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• W2023796631 abstract "Background: Vascular invasion impacts cancer staging, prognosis, and therapy. Malignant infiltration usually results from direct and gross extension from a primary tumor and is readily identified by CT. Cancers may also migrate to remote sites along vascular channels, a process termed angiotropism or EVMM. Sometimes this pattern of spread can be seen with CT. Surgical and autopsy studies also demonstrate microscopic or diminutive (1-3 mm thick) spread not seen with CT. Additionally, a tumor thrombus may only be recognized at surgery or autopsy. We report the EUS FNA diagnosis of malignant perivascular cuffing and tumor thrombosis occurring distant from a primary tumor, including microinvasion with negative helical CT. Aims: To examine the capability and safety of EUS FNA for diagnosing distant perivascular tumor infiltration and tumor thrombus in CT positive and negative (i.e. microinvasion) patients. Methods: Using a prospectively maintained EUS database, we identified all examinations from 09/04 to 11/08 in which FNA was performed of a vascular wall or intravascular thrombus. We abstracted and analyzed date regarding demographic, radiology and EUS features, cytology results, and follow up data. Results: EUS FNA was performed from 31 vascular sites [vascular wall (n=27), intravascular thrombus (n=4)] during 29 exams in 27 patients [15 male, age 55±11 years]. Cancer was diagnosed in 24/27 (89%) patients of whom 20 had pancreatic cancer. For diagnosis of vascular involvement remote from cancer (EVMM), a median of 3 FNAs (range 2-9) was obtained from wall of the celiac artery (n=12), SMA (n=6), hepatic artery (n=5), splenic artery (n=2), SMV (n=1), aorta (n=1); and intravascular FNA of portal vein (n=4). FNA cytology was positive (n=17) or suspicious (n=2) among cancer patients. EUS FNA detected and confirmed microinvasion in 3 patients with negative helical CT. CT and EUS identified indeterminate peri- and intravascular findings in 3 patients ultimately diagnosed with benign disorders after a median follow-up of 3 (0.4-7) months. EUS FNA was negative in each of these patients. Conclusion: CT and EUS can identify peri- and intravascular tumor extension remote from the primary tumor and not resulting from gross infiltration. EUS can detect microinvasion (1-3mm) not seen on helical CT. Further study is needed to determine the prevalence, to establish the safety and accuracy of EUS FNA, and impact on prognosis, clinical care, and outcomes." @default.
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• W2023796631 date "2009-04-01" @default.
• W2023796631 modified "2023-09-22" @default.
• W2023796631 title "EUS FNA of Distant Extra-Vascular Migratory Metastasis (EVMM) and Tumor Thrombosis" @default.
• W2023796631 doi "https://doi.org/10.1016/j.gie.2009.03.161" @default.
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