Original ArticleThe utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum
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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Cited by (0)
See CME section; p. 446.
This work was presented in abstract form at the American Gastroenterology Association meeting, May 2002, San Francisco, California.