Original Article
The utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum

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Background

Breast cancer can metastasize to the esophagus and the mediastinum. EUS-guided FNA (EUS-FNA) is being used increasingly as a less invasive alternative to mediastinoscopy for procuring a tissue diagnosis of mediastinal disease and may be useful for the diagnosis of breast cancer metastatic to the esophagus and the mediastinum.

Methods

Twelve women (age range 54-82 years) with a history of breast cancer presented with dysphagia or other symptoms between 1 and 15 years after initial diagnosis and treatment. CT and endoscopy with biopsies suggested a mediastinal mass or lymphadenopathy with extrinsic esophageal compression but failed to provide a tissue diagnosis. EUS-FNA was performed for diagnosis.

Results

Cytologic evaluation of specimens obtained by EUS-FNA confirmed breast cancer metastases in 11 of 12 patients (91%). Recurrent disease was found in intramural masses and periesophageal lymph nodes. No complication resulted from any EUS-FNA procedure.

Conclusions

EUS-FNA is safe and effective for the diagnosis of breast cancer metastases to the esophagus and the mediastinum. EUS-FNA may be useful as a first-line method of evaluation when breast cancer metastasis to the esophagus and the mediastinum is suspected.

Section snippets

Patients and methods

Twelve women (age range 54-82 years) with a history of resected breast cancer, with or without subsequent adjuvant therapy, presented with symptoms that raised a possibility of recurrent malignancy with mediastinal and/or esophageal involvement. These included dysphagia (n = 10), fever (n = 1), and generalized weakness (n = 1). The patients presented between 1 and 15 years after the initial diagnosis of breast cancer. Barium contrast esophagography, CT, and endoscopy suggested a mediastinal mass,

Results

EUS imaged disrupted esophageal wall architecture, as well as lymph nodes as small as 5 mm in greatest length, with characteristics that raised a suspicion of malignancy (i.e., hypoechogenicity and/or irregular borders) (Figure 1, Figure 2). In 5 cases, esophageal wall thickening or a subepithelial mass was noted. Seven patients had periesophageal lymphadenopathy. EUS-FNA was performed in all cases with a 22-gauge needle (mean 4 passes per lesion, range 1-10).

Cytologic evaluation of specimens

Discussion

EUS-FNA provided a tissue diagnosis of metastatic breast cancer to the esophagus or the mediastinum in 11 of 12 women, thus averting the need for a more invasive surgical biopsy. In the one patient in whom EUS-FNA did not provide a definitive diagnosis, the cytologic sample was sufficiently abnormal to warrant a confirmatory surgical biopsy. These results suggest that EUS-FNA has a high rate of detection (91%) for metastatic breast cancer to the esophagus and mediastinal lymph nodes, and should

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    See CME section; p. 446.

    This work was presented in abstract form at the American Gastroenterology Association meeting, May 2002, San Francisco, California.

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