Abstract
BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for mucinous cystic neoplasm of the pancreas carries a potential risk of inducing peritoneal tumor cell dissemination. We investigated the diagnostic yield and safety of EUS-FNA-based cytology of cells obtained from the pancreatic invasion site of intraductal papillary-mucinous neoplasm-derived adenocarcinoma (IPMC).MethodsWe included 22 surgically resected IPMCs and 84 pancreatic ductal adenocarcinomas (PDACs). Among the IPMC cases, 14 did not undergo EUS-FNA before surgical resection. The diagnostic yield of EUS-FNA was compared between IPMC and PDAC. Additionally, prognosis (relapse-free and overall survival time after resection) and the rate of peritoneal dissemination were compared among IPMC with EUS-FNA, IPMC without EUS-FNA, and PDAC. A survival analysis was performed using the Kaplan-Meier method and log-rank test.Results(EUS-FNA diagnosis) There were no significant differences in the number of needle passages (PDAC 2.5 vs. IPMC 2.0 passages, P = 0.84) or puncture route (stomach/duodenum: 2/6 vs. 45/39, P = 0.29). However, the correct diagnosis rate was significantly higher in PDAC (92.9%) than in IPMC (62.5%) (P = 0.03). No procedure-related adverse events occurred. Peritoneal lavage cytology performed during the operation was negative in all cases. (Prognosis) Among IPMC with EUS-FNA, IPMC without EUS-FNA, and PDAC, there were no significant differences in relapse-free survival (21.0 vs. 22.4 vs. 12.5 months, respectively; P = 0.64) or overall survival time (35.5 vs. 53.1 vs. 35.9 months, respectively; P = 0.42), and peritoneal dissemination was detected during the observation period in 25%, 28.5%, and 21.4% cases, respectively (P = 0.82).ConclusionEven though a correct diagnosis was more difficult to obtain in IPMC than in PDAC, IPMC allows specimens to be obtained without influencing the rate of recurrence and prognosis.
Highlights
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for mucinous cystic neoplasm of the pancreas carries a potential risk of inducing peritoneal tumor cell dissemination
The correct diagnosis rate was significantly lower in intraductal papillary-mucinous neoplasm-derived adenocarcinoma (IPMC) than Pancreatic ductal adenocarcinoma (PDAC) (62.5% vs. 92.9%, P = 0.03) (Table 2)
EUS-FNA Endoscopic ultrasound-guided fine needle aspiration, IPMC Intraductal papillary mucinous neoplasm-derived adenocarcinoma, PDAC Pancreatic ductal adenocarcinoma Data was shown in median
Summary
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for mucinous cystic neoplasm of the pancreas carries a potential risk of inducing peritoneal tumor cell dissemination. We investigated the diagnostic yield and safety of EUS-FNA-based cytology of cells obtained from the pancreatic invasion site of intraductal papillary-mucinous neoplasm-derived adenocarcinoma (IPMC). EUS-FNA is a standard technique used to obtain cystic fluid from IPMNs that has better sensitivity (64.8%) than is obtained using ERCP-based cytology; this procedure carries a potential risk of tumor cell dissemination and is considered contraindication in Japan [9]. To maximize the diagnostic yield of EUS-FNA in pancreatic lesions, we performed EUS-FNA at the pancreatic invasion site of IPMN-derived adenocarcinomas (IPMCs) while avoiding puncturing the cystic component of the disease. We aimed to determine the diagnostic yield and prognostic influence of EUS-FNA used in IPMC in our cases
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