Endoscopic Ultrasound for the Diagnosis of Disease and Staging of Cancers in Adult Patients with Gastroenterological Or Oncological Disease: Guidelines

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TITLE: Endoscopic Ultrasound for the Diagnosis of Disease and Staging of Cancers in Adult Patients with Gastroenterological or Oncological Disease: Guidelines

DATE: 26 February 2014

RESEARCH QUESTION

What are the evidence-based guidelines for the use of endoscopic ultrasound in the diagnosis of disease and staging of cancers in adult patient with gastroenterological or oncological disease?

KEY MESSAGE

Thirteen evidence-based guidelines regarding the use of endoscopic ultrasound in the diagnosis of disease and staging of cancers in adult patient with gastroenterological or oncological disease were identified.

METHODS

A limited literature search was conducted on key resources including PubMed, The Cochrane Library (2014, Issue 2), University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. Methodological filters were applied to limit retrieval to guidelines. The search was also limited to English language documents published between January 1, 2009 and February 11, 2014. Internet links were provided, where available.

The summary of findings was prepared from the abstracts of the relevant information. Please note that data contained in abstracts may not always be an accurate reflection of the data contained within the full article.

RESULTS

Thirteen evidence-based guidelines regarding the staging and diagnosis of cancer and of gastrointestinal diseases were identified. Additional references of potential interest are provided in the appendix.

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OVERALL SUMMARY OF FINDINGS

Thirteen evidence-based guidelines regarding the use of endoscopic ultrasound (EUS) for the diagnosis and staging of various cancers and gastrointestinal diseases were identified. A summary of the recommendations is presented in Table 1 and further detail regarding the recommendations is available in the full text of the guidelines.

Table 1: Summary of the Recommendations Regarding the use of EUS for the diagnosis and Staging of Cancer and Gastrointestinal Diseases Indication Recommendation Rectal and Colorectal • EUS is recommended for the staging of rectal cancer.1,12 Cancer • EUS is recommended for the preoperative locoregional staging of colorectal cancer.3 • Endorectal U/S is particularly useful for staging in patients for whom MRI is contraindicated or if disease is amenable to local excision.10 • Endoluminal U/S can play a complimentary role in the assessment of tumour depth in early stages of disease.11 Lung Cancer • EUS with FNA is less invasive than surgical staging and has a lower risk of complications.2 Endobrachial U/S-FNA with or without EUS-FNA should be offered to patients with suspected lung cancer prior to mediastinoscopy.2 • Radial endobrachial U/S shows potential for a high diagnostic yield in patients with suspected lung cancer.6 • EUS may be helpful for the diagnosis and staging of NSCLC.12 • EUS-FNA has 91% sensitivity and can be an option for staging NSCLC at mediastinum and all abnormal scans should be followed up by tissue biopsy.5 Esophageal Cancer • EUS-FNA in conjunction with cross-sectional imaging is recommended for accurate staging of esophageal carcinoma.4 • CT is recommended for initial staging of esophageal and gastric cancers, however, additional staging may be done with EUS8 and may be helpful for staging of esophageal cancers.12 • EUS-FNA should be performed when the cytological result is likely to affect the decision regarding treatment option.13 • EUS is not helpful for the detailed staging of mucosal disease.8 Gastroenteropancreatic • Multi-modal imaging (using CT, MRI, SSRS, or PET/CT with neuroendocrine Ga68) is recommended for primary imaging, and additional (including carcinoid) imaging can be done with EUS.7 tumours Medistinal adenopathy • Radial EUS within the esophagus provides similar information and Mediastinal lesions to that of axial CT for the imaging of medistinal adenopathy.9 unrelated to lung or • Transesophageal EUS-FNA is recommended for the initial esophageal evaluation of solid mediastinal lesions and enlarged lymph cancer nodes of unknown origin.13 Pancreatic cancer • EUS is likely helpful for differential diagnosis of pancreatic cyst.12 • EUS-FNA is recommended as a first line procedure in

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Table 1: Summary of the Recommendations Regarding the use of EUS for the diagnosis and Staging of Cancer and Gastrointestinal Diseases Indication Recommendation suspected pancreatic cancer.13 Other Cancers • EUS is likely helpful for: 12 o differential diagnosis of subepithelial lesions o assessment of peritoneal involvement in patients with gastric cancer.12 • EUS is likely helpful for the assessment of mucosa-associated lymphoid tissue lymphoma,12 and EUS-FNA of lymph nodes of unknown origin is recommended if they are accessible and the results are likely to change treatment.13 • EUS may be helpful for staging of submucosal GI tumours.13 • EUS-FNA of suspected distant metastases detected during EUS examination is recommended when there is the potential to change patient management.13 • EUS-FNA of adrenal gland masses, suspected distant metastases, and focal solid liver lesions is recommended when malignancy would change patient management.13 Choledocholithiasis • Preoperative EUS is recommended for patients with intermediate probability of choledocholithiasis.14 Gastric wall thickness • EUS may be helpful for the imaging of thickened gastric folds.12 • EUS-TCB, especially when combined with EUS-FNA, is likely accurate for investigation of diffuse esophageal/gastric wall thickening. Pancreatitis • EUS is likely helpful for the diagnosis of chronic pancreatitis and differential diagnosis of a solid mass in patients with chronic pancreatitis.12 Other GI Indications • EUS likely helpful in the diagnosis of common bile duct and gallbladder stones.12 CT = computed tomography; EUS = endoscopic ultrasound; FNA = fine-needle aspiration; GA68 = gallium-68; GI = gastrointestinal; MRI = magnetic resonance imaging; NSCLC = non-small cell lung cancer; PET = positron emission tomography; SSRS = somatostatin receptor scintigraphy; TCB = trucut biopsy; U/S = ultrasound

