EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: a case

Background: Improved methods of tissue diagnosis for obstruction at the hil um of the liver (porta hepatis) have contributed substantially to the preop erative diagnosis of cholangiocarcinoma. Endoscopic brushing during endosco pic retrograde cholangiopancreatography (ERCP), with sensitivity of 20% to 100%, is the preferred technique for obtaining accurate pathologic results. Extensive hepatic resection with curative intent as well as modern approac hes to palliative treatment are based on definitive diagnosis. This is a st udy involving endosonography-guided, fine-needle aspiration (EUS-FNA) for c ytodiagnosis of potentially operable hilar cholangiocarcinoma when brush cy tology was negative or unavailable. Methods: Ten consecutive patients (7 men, 3 women; age 47 to 78 years, medi an 59 years) with bite duct strictures at the hepatic hilum, diagnosed by C T and/or ERCP, underwent EUS-FNA using linear echoendoscopes and 22-gauge n eedles. Results: Adequate material was obtained in nine patients. Cytology revealed cholangiocarcinoma in seven and hepatocellular carcinoma in one. One benig n inflammatory lesion identified on cytology proved to be a false-negative finding by frozen section. Metastatic locoregional hilar lymph nodes were d etected in two patients, and in one patient the celiac and para-aortic lymp h nodes were aspirated to obtain tissue proof of distant metastasis. There were no complications. Conclusions: When standard: methods of tissue diagnosis are inconclusive, E US-guided FNA may have a potential role in the diagnosis of primary cholang iocarcinoma of the hepatic hilum. As a new, minimally invasive approach, it proved to be technically feasible without significant risks.