P-LUM-14: Safety and impact of endoscopic ultrasound-guided fine needle aspiration of the lymph nodes in cirrhotics with hepatocellular carcinoma or pyrexia of unknown origin

BACKGROUND AND OBJECTIVES: Fine needle aspiration (FNA) of the enlarged lymph nodes or adrenal is advisable in patients with cirrhosis who have hepatocellular carcinoma (HCC) or pyrexia of unknown origin (PUO), before choosing optimal management strategy. It is difficult to perform percutaneous FNA due to the presence of collaterals and difficult anatomic location. The influence of endoscopic ultrasound (EUS)-guided FNA in patients with cirrhosis has been seldom reported. PATIENTS AND METHODS: Patients with HCC (n = 97, no extrahepatic disease on positron emission tomography-computed tomography), and PUO (n = 20) or >1 cm lymph nodes on imaging during liver transplantation workup (n = 3) underwent EUS-guided FNA. The data are represented as mean (standard deviation) or median (interquartile range). RESULTS: One hundred and twenty (100 males) patients, with the mean age 56 ± 8 years, had EUS-guided FNA from 129 sites (95 abdominal nodes, 32 mediastinal nodes, and 2 left adrenals). The platelet counts were 1.4 (1–1.7) ×10(5)/cumm and international normalized ratio was 1.2 (1.07–1.43); lymph nodes measured 1.5 (1–1.8) cm and 0.9 (0.7–1.3) cm at long and short axis, respectively. The Child’s score and Model for End-Stage Liver Disease scores were 7 (6–9) and 11 (8–15), respectively. The cytopathological diagnoses were metastatic disease in 28 (21.7%; two mediastinal nodes, one left adrenal, rest abdominal nodes), granulomatous change in 14 (10.9%), histoplasmosis in 2 (1.6% including one left adrenal), and reactive lymphadenopathy in 73 (56.6%) specimens. Twelve (9.3%) specimens were inadequate for opinion. Two patients had transient sedation-related encephalopathy (both Child’s C), and one had mild ooze from the FNA site that ceased spontaneously. CONCLUSION: EUS-guided FNA of the lymph nodes/adrenal is safe and significantly impacts management in patients with cirrhosis.