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CC BY 4.0 · Endosc Int Open 2024; 12(08): E998-E1005
DOI: 10.1055/a-2366-2592
Original article

Endoscopic ultrasound with tissue acquisition of lymph nodes in patients with potentially resectable intrahepatic cholangiocarcinoma

David M. de Jong  ∗
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Sanne van de Vondervoort
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Roy S. Dwarkasing 
2   Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Maarten G.J. Thomeer 
2   Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Michael Doukas
3   Department of Pathology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Rogier P. Voermans 
4   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands
5   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
6   Cancer Treatment and Quality of Life, Cancer Centre Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN571143)
,
Robert C. Verdonk 
7   Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, Netherlands (Ringgold ID: RIN6028)
,
Wojciech G. Polak 
8   Transplantation Institute, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Jeroen de Jonge 
8   Transplantation Institute, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Marco J. Bruno 
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Lydi M.J.W. Van Driel  ‡
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Bas Groot Koerkamp  ‡
9   Cancer Institute, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Abstract

Background and study aims Lymph node (LN) involvement is a poor prognostic factor for patients with intrahepatic cholangiocarcinoma (iCCA). The aim of this study was to evaluate the yield and impact on clinical decision making of endoscopic ultrasound with tissue acquisition (EUS-TA) of LNs in patients with potentially resectable iCCA.

Patients and methods In this multicenter cohort study, patients with potentially resectable iCCA and preoperative EUS between 2010 and 2020 were retrospectively included. The impact of EUS-TA was defined as the percentage of patients who did not undergo surgical exploration due to pathologically confirmed positive LNs found with EUS-TA.

Results A total of 56 patients underwent EUS, with 91% of patients to target suspicious LNs on imaging. EUS-TA of LNs confirmed malignancy in 21 LNs among 19 patients (34%). In 17 patients (30%), surgical exploration was withheld due to nodal involvement. Finally, 24 patients (43%) underwent surgical exploration among whom positive regional LNs were identified in six patients (25%).

Conclusions In patients with potentially resectable iCCA and suspicious LNs on cross-sectional imaging, EUS-TA confirmed LN involvement in 30% of patients. Surgical exploration was withheld mostly because of extraregional LN involvement and regional LN involvement in patients with high surgical risk.

Keywords

Endoscopic ultrasonography - Biliary tract - Tissue diagnosis - Fine-needle aspiration/biopsy - GI surgery

Supplementary Material



Publication History

Received: 16 April 2024

Accepted after revision: 10 July 2024

Accepted Manuscript online:
15 July 2024

Article published online:
23 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zhang X-F, Xue F, Dong D-H. et al. Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis. Ann Surg 2021; 274: e1187-e1195
    CrossrefPubMedSearch in Google Scholar
  • 2 Tan JC, Coburn NG, Baxter NN. et al. Surgical management of intrahepatic cholangiocarcinoma--a population-based study. Ann Surg Oncol 2008; 15: 600-608
    CrossrefPubMedSearch in Google Scholar
  • 3 Jolissaint JS, Soares KC, Seier KP. et al. Intrahepatic cholangiocarcinoma with lymph node metastasis: treatment-related outcomes and the role of tumor genomics in patient selection. Clin Cancer Res 2021; 27: 4101-4108
    CrossrefPubMedSearch in Google Scholar
  • 4 Amin M. AJCC Cancer Staging Manual. Springer; 2017
    Search in Google Scholar
  • 5 Rahnemai-Azar AA, Weisbrod AB, Dillhoff M. et al. Intrahepatic cholangiocarcinoma: current management and emerging therapies. Expert Rev Gastroenterol Hepatol 2017; 11: 439-449
    CrossrefPubMedSearch in Google Scholar
  • 6 Sposito C, Ratti F, Cucchetti A. et al. Survival benefit of adequate lymphadenectomy in patients undergoing liver resection for clinically node-negative intrahepatic cholangiocarcinoma. J Hepatol 2023; 78: 356-363
    CrossrefPubMedSearch in Google Scholar
  • 7 Chen X, Rong D, Zhang L. et al. Evaluation of nodal status in intrahepatic cholangiocarcinoma: a population-based study. Ann Transl Med 2021; 9: 1359
    CrossrefPubMedSearch in Google Scholar
  • 8 van Keulen A-M, Büttner S, Erdmann JI. et al. Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis. Surgery 2023; 173: 973-982
    CrossrefPubMedSearch in Google Scholar
  • 9 Bartolini I, Risaliti M, Fortuna L. et al. Current management of intrahepatic cholangiocarcinoma: from resecton to palliative treatments. Radiol Oncol 2020; 54: 263-271
    CrossrefPubMedSearch in Google Scholar
  • 10 Gleeson FC, Rajan E, Levy MJ. et al. EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc 2008; 67: 438-443
    CrossrefPubMedSearch in Google Scholar
  • 11 Malikowski T, Levy MJ, Gleeson FC. et al. Endoscopic ultrasound/fine needle aspiration is effective for lymph node staging in patients with cholangiocarcinoma. Hepatology 2020; 72: 940-948
    CrossrefPubMedSearch in Google Scholar
  • 12 Eloubeidi MA, Wallace MB, Reed CE. et al. The utility of EUS and EUS-guided fine needle aspiration in detecting celiac lymph node metastasis in patients with esophageal cancer: a single-center experience. Gastrointest Endosc 2001; 54: 714-719
    CrossrefPubMedSearch in Google Scholar
  • 13 de Jong DM, van de Vondervoort S, Dwarkasing RS. et al. Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making. Endosc Int Open 2023; 11: E162-E168
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 de Jong DM, den Hoed CM, Willemssen FEJA. et al. Impact of EUS in liver transplantation workup for patients with unresectable perihilar cholangiocarcinoma. Gastrointest Endosc 2024; 99: 548-556
    CrossrefPubMedSearch in Google Scholar
  • 15 Alvaro D, Gores GJ, Walicki J. et al. EASL-ILCA clinical practice guidelines on the management of intrahepatic cholangiocarcinoma. J Hepatol 2023; 79: 181-208
    CrossrefPubMedSearch in Google Scholar
  • 16 Edge SB. AJCC Cancer Staging Manual. Springer; 2010
    Search in Google Scholar
  • 17 Lamarca A, Ross P, Wasan HS. et al. Advanced intrahepatic cholangiocarcinoma: post hoc analysis of the ABC-01, -02, and -03 clinical trials. J Natl Cancer Inst 2020; 112: 200-210
    CrossrefPubMedSearch in Google Scholar
  • 18 Franken LC, Coelen RJS, Roos E. et al. staging laparoscopy in patients with intrahepatic cholangiocarcinoma: Is it still useful?. Visceral Med 2020; 36: 501-505
    CrossrefPubMedSearch in Google Scholar