Endosonography-guided, fine-needle aspiration cytology extending the indication for organ-preserving pancreatic surgery.
OBJECTIVE
Organ preserving pancreatic resections are considered whenever malignant disease is ruled out. In tumors of low malignant potential such as cystadenomas and neuroendocrine tumors, the diagnosis is rarely established preoperatively. We studied the feasibility of cytodiagnosis using endosonography-guided fine-needle aspiration in determining the operative approach.


METHODS
A total of 78 patients (16 female, 62 male; mean age 61.4 yr, range 31-82 yr) with focal pancreatic lesions underwent EUS-FNA. Final diagnosis was confirmed by histology, cytology, or clinical follow up (>9 months). Patients with tumors of low malignant potential were managed by customized pancreatic resections.


RESULTS
Final diagnosis was malignant tumors in 36 patients, tumors of low malignant potential in nine (six, neuroendocrine, two, borderline mucinous cystadenomas, one, borderline adenocarcinoma), and benign in 31 (two inadequate smears). No complications occurred. With six false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 92%, 84%, 100%, 100%, and 86%, respectively. Five patients with low malignant tumors underwent duodenum-preserving pancreatic head resection, three mid segment resection, and one pylorus-preserving pancreatoduodenectomy.


CONCLUSIONS
EUS-FNA is useful in the preoperative cytodiagnosis of pancreatic tumors of low malignant potential. It extends the indication for organ-preserving pancreatic resections and avoids the unnecessary sacrifice of adjacent organs.
Fritscher-Ravens
A
A
Department of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany.
Izbicki
J R
JR
Sriram
P V
PV
Krause
C
C
Knoefel
W T
WT
Topalidis
T
T
Jaeckle
S
S
Thonke
F
F
Soehendra
N
N
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D018291:Cystadenoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity