Diagnostic Accuracy of EUS-FNA in Presumed Pancreatic Cancer
Abstracts
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Introduction: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of the pancreas allows patients with presumed periampullary cancer to be diagnosed prior to undergoing major laparotomy. At our institution, the diagnostic algorithm for such patients includes pretreatment tissue diagnosis. We reviewed our experience with EUS-FNA to establish the diagnostic accuracy and complication rates of this procedure in patients with presumed pancreatic and periampullary cancer. Methods: Data were reviewed on all patients who presented with presumed pancreatic or periampullary cancer (CT evidence of a pancreatic mass or a malignant biliary stricture on MRCP or cholangiography) who underwent EUS-FNA at our institution between November 1, 1999 and October 1, 2001. In those patients who were proven to have a malignancy, a final diagnosis of cancer was confirmed by surgical pathology and/or patient follow-up. For purposes of subgroup analysis, patients were staged by contrast-enhanced multislice CT as having resectable, locally advanced, or metastatic disease. Patients with extrapancreatic metastatic disease who underwent EUS-FNA had metastases too small to biopsy, and therefore the primary tumor was selected for FNA. Results: EUS-FNA was performed on 260 patients with presumed pancreatic or periampullary cancer. A final diagnosis of cancer was established in 234 (90%), 19 had benign disease and the final diagnosis remains unknown in 7 patients. For the 234 patients subsequently proven to have cancer, FNA results were diagnostic in 205 (88%); 101/119 patients (85%) with resectable disease, 62/66 (94%) with locally advanced disease, and 42/49 (86%) with metastatic disease. Four patients (1.5%) developed a clinically apparent complication which required hospital admission, including 2 patients who required surgery for duodenal perforation. There were no EUS-related deaths. Conclusions: EUS-FNA can safely and accurately establish a cytologic diagnosis in patients with both early-stage and advanced pancreatic cancer. EUS-FNA combined with high-quality CT and endobiliary stent placement allows the diagnostic phase of initial patient evaluation to be separated from treatment. This facilitates outpatient evaluation of cancer treatment options and allows referral to a high-volume center for further staging and consideration of stage-specific multimodality treatment. |
