Abstract
BackgroundTumor biopsy for histological diagnosis is required preoperatively and before initiating chemotherapy or radiation therapy for patients with pancreatic cancer (Cancer of the Pancreas: Clinical Practice Guidelines, European Society for Medical Oncology). Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is widely applied to obtain tissue samples for histological examination. However, in some cases, EUS-FNA cannot be performed safely or tissue samples are insufficient to establish a definitive diagnosis. We present two cases of pancreatic cancer diagnosed by open surgical biopsy after EUS-FNA failed to yield a diagnosis.Case presentationCase 1 was a 50-year-old man. Computed tomography showed a hypovascular lesion in the uncus of the pancreas. Although EUS-FNA was conducted twice, we could not collect enough quantity of tissue samples to establish a definitive diagnosis. Open surgical biopsy revealed adenocarcinoma, and the patient underwent preoperative chemoradiation therapy followed by curative operation. Case 2 was a 68-year-old man. Computed tomography showed a hypovascular tumor in the uncus of the pancreas. EUS revealed a 14-mm hypoechoic lesion, but we could not perform EUS-FNA because the superior mesenteric vein was located in the puncture line. Open surgical biopsy revealed adenocarcinoma, and the patient underwent preoperative chemoradiation therapy followed by pancreaticoduodenectomy.ConclusionsEUS-FNA is the first choice in the diagnostic modalities of pancreatic neoplasm, but open surgical biopsy is an effective diagnostic method if EUS-FNA is unsuccessful.
Highlights
Tumor biopsy for histological diagnosis is required preoperatively and before initiating chemotherapy or radiation therapy for patients with pancreatic cancer (Cancer of the Pancreas: Clinical Practice Guidelines, European Society for Medical Oncology)
The European Society for Medical Oncology (ESMO) clinical guidelines for cancer of the pancreas state that histological diagnosis by tumor biopsy is indicated for patients before initiating chemotherapy or chemoradiation therapy (CRT)
The sensitivity and specificity of Endoscopic ultrasound fine-needle aspiration (EUS-fine-needle aspiration (FNA)) for pancreatic neoplasms are reported as 64– 85 and 90–100%, respectively [9, 13], and the diagnostic accuracy is reported as 78–95% [7, 8]
Summary
Tumor biopsy for histological diagnosis is required preoperatively and before initiating chemotherapy or radiation therapy for patients with pancreatic cancer (Cancer of the Pancreas: Clinical Practice Guidelines, European Society for Medical Oncology). Tumor biopsy was indicated for patients who required a histological diagnosis of malignant disease, preoperatively and before initiating chemotherapy or chemoradiation therapy (CRT). In some patients, EUS-FNA cannot be performed safely because blood vessels or the main pancreatic duct are located along the puncture route or because the lesion cannot be detected by EUS [9, 10].
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