accuracy, and safety profile of EUS-guided FNA is assessed.ObservationsEUS-guided FNA through the ileal conduit was technically feasible in all 3 patients. By EUS, the mass appeared as an irregularly shaped, hypoechoic lesion that was extrinsic to the lumen of the ileum. A diagnosis of recurrent transitional cell cancer was made in 2 patients and anastomotic stricture was found in 1 patient. Both patients with tumor recurrence received palliative chemotherapy, and the patient with an anastomotic stricture was managed by placement of a nephrostomy stent. No complications were encountered.LimitationsSmall number of enrolled subjects; short duration of follow-up.ConclusionsEUS-guided FNA through the ileal conduit is technically feasible, safe, and establishes diagnosis in patients suspected of tumor recurrence after complete cystectomy for bladder cancer.