Clin Endosc.  2020 Sep;53(5):594-599. 10.5946/ce.2019.175.

Endoscopic Ultrasound-Guided Random Omental Fine Needle Aspiration: A Novel Technique for the Diagnosis of Peritoneal Carcinomatosis

• Siddappa PK
• Jain N
• Agarwal NK
• Jain M
• Lamba GS

• KMID: 2507594
• DOI: http://doi.org/10.5946/ce.2019.175

Abstract

Background/Aims
Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%–75% for the detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence of obvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC.
Methods
Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were included after obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performed through the transgastric route using a linear echoendoscope.
Results
Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspected malignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure was successful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was also negative.
Conclusions
Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC and could be employed during EUS evaluation of malignancies.

Keyword

Ascites; Endoscopic ultrasound; Endoscopic ultrasound-guided fine needle aspiration; Omentum; Peritoneal neoplasms

Figure

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  Fig. 1. Endoscopic ultrasound image showing ascites. Ascites visualized as the anechoic area around the liver (arrow).

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  Fig. 2. Endoscopic ultrasound image showing the omentum. Frond-like omentum in the middle of ascites (anechoic, area) (arrow).

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  Fig. 3. Endoscopic ultrasound (EUS) image showing EUS needle penetrating the omentum. Fine needle aspiration needle penetrating the omentum (arrow).

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  Fig. 4. Malignant cells obtained from the needle aspiration of the omentum (hematoxylin-eosin, original magnification ×40).

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