Abstract
s / Pancreatolog Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Background: EUS-FNA has recently taken the place of ERCP for the assessment of various pancreatic diseases; however, in case of possibly resectable PDAC, there might be a risk of seeding of cancer cells and dissemination during EUS-FNA. Thus, we have been attempting to get a preoperative cytological confirmation of PDAC by ERCP first, then followed by EUS-FNA only in unsuccessful cases. The aim of this study was to assess the validity of our diagnostic strategy. Methods: Medical records of consecutive 98 patients diagnosed as having possibly resectable PDAC from 2010 to 2011 were retrospectively reviewed, and abilities to detect cancer cells (class IV or V) of ERCP and EUS-FNA were evaluated. Results: ERCP were performed in 90 patients, 55 of whom (63%) showed positive cancer cells. On the other hand, 23 patients underwent EUS-FNA, and 22 (96%) demonstrated positive results. Post-ERCP pancreatitis developed in 8 patients (9%), all of which were mild, while there was no adverse event after EUS-FNA. A total of 81 patients (83%) had preoperative confirmation of the cancer cells, and the confirmation rate was higher in pancreas head lesions (91%, 64/70) than in body to tail (61%, 17/28, p<0.01). Ninety-six patients (98%) had final diagnosis of cancer after operation (93 PDACs, 2 bile duct cancers, and one neuroendocrine carcinoma), while the other 2 without preoperative cytological confirmation had PanIN-II and autoimmune pancreatitis. Conclusion: Our strategy using “ERCP first” to get cytological confirmation for possibly resectable PDAC seems to be adequate with the high confirmation rate and low morbidity. Further investigation is necessary to clarify whether EUS-FNA might really affect postoperative outcomes.
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