The Role of EUS and EUS-FNA in Detection of Small Sized Liver Metastatic Lesions in Patients with Pancreatic and Gastro-Intestinal Primary Malignancy

HUSSEIN HASSAN OKASHA, M.D., HANAN ABDEL HAFEZ, M.D.;; MOHAMED HASSANY, M.D., AHMED MOHAMED HASHEM, M.Sc.;; EL-NAHAAS, M.D., SAEED M.

doi:10.21608/mjcu.2020.110872

The Role of EUS and EUS-FNA in Detection of Small Sized Liver Metastatic Lesions in Patients with Pancreatic and Gastro-Intestinal Primary Malignancy

Document Type : Original Article

Authors

Endemic Medicine Department and Hepatology Unit*, Internal Medicine Department**, Faculty of Medicine, Cairo University and National Hepatology & Tropical Medicine Research Institute***, Cairo, Egypt

10.21608/mjcu.2020.110872

Abstract

Abstract Background: Liver is common site of metastasis. Small liver masses (<2cm) are not easily detected by ultrasound or computed tomography. Endosonography allows visualization of liver anatomy. Aim of Study: To assess usefulness of endosonography and EUS-FNA in detecting small sized liver metastasis; not diagnosed by CT scan during TMN staging of gastro-intestinal and pancreatic malignancy. Patients and Methods: This prospective comparative study included 92 cases with pancreatic, peri-ampullary and GI malignancies. Patients undergone: CBC, serum bilirubin, AST, ALT, ALP, GGT, serum protocol albumin, prothrombin concentration, creatinine, AFP and CA19.9, abdominal ultrasound, pancreatic computed tomography scan and endosonography. EUS-FNA and cyto-logical examination were performed in 23 patients. Results: CT scan detected 27 patients with liver focal lesions, one patient was missed. While EUS detected 27 cases, and also one patient was missed. Among cases diagnosed by EUS, 4 cases were cholangitic abcesses, EUS-FNA was performed in 23 cases, revealing metastatic lesions in 21 patients, benign lesions in 2 patients (focal fat depletion). EUS had 95.45% sensitivity, 97.14% specificity, 91.3% positive predictive value (PPV), 98.55% negative predictive value (NPV) and 96.74% accuracy. CT had 95.45% sensitivity, 91.43% specificity, 77.78% PPV, 98.46% NPV and 92.39% accuracy. EUS-FNA, had 95.45% sensitivity, 100% specificity, 100% PPV, 98.5% NPV and 98.91% accuracy. Conclusions: EUS and EUS-FNA play a significant role in detecting small sized liver metastasis, where EUS and EUS-FNA showed a higher diagnostic accuracy compared to that of CT scan.

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