The impact of preoperative EUS-FNA for distal resectable pancreatic cancer: Is it really effective enough to take risks?

Jin-Seok Park; Jae Hoon Lee; Tae Jun Song; Joune Seup Lee; Seok Jung Jo; Dong Wook Oh; Ki Byung Song; Dae Wook Hwang; Do Hyun Park; Sang Soo Lee; Song Cheol Kim; Dong Wan Seo; Sung Koo Lee; Myung-Hwan Kim

doi:10.1007/s00464-021-08627-3

The impact of preoperative EUS-FNA for distal resectable pancreatic cancer: Is it really effective enough to take risks?

Surg Endosc. 2022 May;36(5):3192-3199. doi: 10.1007/s00464-021-08627-3. Epub 2021 Jul 12.

Authors

Jin-Seok Park^#¹, Jae Hoon Lee^#², Tae Jun Song³, Joune Seup Lee⁴, Seok Jung Jo⁴, Dong Wook Oh⁴, Ki Byung Song², Dae Wook Hwang², Do Hyun Park⁴, Sang Soo Lee⁴, Song Cheol Kim², Dong Wan Seo⁴, Sung Koo Lee⁴, Myung-Hwan Kim⁴

Affiliations

¹ Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
² Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
³ Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. drsong@amc.seoul.kr.
⁴ Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

^# Contributed equally.

PMID: 34254183
DOI: 10.1007/s00464-021-08627-3

Abstract

Background and aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is frequently used for the preoperative histologic diagnosis of pancreatic cancer. However, debate continues regarding the clinical merits of preoperative EUS-FNA for the management of resectable pancreatic cancer. We aimed to evaluate the benefits and safety of preoperative EUS-FNA for resectable distal pancreatic cancer.

Methods: The medical records of 304 consecutive patients with suspected distal pancreatic cancer who underwent EUS-FNA were retrospectively reviewed to evaluate the clinical benefits of preoperative EUS-FNA. We also reviewed the medical records of 528 patients diagnosed with distal pancreatic cancer who underwent distal pancreatectomy with or without EUS-FNA. The recurrence rates and cancer-free survival periods of patients who did or did not undergo preoperative EUS-FNA were compared.

Results: The diagnostic accuracy of preoperative EUS-FNA was high (sensitivity, 87.5%; specificity, 100%; positive predictive value 100%; accuracy, 90.7%; negative predictive value, 73.8%). Among patients, 26.7% (79/304) avoided surgery based on the preoperative EUS-FNA findings. Of the 528 patients who underwent distal pancreatectomy, 193 patients received EUS-FNA and 335 did not. During follow-up (median 21.7 months), the recurrence rate was similar in the two groups (EUS-FNA, 72.7%; non-EUS-FNA, 75%; P = 0.58). The median cancer-free survival was also similar (P = 0.58); however, gastric wall recurrence was only encountered in the patients with EUS-FNA (n = 2).

Conclusion: Preoperative EUS-FNA is not associated with increased risks of cancer-specific or overall survival. However, clinicians must consider the potential risks of needle tract seeding, and care should be taken when selecting patients.

Keywords: Accuracy; Differential diagnosis; Endoscopic ultrasound-guided fine needle aspiration; Neoplasm seeding; Pancreatic cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Endoscopic Ultrasound-Guided Fine Needle Aspiration*
Humans
Pancreatectomy
Pancreatic Neoplasms* / diagnostic imaging
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Retrospective Studies