The usefulness of contrast-enhanced harmonic EUS-guided fine-needle aspiration for evaluation of hepatic lesions (with video).

Background And Aims: Small hepatic masses often do not have distinct margins on B-mode EUS images. Contrast-enhanced harmonic EUS (CEH-EUS) is widely used for evaluating ambiguous pancreatic lesions. However, its role in detecting hepatic lesions and the use of EUS-guided FNA are not well evaluated. We investigated the usefulness of CEH-EUS-guided FNA for evaluating hepatic lesions.

Methods: Thirty consecutive patients with hepatic masses underwent CEH-EUS and CEH-EUS-guided FNA between September 2010 and November 2016.

Results: Twenty-eight patients (93.3%) had malignant tumors and 2 patients (6.7%) had benign hepatic masses. Before contrast enhancement, 73.3% of the hepatic lesions (22/30) in the patient cohort were visible on B mode. After contrast enhancement, 93.3% of these hepatic lesions (28/30) were distinguishable from the surrounding liver parenchyma. The technical success rate was 100%. The median tumor size on EUS and the number of needle passes were 24.5 mm (interquartile range [IQR], 14.5-40.8) and 2 (IQR, 2-3), respectively. The diagnostic accuracy of CEH-EUS-guided FNA was 86.7% (26/30 cases). There were no procedure-related adverse events.

Conclusions: CEH-EUS-guided FNA can be a safe and efficient method for the diagnosis of hepatic masses. It can result in high diagnostic accuracy in cases where the hepatic lesions are poorly visible on conventional EUS.