P2343 - Metastatic Breast Cancer to the Stomach Diagnosed With EUS Fine Needle Biopsy

Timothy Graziano, DO¹, William Ghaul, DO¹, Amanda Jacubowsky, DO, MSMEd¹, Chandler Patton, DO¹, Shashin Shah, MD^2
1Lehigh Valley Health Network, Allentown, PA; ²Eastern Pennsylvania Gastrointestinal and Liver Specialists, Allentown, PA

Introduction: Endoscopic ultrasound (EUS) is a key tool in the assessment of upper gastrointestinal and local extramural sites. Several case reports have highlighted its developing value as a diagnostic tool for locally invasive cancers. Here, we present an interesting case of breast carcinoma metastatic to the stomach that was diagnosed by EUS-guided fine needle biopsy.

Case Description/Methods: An 80-year-old female with a past medical history of recurrent left-sided breast cancer with prior osseous and pleural metastases was referred to Gastroenterology by her Hematologist-Oncologist for gastric biopsy. A recent PET CT demonstrated new intense FDG activity and wall thickening involving the lesser gastric curvature. At the time of evaluation, she reported intermittent lower abdominal pain but denied unintentional weight loss, upper/ epigastric abdominal pain, black/ bloody stools, and changes in bowel habits. EUS-guided fine-needle biopsy of the gastric body was completed using 22 gauge FNA. Pathology was consistent with metastasis of the patient’s known breast carcinoma. The patient thereafter continued palliative chemotherapy for her extensive and progressive disease burden.

Discussion: EUS is rapidly gaining momentum as an expedient, cost-effective technique for diagnostic and therapeutic interventions in the upper GI tract, particularly with respect to cancer. It offers a lower-risk alternative for the biopsy of supradiaphragmatic masses when compared to surgery, with the added benefit of high-resolution imaging in real time. In the case of our patient, it yielded an unfortunate diagnosis of invasive metastatic breast cancer. Specimens collected using 22 gauge FNA were sufficient for accurate diagnosis. Although similar techniques have been described previously in the endoscopic literature, these reports are sparse. We can expect EUS to continue to be used in similar fashion for related cases, in collaboration with radiographic and Surgical Oncologic techniques.


Disclosures:


Timothy Graziano, DO¹, William Ghaul, DO¹, Amanda Jacubowsky, DO, MSMEd¹, Chandler Patton, DO¹, Shashin Shah, MD². P2343 - Metastatic Breast Cancer to the Stomach Diagnosed With EUS Fine Needle Biopsy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.