Download PDF
Endoscopy 2019; 51(02): 165-168
DOI: 10.1055/a-0647-6824
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

The impact of endoscopic ultrasound-guided fine-needle aspiration of lymph nodes on subsequent positron emission tomography/computed tomography imaging: a prospective study

Ole Steen Bjerring
1   Department of Surgery, Upper GI Section and Odense Pancreas Center, Odense University Hospital, Odense, Denmark
2   Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
,
Søren Hess
2   Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
3   Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
4   Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark
,
Claus Wilki Fristrup
1   Department of Surgery, Upper GI Section and Odense Pancreas Center, Odense University Hospital, Odense, Denmark
2   Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
,
Poul Flemming Høilund-Carlsen
2   Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
3   Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
4   Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark
,
Michael Bau Mortensen
1   Department of Surgery, Upper GI Section and Odense Pancreas Center, Odense University Hospital, Odense, Denmark
2   Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
› Author AffiliationsTRIAL REGISTRATION: Single-center, prospective trial NCT02209415 at clinicaltrials.gov
Further Information

Publication History

submitted 04 December 2017

accepted after revision 06 June 2018

Publication Date:
23 July 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Background Modern cancer diagnostic work-up is based on multiple modalities within a short time period. The interplay between these modalities is complex and not well known. Performing biopsy procedures prior to (18)F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is considered to pose a risk of false-positive imaging results; however, this is not based on solid scientific evidence. The use of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is commonly used in upper gastrointestinal malignancies, is proven safe, and has very little risk of complications. This study aimed to assess whether EUS-FNA induces inflammation that would increase FDG uptake on subsequent PET/CT.

Methods 27 patients who were referred for upper gastrointestinal EUS for different reasons initially underwent FDG-PET/CT to detect biopsy-eligible lymph nodes with no FDG uptake. Patients then underwent EUS-FNA of the benign lymph nodes, with a minimum of three passes. Patients were re-evaluated with FDG-PET/CT 1 week later, with specific emphasis on the biopsied lymph nodes.

Results None of the biopsied lymph nodes showed increased FDG uptake on follow-up FDG-PET/CT. No adverse events occurred.

Conclusion EUS-FNA prior to FDG-PET/CT did not lead to false-positive FDG uptake. The interpretive impact of minor procedures prior to FDG-PET/CT needs to be re-evaluated.

 

  • References

  • 1 Johansen J, Buus S, Loft A. et al. Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 2008; 30: 471-478
    CrossrefPubMedGoogle Scholar
  • 2 Strobel K, Haerle SK, Stoeckli SJ. et al. Head and neck squamous cell carcinoma (HNSCC) – detection of synchronous primaries with (18)F-FDG-PET/CT. Eur J Nucl Med Mol Imaging 2009; 36: 919-927
    CrossrefPubMedGoogle Scholar
  • 3 Culverwell AD, Scarsbrook AF, Chowdhury FU. False-positive uptake on 2-[(1)(8)F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) in oncological imaging. Clin Radiol 2011; 66: 366-382
    CrossrefPubMedGoogle Scholar
  • 4 American College of Radiologists. ACR–SPR practice parameter for performing FDG-PET/CT in oncology. Revised 2016 Available from: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/fdg-pet-ct.pdf
    PubMedGoogle Scholar
  • 5 Matthes K, Bounds BC, Collier K. et al. EUS staging of upper GI malignancies: results of a prospective randomized trial. Gastrointest Endosc 2006; 64: 496-502
    CrossrefPubMedGoogle Scholar
  • 6 Mortensen MB, Edwin B, Hunerbein M. et al. Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer: an international multicenter study. Surg Endosc 2007; 21: 431-438
    CrossrefPubMedGoogle Scholar
  • 7 Varadarajulu S, Eloubeidi MA. The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Gastrointest Endosc Clin N Am 2005; 15: 497-511 , viii-ix
    CrossrefPubMedGoogle Scholar
  • 8 Mortensen MB, Pless T, Durup J. et al. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy 2001; 33: 478-483
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Larsen MH, Fristrup CW, Pless T. et al. Endoscopic ultrasound-guided fine-needle marking of lymph nodes. Endoscopy 2010; 42: 133-137
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Boellaard R, Delgado-Bolton R, Oyen WJ. et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015; 42: 328-354
    CrossrefPubMedGoogle Scholar
  • 11 Truong MT, Pan T, Erasmus JJ. Pitfalls in integrated CT-PET of the thorax: implications in oncologic imaging. J Thorac Imaging 2006; 21: 111-122
    CrossrefPubMedGoogle Scholar
  • 12 Basu S, Hess S, Nielsen Braad PE. et al. The basic principles of FDG-PET/CT Imaging. PET Clin 2014; 9: 355-370 , v
    CrossrefPubMedGoogle Scholar
  • 13 Sivapalan P, Naur TMH, Colella S. et al. Impact of EBUS-TBNA on PET-CT imaging of mediastinal nodes. J Bronchology Interv Pulmonol 2017; 24: 188-192
    CrossrefPubMedGoogle Scholar
  • 14 Petrone MC, Arcidiacono PG. Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: How many passes?. Endosc Ultrasound 2014; 3: 22-27
    CrossrefPubMedGoogle Scholar
  • 15 Wee E, Lakhtakia S, Gupta R. et al. Endoscopic ultrasound guided fine-needle aspiration of lymph nodes and solid masses: factors influencing the cellularity and adequacy of the aspirate. J Clin Gastroenterol 2012; 46: 487-493
    CrossrefPubMedGoogle Scholar