Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA.
BACKGROUND
Studies have suggested an increased risk of peritoneal seeding in patients with pancreatic cancer diagnosed by percutaneous FNA. EUS-FNA is an alternate method of diagnosis. The aim of this study was to compare the frequency of peritoneal carcinomatosis as a treatment failure pattern in patients with pancreatic cancer diagnosed by EUS-FNA vs. percutaneous FNA.


METHODS
Retrospective review of patients with non-metastatic pancreatic cancer identified 46 patients in whom the diagnosis was made by EUS-FNA and 43 with the diagnosis established by percutaneous FNA. All had neoadjuvant chemoradiation. Patients underwent restaging CT after completion of therapy, followed by attempted surgical resection if there was no evidence of disease progression.


RESULTS
There were no significant differences in tumor characteristics between the two study groups. In the EUS-FNA group, one patient had developed peritoneal carcinomatosis compared with 7 in the percutaneous FNA group (2.2% vs. 16.3%; p<0.025). No patient with a potentially resectable tumor in the EUS-FNA group had developed peritoneal carcinomatosis.


CONCLUSIONS
Peritoneal carcinomatosis may occur more frequently in patients who undergo percutaneous FNA compared with those who have EUS-FNA for the diagnosis of pancreatic cancer. A concern for peritoneal seeding of pancreatic cancer via percutaneous FNA is warranted. EUS-guided FNA is recommended as the method of choice for diagnosis in patients with potentially resectable pancreatic cancer.
Duke University Medical Center, Department of Medicine, Durham, North Carolina 27710, USA.
Carlos
C
Micames
Paul S
PS
Jowell
Rebekah
R
White
Erik
E
Paulson
Rendon
R
Nelson
Michael
M
Morse
Herbert
H
Hurwitz
Theodore
T
Pappas
Douglas
D
Tyler
Kevin
K
McGrath
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000009:adverse effects* / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000209:etiology*; D012189:Retrospective Studies