scholarly journals Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Akinori Maruta ◽  
Takuji Iwashita ◽  
Kensaku Yoshida ◽  
Shinya Uemura ◽  
Ichiro Yasuda ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Method ◽  
Peritoneal Dissemination ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Ultrasound Guided ◽  
Diagnostic Ability ◽  
Fine Needle ◽  
Significant Difference ◽  
Preoperative Diagnostic

Abstract Background A pathological diagnosis of pancreatic cancer should be performed as much as possible to determine the appropriate treatment strategy, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the primary method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified. Aims To evaluate the diagnostic ability of EUS-FNA and its effect on the preoperative diagnosis, surgical outcome, and prognosis of pancreatic cancer. Methods Between January 2005 and June 2017, 293 patients who underwent surgical resection for pancreatic cancer were retrospectively evaluated. The outcomes of interest were the diagnostic ability of EUS-FNA and its influence on the surgical results and prognosis. Results The diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than that of endoscopic retrograde cholangiopancreatography (ERCP) (45.5%) (p < 0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p = 0.001). Patients were divided into FNA group (N = 160) and non-FNA group (N = 133) for each preoperative diagnostic method. In the study of surgical curability R0 between the two groups, there was no significant difference in FNA group (65.0% [104/160]) and non-FNA group (64.7% [86/133], p = 1.000). In the prognostic study, 256 patients with curative R0 or R1 had a recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in the non-FNA group. Moreover peritoneal dissemination occurred in 34.3% (24/70) in the FNA group and in 21.9% (16/73) in the non-FNA group, neither of which showed a significant difference. The median survival times of the FNA and non-FNA groups were 955 days and 799 days, respectively, and there was no significant difference between the two groups (log-rank p = 0.735). In the Cox proportional hazards model, factors influencing prognosis, staging, curability, and adjuvant chemotherapy were the dominant factors, but the preoperative diagnostic method (EUS-FNA) itself was not. Conclusions EUS-FNA is a safe procedure with a high diagnostic ability for the preoperative examination of pancreatic cancer. It was considered the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.

scholarly journals Evaluation of Preoperative Diagnostic Methods for Resectable Pancreatic Cancer

2021 ◽  
Author(s):  
Akinori Maruta ◽  
Takuji Iwashita ◽  
Kensaku Yoshida ◽  
Shinya Uemura ◽  
Ichiro Yasuda ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Method ◽  
Peritoneal Dissemination ◽  
Diagnostic Methods ◽  
Adverse Event Rate ◽  
Safe Procedure ◽  
Diagnostic Ability ◽  
First Choice ◽  
Significant Difference ◽  
Preoperative Diagnostic

Abstract Background: In pancreatic cancer clinical practice guideline 2016, it is recommended to perform pathological diagnosis as much as possible, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, EUS-FNA has become mainstream as a method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified.Aims: To evaluate the diagnostic ability of EUS-FNA and preoperative diagnosis affects surgical outcome and prognosis of pancreatic cancer.Methods: Between January 2005 and June 2017, 293 patients who had surgical resection for pancreatic cancer were retrospectively evaluated. The interested outcomes were diagnostic ability of EUS-FNA and the influence for surgical result and prognosis.Results: The diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than ERCP (45.5%) (p<0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p=0.001). Patients were divided into FNA group (N=160) and non-FNA group (N=133) for each preoperative diagnostic method. In the study of surgical curability R0 between two groups, there was no significant difference in FNA group: 65.0% (104/160) and non-FNA group: 64.7% (86/133), (p=1.000). In the prognostic study, the total of 256 patients with curability R0 or R1, the recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in non-FNA group. Moreover peritoneal dissemination occurred 34.3% (24/70) in the FNA group and 21.9% (16/73) in the non-FNA group, neither of which showed significant difference. The median survival time of FNA group and non-FNA group were 955 days and 799 days, respectively, and there was no significant difference between the two groups (Log rank p=0.735). In the Cox proportional hazards model examining factors influencing prognosis, staging, curability and adjuvant chemotherapy were dominant factors, but preoperative diagnostic method(EUS-FNA) itself was not.Conclusions: As a preoperative examination of pancreatic cancer, EUS-FNA was shown to be a safe procedure with high diagnostic ability. It was considered to be the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.

scholarly journals Infected Pancreatic Necrosis Mimicking Pancreatic Cancer

2020 ◽  
Vol 14 (2) ◽  
pp. 436-442
Author(s):  
Jun Heo
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Needle Aspiration ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided ◽  
Fine Needle

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.

Current Concept of Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Cancer

Pancreatology ◽  
2011 ◽  
Vol 11 (2) ◽  
pp. 40-46 ◽  
Author(s):  
Nobumasa Mizuno ◽  
Kazuo Hara ◽  
Susumu Hijioka ◽  
Vikram Bhatia ◽  
Yasuhiro Shimizu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Current Concept ◽  
Ultrasound Guided ◽  
Fine Needle

scholarly journals Pull vs. wet: rendimiento diagnóstico y calidad de las muestras de las PAAF guiadas por USE en las masas sólidas del páncreas

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Cecilia Curvale ◽  
Ignacio Málaga ◽  
Paloma Rojas Saunero ◽  
Viviana Tassi ◽  
Enrique Martins ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Double Blind Study ◽  
Cell Block ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Fine Needle ◽  
Significant Difference

Differential diagnosis of pancreatic masses is challenging. The endoscopic ultrasound-guided fine-needle aspiration method with the highest diagnostic yield has not been established. It was realized a prospective, randomized, double-blind study of the endoscopic ultrasound-guided fine-needle aspiration in solid lesions of the pancreas to compare and evaluate diagnostic yield and aspirate quality between wet and pull technique. Forty-one patients were enrolled. The wet technique presented a sensitivity, a specificity, a positive and negative predictive value, and a diagnostic accuracy of 58.3%, 100%, 100%, 25% and 63.4%, respectively. In the capillary technique they were: 75%, 100%, 100%, 35.7% and 78.1%, respectively. Comparing the diagnostic yield between both techniques, there was no statistically significant difference (McNemar’s test p = 0.388). Regarding the cellularity of the specimen, both in cytology and the cell block samples, no significant difference was observed between the techniques (p = 0.84 and 0.61, respectively). With respect to contaminating blood in the specimen, there was no difference in cytology samples (p = 0.89) and no difference in cell block samples (p = 0.08). The suitability of cytology samples for diagnosis was similar in both techniques (wet = 57.5% and capillary = 56.7%, p = 0.94) and there was no difference in cell block samples (wet = 75% and capillary = 66.1%, p = 0.38). In this study we did not observe differences in diagnostic yield or sample quality. Since both techniques are effective, we suggest the simultaneous and alternate use of both methods.

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