Abstract
BackgroundEUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions.The aim of this study was to compare approaches among involved/relevant physicians to the controversies surrounding the use of FNA in EUS.MethodsA five-case survey was developed, piloted, and validated. It was collected from a total of 101 physicians, who were all either gastroenterologists (GIs), surgeons or oncologists. The survey compared the management strategies chosen by members of these relevant disciplines regarding EUS-guided FNA.ResultsFor CT operable T2NOM0 pancreatic tumors the research demonstrated variance as to whether to undertake EUS-guided FNA, at p < 0.05. For inoperable pancreatic tumors 66.7% of oncologists, 62.2% of surgeons and 79.1% of GIs opted for FNA (p < 0.05). For cystic pancreatic lesions, oncologists were more likely to send patients to surgery without FNA. For stable simple pancreatic cysts (23 mm), most physicians (66.67%) did not recommend FNA. For a submucosal gastric 19 mm lesion, 63.2% of surgeons recommended FNA, vs. 90.0% of oncologists (p < 0.05).ConclusionsControversies as to ideal application of EUS-FNA persist. Optimal guidelines should reflect the needs and concerns of the multidisciplinary team who treat patients who need EUS-FNA. Multi-specialty meetings assembled to manage patients with these disorders may be enlightening and may help develop consensus.
Highlights
EUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions
The groups were subdivided into two categories: Those who treat the relevant patients by themselves and those who do not. 55% of surgeons, 35% of oncologists, and 16.3% of gastroenterologists personally treat these patients
As demonstrated in the first case, for T2N0MO pancreatic lesions, in contrast to gastroenterologist and oncologist opinions (73.389.5%), only 51.4 percent of surgeons wrote that FNA is indicated prior to surgery
Summary
EUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions. Pancreatic cancer (PCA) is the fourth leading cause of cancer-related death in the United States [1]. It is considered challengingly difficult both to diagnose early and to treat. Pancreatic solid tumors are often malignant, with adenocarcinoma being the most prevalent histological form. The less common pancreatic malignancies, Several methods are used for detecting and diagnosing pancreatic lesions. Understaging results regarding the resectability of pancreatic tumors leads to undertaking futile and dangerous operations [3,4]. Overstaging of a pancreatic tumor by any of these methods (all of which have some proven fallibility) would lead to a potentially operable lesion being treated with only palliative measures, essentially ‘giving up’ on rescuing the patient’s life, or lead to unnecessary neoadjuvant therapies
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