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Pharma Summit 2018 & Gastro Summit 2018 Asian Journal of Biomedical and Pharmaceutical Sciences | ISSN: 2249-622X | Volume 8
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Asian J Biomed Pharmaceut Sci 2018, Volume 8 | DOI: 10.4066/2249-622X-C5-015
ENDOSCOPIC ULTRASOUND GUIDED LEFT LOBE LIVER LESIONS
BIOPSY (EUS-LLB) WITH ATYPICAL MALIGNANCIES, AN ALTERNATIVE
APPROACH TO RADIOLOGICAL IMAGE GUIDED BIOPSY: INITIAL
EXPERIENCE FROM A SINGLE TERTIARY CARE CENTRE
Adeel Urrehman
and
Mohammad Mubarak
Sindh institute of Urology and transplantation, Pakistan
Introduction:
Endoscopic ultrasound (EUS) is gaining attraction as an alternative method of biopsy. It offers a more targeted ap-
proach for focal lesions in liver especially those areas which are accessible via EUS-guided method with its high diagnostic yield
and limited adverse event profile making it more promising2.
Methods:
A total of 7 patients from Feb 2018 till September 2018 underwent EUS-guided Left Lobe lesions biopsies. All patients
gave informed written consent and procedure related details were explained. Coagulation profile and preprocedural Nil per oral
was similar as per standard Gastroscopy and procedures were done under conscious sedation. EUS Guided LLB performed using
22G FNA needle, 2 passes were done with slow pull technique over one minute with 10-15 strokes in each pass to obtained core
samples. All patients were discharged after 2 hrs of observation like post gastroscopy practice with nil complications. Duration
of procedures ranges from 15-30 minutes.
Results:
Case 1, 78-Years-old male with history of gastrectomy 5 years back for biopsy proven gastric cancer, presented with
weight loss and vague epigastric pain, CT scan showed left lobe SOL. Biopsy showed well differentiated Adenocarcinoma fromGI
Tract. Case 2, 58-years-old male presented with weight loss and Liver mass on CT Scan. Hepatitis B & C screen was negative with
normal AFP levels. Biopsy revealed Sarcomatoid Carcinoma. Case 3, 53-Years-old male presented with weight loss and abdom-
inal pain. He had multiple lesions identified on CT scan in liver. Biopsy revealed Neuroendocrine Tumour. Case 4, 35-years-old
male presented with abdominal pain. Laboratory tests showed anti-HCV reactive with normal AFP levels. CT Scan showed liver
lesion suggestive of atypical Hepatocellular carcinoma. Biopsy revealed Smooth Muscle Tumour. As part of workup he also had
gastroscopy and Colonoscopy with no evidence of luminal malignancy. Case 5, 60-years-old female presented with Weight loss,
CT scan showed pancreatic malignancy with liver metastasis. Biopsy revealed Metastatic Adenocarcinoma. Case 6, 42-years-
old female presented with Obstructive jaundice from Ampullary Carcinoma. She underwent EUS staging which revealed left lobe
lesion. Biopsy revealed Metastatic Adenocarcinoma. Case 7, 32-years-old male presented with Weight loss and Obstructive jaun-
dice, CT scan showed left lobe malignancy consistent with Cholangiocarcinoma with normal AFP and CA19-9 levels, his hepatitis
B & C screen negative, biopsy revealed Lymphoproliferative disease (Lymphoma).
Conclusion:
EUS-guided LLB is an alternative new technique for biopsy of liver lesions with suspected atypical malignancies.
It appears to have higher level of safety and accuracy for targeted lesional biopsies. Further larger series are required for more
supportive evidence.
Keywords:
Endoscopic Ultrasound, Left lobe lesions, Atypical Malignancies and CT Scan.