Gut | 2019
IDDF2019-ABS-0119\u2005Endoscopic ultrasound-guided left lobe liver lesions biopsy (EUS-LLB) with atypical malignancies, an alternative approach to radiological image-guided biopsy
Abstract
Background Endoscopic ultrasound (EUS) is gaining attraction as an alternative method of biopsy. It offers a more targeted approach for focal lesions in liver especially those areas which are accessible via EUS-guided method. Methods A total of 7 patients from Feb 2018 till September 2018 underwent EUS-guided Left Lobe lesions biopsies. EUS Guided LLB performed using 22G FNA needle, 2 passes were done with slow pull technique over one minute with 10–15 strokes in each pass to obtained core samples. Duration of procedures ranges from 15–30 minutes. Results Case 1, 78-Years-old male with a history of gastrectomy 5 years back for biopsy-proven gastric cancer, presented with weight loss and vague epigastric pain, CT scan showed left lobe SOL. Biopsy showed well-differentiated Adenocarcinoma from GI Tract. Case 2, 58-years-old male presented with weight loss and Liver mass on CT Scan. Hepatitis B & C screen was negative with normal AFP levels. Biopsy revealed Sarcomatoid Carcinoma. Case 3, 53-Years-old male presented with weight loss and abdominal pain. He had multiple lesions identified on CT scan in the liver. Biopsy revealed Neuroendocrine Tumor. Case 4, 35-years-old male presented with abdominal pain. Laboratory tests showed anti-HCV reactive with normal AFP levels. CT Scan showed liver lesion suggestive of atypical Hepatocellular carcinoma. Biopsy revealed Smooth Muscle Tumor. As part of workup, he also had gastroscopy and Colonoscopy with no evidence of luminal malignancy. Case 5, 60-years-old female presented with Weight loss, CT scan showed pancreatic malignancy with liver metastasis. Biopsy revealed Metastatic Adenocarcinoma. Case 6, 42-years-old female presented with Obstructive jaundice from Ampullary Carcinoma. She underwent EUS staging which revealed left lobe lesion. Biopsy revealed Metastatic Adenocarcinoma. Case 7, 32-years-old male presented with Weight loss and Obstructive jaundice, CT scan showed left lobe malignancy consistent with Cholangiocarcinoma with normal AFP and CA19–9 levels, his hepatitis B & C screen negative, the biopsy revealed Lymphoproliferative disease (Lymphoma). Conclusions EUS-guided LLB is an alternative new technique for biopsy of liver lesions with suspected atypical malignancies.