A total of 78 lymph nodes were observed by plain EUS and CH-EUS. The size (short and long axes), shape (round or oval), and edge characteristics (sharp or fuzzy) of each lymph node were assessed by plain EUS. After changing to CH-EUS, the vascularity of the lymph node was observed. The lymph nodes were categorized into 2 vascular enhancement
patterns on CH-EUS: heterogeneous and homogeneous enhancement. How the benign and malignant lesions differed in terms of features on plain EUS and vascular enhancement patterns on CH-EUS was examined. The utility of plain EUS and CH-EUS in differentiating selleck compound malignant from benign lesions was also evaluated. The final diagnoses were made by histological and/or cytological analyses of the samples obtained by EUS-FNA. Of the 20 malignant lymph nodes, 19 (95%) exhibited heterogeneous enhancement. Of the 58 benign lymph nodes, 56 (97%) exhibited homogeneous enhancement. Malignant and benign lymph nodes differed significantly in vascular enhancement patterns (P<0.001). The sensitivity, specificity, and accuracy with which CH-EUS differentiated malignant from benign lesions were 95%, 97%, and 97%, respectively. By receiver operating
characteristics (ROC) analysis, short axes >11mm and long axes >19mm provided the best sensitivity and specificity for predictive malignancy. The sensitivity, specificity, and accuracy with which short axes over 11mm predicted Epigenetics inhibitor enough malignancy were 80%, 79%, and 79%, respectively. Those values of long axes over 19mm were 65%, 62%, and 63%, respectively. Those values of round shape were 60%, 74%, and 71%, respectively. Those values of sharp edge were 90%, 28%, and 44%, respectively. The diagnostic accuracy of vascular assessment by CH-EUS was significantly higher than any other parameters of plain EUS. CH-EUS depicts the microvasculature of intra-abdominal lymphadenopathy very clearly and plays an important role in characterization of such lesions. It may be useful for determining the target lymph node of EUS-FNA. “
chemotherapy is an effective modality to treat unresectable hepatic metastasis from colorectal primaries if systemic chemotherapy has failed. To evaluate efficacy and safety of a new technique, EUS-guided fine-needle intra-arterial injection of chemotherapy. Between 2007 and 2012, a total of 25 patients with colorectal cancer and liver metastasis were randomized to receive intra-arterial chemotherapy with EUS-FNI (12[48%]) and conventional technique (13 [52%]). Exclusion criteria: Lesions up to 5cm of length, maximum 3 metastasis and localized in segments I, VI, VII and VIII. Chemotherapy regimen and dose were similar in both groups and consisted of 5-Fluoracil or 5-Fluorodeoxymidina. EUS-FNI was performed through the stomach or duodenum using a 22-G needle and searching the intra-hepatic artery by using color and power doppler.