EUS-guided FNA for the diagnosis of recurrent bladder cancer through the ileal conduit: a novel approach.

Background: Diagnosing local recurrence of tumor after cystectomy and ileal conduit construction for urinary bladder cancer remains a diagnostic challenge. Also, distinction of benign stricture from recurrent tumor at the site of ureteral anastomosis in the ileal conduit is difficult.

Objective: A new method is described for performing EUS-guided FNA through the ileal conduit in patients suspected of having local tumor recurrence after complete cystectomy for bladder cancer.

Design: Case series, part of a large prospective study on EUS-guided FNA.

Patients: Three patients who had undergone total cystectomy and ileal conduit construction for bladder cancer underwent EUS-guided FNA through the ileal conduit for evaluation of suspected tumor recurrence at the site of anastomosis of the distal ureter and the ileal conduit.

Main Outcome Measurements: The feasibility, diagnostic accuracy, and safety profile of EUS-guided FNA is assessed.

Observations: EUS-guided FNA through the ileal conduit was technically feasible in all 3 patients. By EUS, the mass appeared as an irregularly shaped, hypoechoic lesion that was extrinsic to the lumen of the ileum. A diagnosis of recurrent transitional cell cancer was made in 2 patients and anastomotic stricture was found in 1 patient. Both patients with tumor recurrence received palliative chemotherapy, and the patient with an anastomotic stricture was managed by placement of a nephrostomy stent. No complications were encountered.

Limitations: Small number of enrolled subjects; short duration of follow-up.

Conclusions: EUS-guided FNA through the ileal conduit is technically feasible, safe, and establishes diagnosis in patients suspected of tumor recurrence after complete cystectomy for bladder cancer.