Endoscopic ultrasound for peripancreatic masses.
BACKGROUND
Pancreatic neoplasms can be difficult to diagnose and stage preoperatively. Accurate staging allows the surgeon to select which patients can benefit from resection versus palliative therapy. Endoscopic ultrasound (EUS) with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a diagnostic modality that provides visualization of peripancreatic tumors and their relationship to the surrounding structures as well as enabling cytologic diagnosis of the tumor and adjacent lymphadenopathy.


METHODS
To define the role of this technique, a retrospective study was performed on 20 patients in the past year with peripancreatic tumors.


RESULTS
Twelve men and 8 women ranging in age from 28 to 84 years (mean 67) were included in the study. Each patient underwent computed tomography followed by EUS-FNA, and the results were compared with operative findings or clinical course. The EUS-FNA findings included 10 pancreatic ductal carcinomas (50%), 5 pancreatitis (25%), 2 spindle cell neoplasms (10%), 1 cholangiocarcinoma (5%), 1 cystadenoma (5%), and 1 metastatic breast carcinoma (5%). Overall, EUS-FNA led to a significant change in the management of 12 patients (60%) through either diagnosing benign pathology, upstaging of the carcinoma, or determination that the peripancreatic mass represented a metastatic lesion. Five patients underwent resection of their peripancreatic tumors, and 3 patients had palliative procedures. Operative findings corresponded with EUS-FNA in all 8 patients. The 5 patients diagnosed with pancreatitis continued to be followed up for the possibility of a false negative FNA, but to date none have developed malignancy.


CONCLUSIONS
EUS-FNA is a useful tool for the imaging and staging of peripancreatic tumors and will aid in the proper preoperative selection of patients who will benefit from resectional therapy.
Frazee
R C
RC
Department of Surgery, Scott & White Clinic and Memorial Hospital, Texas A&M University Health Science Center, College of Medicine, Temple 76508, USA.
Singh
H
H
Erickson
R A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D002277:Carcinoma / Q000000981:diagnostic imaging; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010195:Pancreatitis / Q000000981:diagnostic imaging; D018579:Patient Selection; D018084:Ultrasonography, Interventional