ABSTRACT
Background/Aims@#Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA; EUS-FNA) allows for diagnostic tissue specimens from various regions to be analyzed. How-ever, diagnosing recurrent pancreaticobiliary cancer after surgery is sometimes difficult. We evaluated the efficacy of EUS-FNA in the diagnosis of local recurrence of pancreatico-biliary cancer and analyzed the factors associated with falsenegative results. @*Methods@#Fifty-one consecutive patients who underwent EUS-FNA due to suspected recurrence of pancreaticobiliary cancer after surgery in an academic cen-ter were retrospectively analyzed. The criteria for EUS-FNA were a resected margin or remnant pancreas mass, round swollen lymph node (≥10 mm in diameter), and soft-tissue enhancement around a major artery. Patients with suspected liver metastasis or malignant ascites were excluded. @*Results@#Thirty-nine of the 51 patients had pancreatic cancer; the remaining 12 had biliary cancer. The target sites for EUS-FNA were the soft tissue around a major artery (n=22, 43%), the resected margin or remnant pancreas (n=12, 24%), and the lymph nodes (n=17, 33%). The median size of the suspected recurrent lesions was 15 mm (range, 8 to 40 mm). The over-all sensitivity, specificity and accuracy of EUS-FNA for the diagnosis of recurrence was 84% (32/38), 100% (13/13), and 88% (45/51), respectively. FNA of the soft tissue around major arteries (odds ratio, 8.23; 95% confidence interval, 1.2 to 166.7; p=0.033) was significantly associated with a falsenegative diagnosis in the multivariate analysis. @*Conclusions@#EUS-FNA is useful for diagnosing recurrent cancer, even after pancreaticobiliary surgery. The diagnoses of recurrence at soft-tissue sites should be interpreted with caution.
ABSTRACT
<b>Introduction:</b> We report three cases of women who developed secondary lower-extremity lymphedema after surgery for endometrial cancer. The cancer stage was 2 as per the International Society of Lymphology risk stratification. <b>Case Reports:</b> We performed intensive lymphdrainage of two-phase complex decongestive physiotherapy in each case during a 1-week hospitalization period. The average leg circumference at discharge improved to 92～96% from baseline. Case 1: After primary treatment, a 35-year-old woman presented with temporarily poor self lymphatic drainage during maintenance therapy, and her leg circumference progressively enlarged. However, the patient received reeducation for self lymphatic drainage and outpatient service for lymphedema regularly. Since then, the leg lymphedema has improved. Case 2: A 63-year old woman improved to 92% of baseline and continued an excellent self lymphatic drainage, maintaining 83% with her depression recovered 2.5 years after this hospitalization. Case 3: This case involved a 70-year-old woman in whom maintenance therapy progressed well without aggravation of lymphedema; however, she died in 1.2 years after the first phase treatment due to cancer recurrence. <b>Discussion:</b> Intensive care under short-term hospitalization (for one week) for lower-extremity lymphedema was effective. However, there was one patient in whom self lymphatic drainage became poor. The patients required long-term care for maintenance therapy after primary treatment.