Abstracts
1999 Digestive Disease Week

# 2133 DIAGNOSIS OF BORDERLINE PANCREATIC TUMORS BY ENDOSONOGRAPHY GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY ALLOWING CUSTOM-MADE PANCREATIC SURGERY
Annette Fritscher-Ravens, P.V.J. Sriram, C Bloechle, Boris Brand, J Itzbicki, Nib Soehendra, Univ Hosp Eppendorf, Hamburg Hamburg

BACKGROUND: Results of surgery in pancreatic malignancy are not satisfactory due to late stage of presentation. Detected early these tumors may have a better chance of curative surgery. We diagnosed borderline tumors by endosonography guided fine-needle aspiration (EUS-FNA) cytology and performed organ preserving pancreatic surgery. METHODS: Fifty one consecutive patients (30M, 21F; mean age:59.9 yrs. r:31-88) referred as suspected pancreatic malignancy had undergone EUS-FNA. Patients with evidence of metastatic disease were excluded. We used Olympus UM 200 / Pentax 34UX echo-endoscopes and a 22G,170cm long needle (GIP: Grassau, Germany). Histology (27) and clinical follow-up (22) confirmed the diagnosis. RESULTS: EUS-FNA was successful in all and material was adequate in 50 patients (98%). There were no complications. Cytology diagnosed malignancy correctly in 18/18 patients (adenocarcinoma-16; metastasis-2) and there were no false positives. In 21/26 cases benign disease was diagnosed correctly. In addition in 6 patients borderline malignancy was diagnosed on FNA. The overall sensitivity, specificity, positive and negative predictive values were 82.7,100,100,80.7%. EUS features of the 6 borderline tumors were a mean size of 3.8 cm (r:1.8-5.5), located in the pancreatic head (5) or body (1) with distinct borders in 4 and ill-defined in two. The lesions were hypo echoic (6) with a prominent cystic component (3) or non-homogenous echo texture (3). Rest of the pancreatic parenchyma was normal in all. Cytology revealed borderline pseudo mucinous cystadenoma (2), non-secreting neuro- endocrine tumor (2), gastrinoma (1) and epithelial malignancy (1). Segmental resection (2), duodenum preserving pancreatic head resection (3) and Whipple

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