EUS-guided fiducial placement for image-guided radiation therapy in GI malignancies by using a 22-gauge needle (with videos).
Academic Article
Overview
abstract
BACKGROUND: Image-guided radiation therapy (IGRT) is dependent on the presence of fiducial markers for target localization and tracking. EUS-guided placement of fiducial markers with a 19-gauge needle has been reported. However, the size and stiffness of the 19-gauge needle may compromise the safety and ease of fiducial placement. OBJECTIVE: The aim of this study was to evaluate the safety and feasibility of EUS-guided placement of thin flexible gold coil fiducials by using a 22-gauge needle. DESIGN: Retrospective study. SETTING: Memorial Sloan-Kettering Cancer Center, between December 2008 and November 2009. PATIENTS: A total of 30 patients with GI malignancies of the mediastinum and upper abdomen who were to undergo IGRT. INTERVENTIONS: EUS evaluation with a curvilinear-array echoendoscope was performed. The target lesion was identified, a 22-gauge needle preloaded with a gold coil fiducial was inserted into the lesion, and the fiducial was deployed under EUS guidance. MAIN OUTCOME MEASUREMENTS: Technical success was defined as the ability to place fiducials in the desired location. Immediate and delayed complications were also noted. RESULTS: A total of 69 fiducials were placed in 12 different sites in the mediastinum and upper abdomen. Technical success was achieved in 29 out of 30 cases (97%). No intraprocedural complications were encountered. One patient developed a fever and abnormal liver function tests 12 hours after fiducial placement. LIMITATIONS: Retrospective design, small case series. CONCLUSIONS: EUS-guided placement of thin flexible gold coil fiducials by using a 22-gauge needle is both safe and feasible for upper GI malignancies.
