Endoscopic-Ultrasound-Guided Tissue Sampling Facilitates the Detection of Local Recurrence and Extra Pelvic Metastasis in Pelvic Urologic Malignancy

Abstract

Pelvic lymph node dissection is the gold standard for assessing nodal disease in prostate or bladder cancer and is superior to CT, MRI and PET staging. Endoscopic ultrasound (EUS) provides an alternative, less invasive method of cytohistologic material acquisition, but its performance in pelvic urologic malignancy is unknown. Therefore, our aim was to evaluate the diagnostic accuracy of EUS guided tissue sampling for these malignancies when compared to a composite cytohistologic and surgical gold standard. A median of 3 FNA passes were performed (n = 19 patients) revealing a sensitivity, specificity, PPV and NPV of 94.4% (72–99), 100% (2–100), 100% (80–100) and 50% (1–98) respectively. The perirectal space was the most frequently sampled location irrespective of the primary urological cancer origin. Final diagnosis established by EUS tissue sampling included bladder cancer (n = 1), bladder cancer local recurrence (n = 8), bladder cancer extra pelvic metastases (n = 1), prostate cancer (n = 2), prostate cancer local recurrence (n = 4), prostate cancer extra pelvic metastases (n = 1), testicular cancer extra pelvic metastases (n = 1) and a benign seminal vesicle (n = 1). EUS guided sampling of the gut wall, lymph nodes, or perirectal space yields suitable diagnostic material to establish the presence of primary, local recurrence or extra pelvic metastases of pelvic urologic malignancy.

Usefulness of endoscopic ultrasound‑guided fine needle aspiration for lymphadenopathy

“…EUS-FNA is used for mediastinal lymphadenopathy, with a sensitivity of 82–93% and a specificity of 89–100% ( 12 – 14 ). In addition, EUS-FNA is used with a lower gastrointestinal tract approach for pelvic lymphadenopathy ( 15 ). This procedure has been reported to be useful for urological cancer types, including prostate and bladder cancer, with a sensitivity of 94.4% ( 15 ).…”

“…In addition, EUS-FNA is used with a lower gastrointestinal tract approach for pelvic lymphadenopathy ( 15 ). This procedure has been reported to be useful for urological cancer types, including prostate and bladder cancer, with a sensitivity of 94.4% ( 15 ). EUS-FNA was also useful for diagnosing malignant lymphoma.…”

“…In addition, thinner needles may be easier to use due to increased flexibility, particularly for locations that require the scope to bend ( 17 ). Therefore, the majority of studies on EUS-FNA have been performed using 22-gauge needles ( 11 , 12 , 15 ). As aforementioned, a 25-gauge needle is suitable for lesions that require puncturing in a tight angulated scope position and lesions that contain small blood vessels.…”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)

“…EUS and EUS-guided sampling may play a pivotal role in the detection and diagnosis of disease recurrence or late distant spread of gastrointestinal cancer [391]. A high accuracy with clinical impact of EUS-guided sampling has been shown in establishing recurrent malignancy following curative treatment [55, 175 -178, 215, 359, 365, 427, 468], and metastatic disease, in particular affecting the pancreas [147,206,212,213,215], spleen [469,470], pelvis [59,61,471], and peritoneal space [466, 472 -483].…”

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“…EUS and EUS-guided sampling may play a pivotal role in the detection and diagnosis of disease recurrence or late distant spread of gastrointestinal cancer [391]. A high accuracy with clinical impact of EUS-guided sampling has been shown in establishing recurrent malignancy following curative treatment [55, 175 -178, 215, 359, 365, 427, 468], and metastatic disease, in particular affecting the pancreas [147,206,212,213,215], spleen [469,470], pelvis [59,61,471], and peritoneal space [466, 472 -483].…”