Clin Endosc.  2021 Jul;54(4):613-617. 10.5946/ce.2020.241.

Micro-Biopsy Forceps in the Assessment of Peritoneal Carcinomatosis: A Possible New Indication?

• Binda C
• Dabizzi E
• Sinagra E
• Fornelli A
• Saragoni L
• Cennamo V
• Anderloni A
• Fabbri C

• KMID: 2518867
• DOI: http://doi.org/10.5946/ce.2020.241

Abstract

Peritoneal carcinomatosis (PC) is defined as a metastatic involvement of the peritoneum by several other primary sites and it is characterized by a marked worsening of prognosis, with limited treatment opportunities. Subsequently, PC should be ruled out before any invasive treatment is administered. A new through-the-needle micro-biopsy forceps (MF) was recently introduced that permits micro-histology cores. In this case series, we evaluated the feasibility of MF in the assessment of PC to complete patient diagnostic work-ups. Five consecutive patients referred for endoscopic ultrasound staging were sampled using MF. Sampling was feasible in all patients with a technical success of 100%. No adverse events were reported in any cases. This technique was feasible and safe with a technical success rate of 100%. It permitted sampling of peritoneal irregularity, obtained high-quality tissue fragments in all cases, and enabled an additional assessment, i.e., immunohistochemical staining.

Keyword

Carcinomatosis; Endoscopic ultrasonography; Fine needle biopsy; Peritoneum

Figure

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  Fig. 1. Endoscopic ultrasound evaluation of a suspicious peritoneal thickening.

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  Fig. 2. Endoscopic ultrasound view of MorayTM (US Endoscopy, Mentor, OH, USA) forceps introduced through a 19G needle for tissue sampling of a suspected peritoneal nodule.

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  Fig. 3. MorayTM (US Endoscopy, Mentor, OH, USA) forceps.

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  Fig. 4. Hematoxylin and eosin staining (original magnification ×400) of a nodule of peritoneal carcinomatosis sampled using of MorayTM (US Endoscopy, Mentor, OH, USA) forceps. The specimen consists of a small tissue fragment covered by pleomorphic cells with a glandular arrangement. The final diagnosis was adenocarcinoma of gastric origin.

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  Fig. 5. Ber-EP4 nicely identifies malignant epithelial cells, allowing their distinction from reactive mesothelium (original magnification ×400).

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