Endoscopic ultrasound and paracentesis in the evaluation of small volume ascites in patients with intra-abdominal malignancies.

The evaluation of ascites in patients with known or suspected malignancy is a critical aspect of preoperative staging. Endoscopic evaluation by ultrasound of low volume ascites and sampling of the ascitic fluid by endoscopic ultrasound guided paracentesis (EUS-P) is both a sensitive and specific modality for the determination of peritoneal implants, which is not only an important prognostic indicator but a crucial factor in determining treatment strategy. It is common practice to utilize EUS for gastrointestinal malignancies such as pancreatic or gastric masses, with the performance of paracentesis during the same procedure for the purpose of imaging the abnormality and possibly performing fine needle aspiration for biopsy of the neoplasm itself. However, given the ability of EUS-P to adequately sample even minimal ascites, detecting much smaller volumes than traditional computed tomography or magnetic resonance imaging, EUS-P may be a useful modality for the standard metastatic workup of any newly diagnosed or suspected malignancy. In this "Field of Vision" commentary, we discuss the role of EUS-P, including the article by Suzuki et al reporting their experience with EUS-P using an automated spring-loaded needle device. We also review the utility of EUS-P for non-gastrointestinal malignancies, such as ovarian cancer, which has a high incidence of malignant ascites.

Race/Ethnicity is predictive of lymph node status in patients with early gastric cancer.

BACKGROUND: Race/ethnicity has long been suspected to affect survival in patients with gastric adenocarcinoma. However, the clinicohistopathological impact of race or ethnicity on early gastric cancer (EGC) is not known. METHODS: From 2000 to 2013, 286 patients underwent gastrectomy and 104 patients had pathological confirmation of EGC. A retrospective analysis of pathological and clinical prognostic indicators was performed. RESULTS: The study population consisted of 38 (37%) Asian Americans and 66 (63%) non-Asian Americans. Of these, 2 (5.3%) Asian Americans and 19 (28.8%) non-Asian Americans had pathological confirmation of lymph node metastasis (LNM) (p = 0.004). Univariate analysis comparing the clinicohistopathological characteristics in each group did not reveal significant difference regarding histotype, tumor size, grade, location, morphology, or lymphovascular invasion, except for the LNM rate and mean body mass index (23.2 versus 26.6, p < 0.001). Multivariate analysis showed that non-Asian race/ethnicity (odds ratio (OR), 9.09; 95% confidence interval (CI), 1.12-71.43; p = 0.038), younger age (OR, 1.11; 95% CI, 1.01-1.12; p = 0.046), and lymphovascular invasion (OR, 13.9; 95% CI, 2.40-79.99; p = 0.003) were significant predictors for LNM. CONCLUSIONS: This study demonstrated that Asian American race in EGC is associated with a significantly decreased rate of LNM in comparison to non-Asian Americans, despite similar histopathological characteristics of each group.

Evidence-based review of the management of cancers of the gastroesophageal junction.

The management of localized esophageal cancer has traditionally been surgical resection; yet, despite improvements in outcomes and techniques, survival for patients with esophageal cancer, especially those with evidence of nodal involvement, remains poor. In this article, we have used an evidence-based approach to define optimal therapy based on clinical stage for esophageal cancer. We review the currently available evidence supporting the use of neoadjuvant and adjuvant therapies for locally advanced esophageal cancer. Additionally, we review the evidence supporting the role of endoscopic therapies, rather than resection, for early-stage esophageal cancer.