Adjuvant surgery following chemotherapy with gemcitabine plus S-1 for initially unresectable pancreatic cancer diagnosed during perioperative re-evaluation

Abstract

Introduction: Endoscopic Ultrasound (EUS) with fine-needle aspiration (FNA) is an important tool for the study and diagnosis of pancreatic masses. We know that a rapid on-site evaluation (ROSE) of pancreatic masses samples increase the diagnostic accuracy to over 90%. In the abscense of ROSE, we don't know if these results could be achieved by an EUS-FNA experienced endoscopist. Aims: To evaluate the diagnostic accuracy of USE-FNA in the study of pancreatic masses in the presence and abscense of ROSE and the role of the endoscopist experience. Patients & methods: We performed 379 USE-FNA procedures from January 2007 to may 2014 in patients with pancreatic solid masses. Finally we included 375 procedures. 67.3% were male and the mean age was 62.8 (12.7) years. Results: We found 298 (79.5%) malign lesions (adenocarcinoma 253, neuroendocrin 26, others 19) and 77 (20.5%) benign lesions. 162 (43.2%) procedures were performed with ROSE. The global diagnostic accuracy was 89.3%. Diagnostic accuracy was 93.8% with ROSE and 85.95% without ROSE, p1⁄40.0014. However, the diagnostic accuracy was significantly higher with ROSE at the beginning: 92.6% vs 88%, p1⁄40.014, comparing with the last years when there were no differences with and without ROSE, 97.5% vs 88%, p1⁄40.074. Conclusion: We show that the diagnostic accuracy for USE-FNA in the study of solid pancreatic masses increases with the experience of both pathologist and endoscopist. However, USE-FNA with ROSE is still necessary to get a diagnostic accuracy over 90%.