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REFERENCES SUMMARIZED

Guidelines and Recommendations

Cancer

1. National Comprehensive Cancer Network. Rectal cancer. Version 3.2014. Fort Washington (PA): The Network; 2014. Free subscription required. See: Clinical Evaluation/Staging. p. MS-8

2. Scottish Intercollegiate Guidelines Network. Management of lung cancer: a national clinical guideline [Internet]. Edinburgh (GB): The Network; 2014. (SIGN publication no. 137). [cited 2014 Feb 21]. Available from: http://www.sign.ac.uk/pdf/SIGN137.pdf See: Section 5.3.6 Endoscopic sampling of the mediastinal nodes

3. ASGE Standards of Practice Committee, Fisher DA, Shergill AK, Early DS, Acosta RD, Chandrasekhara V, et al. Role of endoscopy in the staging and management of colorectal cancer. Gastrointest Endosc. 2013 Jul;78(1):8-12. PubMed: PM23664162 NGC summary: http://www.guideline.gov/content.aspx?id=46944&search=endosonography

4. ASGE Standards of Practice Committee, Evans JA, Early DS, Chandraskhara V, Chathadi KV, Fanelli RD, et al. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc. 2013 Mar;77(3):328-34. PubMed: PM23410694 NGC summary: http://www.guideline.gov/content.aspx?id=44119&search=endoscopic+ultrasound+and+% 22endoscopic+ultrasound%22

5. Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e211S-e250S. PubMed: PM23649440

6. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence- based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e142S-e165S. PubMed: PM23649436

7. Ramage JK, Ahmed A, Ardill J, Bax N, Breen DJ, Caplin ME, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut [Internet]. 2012 Jan [cited 2014 Feb 24];61(1):6-32. Available from: http://www.bsg.org.uk/images/stories/docs/clinical/guidelines/pancreatic/gastro_nets_12.p df PubMed: PM22052063

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8. Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R, et al. Guidelines for the management of oesophageal and gastric cancer. Gut [Internet]. 2011 Nov [cited 2014 Feb 24];60(11):1449-72. Available from: http://www.bsg.org.uk/images/stories/docs/clinical/guidelines/gastroduodenal/bsg_ogc_20 11.pdf PubMed: PM21705456

9. ASGE Standards of Practice Committee, Jue TL, Sharaf RN, Appalaneni V, Anderson MA, Ben-Menachem T, et al. Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc. 2011 Aug;74(2):239-45. PubMed: PM21802583

10. National Institute for Health and Care Excellence. Colorectal cancer: the diagnosis and management of colorectal cancer [Internet]. London: The Institute; 2011. [cited 2014 Feb 21]. Available from: http://www.nice.org.uk/nicemedia/live/13597/56957/56957.pdf See: Chapter 2. Investigation, diagnosis and staging

11. Scottish Intercollegiate Guidelines Network. Diagnosis and management of colorectal cancer [Internet]. Edinburgh (GB): The Network; 2011. (SIGN publication no. 126). [cited 2014 Feb 21]. Available from: http://www.sign.ac.uk/pdf/sign126.pdf

12. Maluf-Filho F, Dotti CM, Halwan B, Queiros AF, Kupski C, Chaves DM, et al. An evidence- based consensus statement on the role and application of endosonography in clinical practice. Endoscopy. 2009 Nov;41(11):979-87. PubMed: PM19866396

Gastrointestinal Diseases

13. Dumonceau JM, Polkowski M, Larghi A, Vilmann P, Giovannini M, Frossard JL, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy [Internet]. 2011 [cited 2014 Feb 24];43:1-16. Available from: http://en.grupuge.com.pt/uploads/2011_clinical_impact_endo_ultrasound.pdf

14. ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010 Jan;71(1):1-9. PubMed: PM20105473 NGC summary: http://www.guideline.gov/content.aspx?id=25712&search=endoscopic+ultrasound+and+% 22endoscopic+ultrasound%22

PREPARED BY: Canadian Agency for Drugs and Technologies in Health Tel: 1-866-898-8439 www.cadth.ca

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APPENDIX – FURTHER INFORMATION:

Guidelines and Recommendations: Unclear if EUS included

15. American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee, Anderson MA, Appalaneni V, Ben-Menachem T, Decker GA, Early DS, et al. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc. 2013 Feb;77(2):167-74. PubMed: PM23219047

16. ASGE Standards of Practice Committee, Evans JA, Early DS, Fukami N, Ben-Menachem T, Chandrasekhara V, et al. The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012 Dec;76(6):1087-94. PubMed: PM23164510

