Endoscopic Ultrasound in Borderline & Locally Advanced Pancreatic: Leeds Experience

Abstract

Introduction: Endoscopic ultrasonography (EUS) is an essential pancreatic cancer investigation which has picked up in the last decade and is commonly used in combination with more traditional cross-sectional imaging techniques. Up to 79% of all pancreatic malignancies are locally advanced (stage 3) or metastatic (stage 4) at initial presentation. Developments in technology, such as contrast enhancement, elastography and fine needle aspiration (EUS-FNA) have further increased EUS diagnostic yield. EUS-FNA is accepted as the optimal method of obtaining tissue for histological diagnosis prior to starting neoadjuvant treatment (NAT) and has a lower incidence of complications such as pancreatitis, bleeding and tumour seeding. The aim of this study was to evaluate the role of EUS in advanced pancreatic cancers. Methods: Patients with borderline and locally advanced pancreatic ductal adenocarcinoma between 2016 and 2020 were retrieved from institutional pancreatic tumour database. Patients with IPMN, MCN, periampullary cancers and metastatic pancreatic cancer were excluded. All patients with BRPC, LAPC received NAT. Data of patients undergoing EUS were retrieved and compared with cross-sectional imaging. Appropriate statistical analysis was performed where applicable. Results: 96 patients underwent EUS and FNB. Diagnosis of PDAC was confirmed in 81.25% (78) cases before starting neoadjuvant treatment. Mean tumour size on EUS was 2.7cm as compared to 3cm on CT. CT confirmed N1 disease was seen in 21.6% (26) patients however, in only 2.5% (3) cases local lymphadenopathy was detected using EUS. Vascular involvement was seen in 50.8% (61) cases on CT and only in 44.1% (53) in the EUS group. EUS induced pancreatitis was seen in 3.12% (3) patients. > 2 attempts to confirm tissue diagnosis was seen in 3.84% of patients. Dysplasia, IPMN, Pancreatitis and Suspicious lesions were detected in 1.04%, 2.08%, 1% and 15.62% is suspected PDAC on imaging. There were no EUS induced bleeding or other complications during the study period. Conclusion: EUS has a role in the evaluation of advanced pancreatic malignancies and in assessment of vascular involvement and local lymphadenopathy. It also provides cytological and histological confirmation prior to commencing NAT. EUS-guided therapeutic interventions also provide effective biliary drainage particularly in individuals where ERCP is not feasible.