Endoscopic ultrasound-guided fine-needle marking of lymph nodes

Background and study aims: No previous studies have evaluated the ability of endoscopic ultrasonography to describe the anatomic location of lymph nodes on the basis of a node-to-node comparison. The aim of this study was to assess the feasibility and safety of a new endoscopic ultrasound (EUS)-guided fine-needle technique for marking lymph nodes.

Patients and methods: Twenty-five patients with suspected or confirmed malignancies of the upper gastrointestinal tract were prospectively included. EUS-guided fine-needle marking (EUS-FNM) was performed with a silver pin with a diameter that allowed it to fit into a 19-gauge needle. The position of the pin was verified by EUS. End points were the ability to identify and isolate the marked lymph node during surgery and a comparison between the location of the pin as suggested by EUS and the actual location found in the resected specimen.

Results: Twenty-three lymph nodes were marked. Nineteen intended surgical isolations were performed. The lymph nodes were isolated in the resection specimens in 18 patients (95 %). In 2 out of 20 cases the pin was not localized by laparoscopic ultrasonography. In 89 % of the cases the marked lymph node was in the same location as described by EUS. One pin (5 %) was not retrieved. In three cases, a small hematoma was observed. There was no sign of long-term complications.

Conclusion: EUS-FNM with a silver pin in lymph nodes is feasible and safe. EUS-FNM seems to be a suitable tool for evaluating lymph nodes on the basis of a node-to-node comparison.

References

• 1 Puli S R, Reddy J B, Bechtold M L. et al . Accuracy of endoscopic ultrasound in the diagnosis of distal and celiac axis lymph node metastasis in esophageal cancer: a meta-analysis and systematic review.  Dig Dis Sci. 2008;  53 2405-2014
• 2 Chen V K, Eloubeidi M A. Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy.  Am J Gastroenterol. 2004;  99 628-633
• 3 Vazquez-Sequeiros E, Wiersema M J, Clain J E. et al . Impact of lymph node staging on therapy of esophageal carcinoma.  Gastroenterology. 2003;  125 1626-1635
• 4 Eloubeidi M A, Cerfolio R J, Chen V K. et al . Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans.  Ann Thorac Surg. 2005;  79 263-268
• 5 Puli S R, Batapati K rishna, Bechtold M L. et al . Endoscopic ultrasound: its accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review.  World J Gastroenterol. 2008;  14 3028-3037
• 6 Savoy A D, Ravenel J G, Hoffman B J, Wallace M B. Endoscopic ultrasound for thoracic malignancy: a review.  Curr Probl Diagn Radiol. 2005;  34 106-115
• 7 Mariette C, Balon J M, Maunoury V. et al . Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma.  Br J Surg. 2003;  90 1367-1372
• 8 Bentrem D, Gerdes H, Tang L. et al . Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer.  Ann Surg Oncol. 2007;  14 1853-1859
• 9 Pfau P R, Perlman S B, Stanko P. et al . The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography.  Gastrointest Endosc. 2007;  65 377-384
• 10 Natsugoe S, Yoshinaka H, Moringa T. et al . Assessment of tumor invasion of the distal esophagus in carcinoma of the cardia using endoscopic ultrasonography.  Endoscopy. 1996;  28 750-755
• 11 Hiele M, De L P, Schurmans P. et al . Relation between endoscopic ultrasound findings and outcome of patients with tumors of the esophagus or esophagogastric junction.  Gastrointest Endosc. 1997;  45 381-386
• 12 Kelly S, Harris K M, Berry E. et al . A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma.  Gut. 2001;  49 534-539
• 13 Peng H Q, Greenwald B D, Tavora F R. et al . Evaluation of performance of EUS-FNA in preoperative lymph node staging of cancers of esophagus, lung, and pancreas.  Diagn Cytopathol. 2008;  36 290-296
• 14 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
• 15 Chang K J. EUS-guided fine needle injection (FNI) and anti-tumor therapy.  Endoscopy. 2006;  38 Suppl 1 S88-S93
• 16 Pishvaian A C, Collins B, Gagnon G. et al . EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies.  Gastrointest Endosc. 2006;  64 412-417
• 17 Ashida R, Yamao K, Okubo K. et al . Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors.  Endoscopy. 2006;  38 190-192
• 18 Gress F G, Barawi M, Kim D, Grendell J H. Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing.  Gastrointest Endosc. 2002;  55 594-597
• 19 Farrell J J, Sherrod A, Parekh D. EUS-guided fine-needle tattooing for preoperative localization of early pancreatic adenocarcinoma.  Gastrointest Endosc. 2009;  69 176-177
• 20 Magno P, Giday S A, Gabrielson K L. et al . EUS-guided implantation of radiopaque marker into mediastinal and celiac lymph nodes is safe and effective.  Gastrointest Endosc. 2007;  66 387-392
• 21 Dahl S, Mortensen M B. Endoscopic ultrasound-guided fine-needle aspiration can lead to nonresectability of pancreatic cancer due to severe biopsy-introduced inflammation.  Endoscopy. 2008;  40 Suppl 2 E96
• 22 Larsen M H, Fristrup C, Mortensen M B. Endoscopic ultrasound (EUS) – fine needle marking (FNM) of a small pancreatic tumour.  Endoscopy. 2009;  41 Suppl 2 E175-E176
• 23 Annema J T, Versteegh M I, Veselic M. et al . Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging.  J Clin Oncol. 2005;  23 8357-8361
• 24 Ribeiro A, Franceschi D, Parra J. et al . Endoscopic ultrasound restaging after neoadjuvant chemotherapy in esophageal cancer.  Am J Gastroenterol. 2006;  101 1216-1221
• 25 Stigt J A, Oostdijk A H, Timmer P R. et al . Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer.  Lung Cancer. 2009;  66 198-204