Practice Guidelines, Guidelines of Unknown Rigour

17. Del Chiaro M, Verbeke C, Salvia R, Kloppel G, Werner J, McKay C, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis. 2013 Sep;45(9):703-11. PubMed: PM23415799

18. Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis. 2013 Aug;7(7):556-85. PubMed: PM23583097

19. Vazquez-Sequeiros E, Gonzalez-Panizo-Tamargo F, Barturen A, Calderon A, Esteban JM, Fernandez-Esparrach G, et al. The role of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in non small cell lung cancer (NSCLC) patients: SEED-SEPD-AEG Joint Guideline. Rev Esp Enferm Dig. 2013 Apr;105(4):215-24. PubMed: PM23859450

20. Polkowski M, Larghi A, Weynand B, Boustiere C, Giovannini M, Pujol B, et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy. 2012 Feb;44(2):190-206. PubMed: PM22180307

21. Sanchez de CJ, Hernandez JH, Lopez MF, Sanchez SP, Gratacos AR, Porta RR, et al. SEPAR guidelines for lung cancer staging. Arch Bronconeumol. 2011 Sep;47(9):454-65. PubMed: PM21824707

22. Anthony LB, Strosberg JR, Klimstra DS, Maples WJ, O'Dorisio TM, Warner RR, et al. The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (nets): well-differentiated nets of the distal colon and rectum. Pancreas [Internet]. 2010 Aug [cited 2014 Feb 24];39(6):767-74. Available from: http://www.nanets.net/pdfs/pancreas/06.pdf

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23. Bornman PC, Botha JF, Ramos JM, Smith MD, Van der Merwe S, Watermeyer GA, et al. Guideline for the diagnosis and treatment of chronic pancreatitis. S Afr Med J. 2010 Dec;100(12 Pt 2):845-60. PubMed: PM21414280

24. Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010 Nov;42 Suppl 6:S381-S406. PubMed: PM21078490

25. Kang YK, Kim KM, Sohn T, Choi D, Kang HJ, Ryu MH, et al. Clinical practice guideline for accurate diagnosis and effective treatment of gastrointestinal stromal tumor in Korea. J Korean Med Sci [Internet]. 2010 Nov [cited 2014 Feb 24];25(11):1543-52. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966989/pdf/jkms-25-1543.pdf PubMed: PM21060741

26. Oberg K, Hellman P, Kwekkeboom D, Jelic S, ESMO Guidelines Working Group. Neuroendocrine bronchial and thymic tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol [Internet]. 2010 May [cited 2014 Feb 24];21 Suppl 5:v220-v222. Available from: http://annonc.oxfordjournals.org/content/21/suppl_5/v220.full PubMed: PM20555085

27. Vinik AI, Woltering EA, Warner RR, Caplin M, O'Dorisio TM, Wiseman GA, et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. Pancreas [Internet]. 2010 Aug [cited 2014 Feb 24];39(6):713-34. Available from: http://www.nanets.net/pdfs/pancreas/03.pdf PubMed: PM20664471

28. Casali PG, Jost L, Reichardt P, Schlemmer M, Blay JY, ESMO Guidelines Working Group. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol [Internet]. 2009 May [cited 2014 Feb 24];20 Suppl 4:64-7. Available from: http://annonc.oxfordjournals.org/content/20/suppl_4/iv64.full PubMed: PM19454466

29. Jackson C, Cunningham D, Oliveira J, ESMO Guidelines Working Group. Gastric cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol [Internet]. 2009 May [cited 2014 Feb 24];20 Suppl 4:34-6. Available from: http://annonc.oxfordjournals.org/content/20/suppl_4/iv34.full PubMed: PM19454457

Review Articles

30. Varadarajulu S, Fockens P, Hawes RH. Best practices in endoscopic ultrasound-guided fine-needle aspiration. Clin Gastroenterol Hepatol. 2012 Jul;10(7):697-703. PubMed: PM22475740

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Additional References

31. ASGE Standards of Practice Committee, Early DS, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc. 2013 Jun;77(6):839-43. PubMed: PM23684089

32. Forcione DG. On-site cytopathology for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses: is it time to make it standard of care? Cancer Cytopathol. 2013 Sep;121(9):471-2. PubMed: PM24039158

33. Wani S, Cote GA, Keswani R, Mullady D, Azar R, Murad F, et al. Learning curves for EUS by using cumulative sum analysis: implications for American Society for Gastrointestinal Endoscopy recommendations for training. Gastrointest Endosc. 2013 Apr;77(4):558-65. PubMed: PM23260317

34. Dumonceau JM, Polkowski M, Larghi A, Vilmann P, Giovannini M, Frossard JL, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2011 Oct;43(10):897-912. PubMed: PM21842456

35. National Institute for Health and Care Excellence. Endobronchial ultrasound-guided transbronchial biopsy for peripheral lung lesions [Internet]. London: The Institute; 2010. (Interventional procedure guidance no. 337). [cited 2014 Feb 24]. Available from: http://www.nice.org.uk/nicemedia/live/12189/47961/47961.pdf

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