Surgery, Gastroenterology and Oncology
Vol. 23, Nr. 5, Oct 2018
Comparison of Diagnostic Sensitivities for Resectable Pancreatic Adenocarcinoma Between Endoscopic Ultrasound-guided Fine-needle Aspiration and Blinded Computed Tomography
Daisuke Ito, Yoshikuni Kawaguchi, Naoki Okura, Junichi Arita, Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama, Nobuhisa Akamatsu, Junichi Kaneko, Yoshihiro Sakamoto, Kazuhiko Koike, Norihiro Kokudo, Kiyoshi Hasegawa
Article DOI: 10.21614/sgo-23-5-320
Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is performed for diagnosing pancreatic lesions. As EUS-FNA can develop needle track seeding, its use for radiographically-diagnosed pancreatic malignancy remains controversial.
We investigated a useful setting of EUS-FNA for resectable pancreatic adenocarcinoma by comparing the diagnostic sensitivity between EUS-FNA and contrast enhanced-computed tomography (CT), and by evaluating the short- and long-term outcomes.

Methods: Between January 2012 and March 2015, 107 consecutive patients underwent resection for pancreatic adenocarcinoma were evaluated retrospectively. Short- and longterm outcomes were compared between patients receiving EUS-FNA and patients who did not.

Results: EUS-FNA was performed for 52 patients (48.6%).Diagnostic sensitivity of EUS-FNA (90.4%) was significantly higher than for blinded CT(69.2%) (p=0.021). EUS-FNA accurately diagnosed pancreatic adenocarcinoma in 16 of 16 (100%) patients who had small tumor diameter, autoimmune pancreatitis, or IPMN-related tumor although they were not correctly diagnosed by radiographic findings.
In particular, the sensitivity of EUS-FNA was approximately 90%, irrespective of tumor size, while that for blinded CT was low in cases with a small tumor size (46% for TS1 tumor). Preoperative EUS-FNA was not associated with overall survival (p=0.958), recurrence-free survival (p=0.357), and relapse rate at peripancreatic tissue and or peritoneum(p=0.641).

Conclusion: EUS-FNA is particularly useful for diagnosing small pancreatic ductal adenocarcinoma, adenocarcinoma with pancreatitis or IPMN-related adenocarcinoma, providing high diagnostic sensitivity and acceptable prognostic outcomes.

Abbreviations: AC, adjuvant chemotherapy; ASA, American Society of Aesthesiologists; CA19-9, carbohydrate antigen 19-9; CE, contrast enhanced, CEA, carcinoembryonic antigen; CI, confidence interval; CT, computed tomography; DUPAN-2, duke pancreatic monoclonal antigen type 2; EUS, endoscopic ultrasound; FNA, fine-needle aspiration; HR, hazard ratio; IPMC, intrapapillary mucinous carcinoma; OS, overall survival; RFS, recurrence-free survival; Span-1, s-pancreas-1 antigen; TS, tumor size; UICC, International Union Against Cancer.

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Surgery, Gastroenterology and Oncology is indexed in Scopus, CrossRef (DOI: 10.21614/sgo)

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