Endoscopic ultrasound-guided fine-needle aspiration using helical computerized tomography for TN staging and vascular injury in operable pancreatic carcinoma.
BACKGROUND
EUS-FNA is increasingly being used in operable pancreatic carcinoma cases identified by CT.


OBJECTIVE
Determine the safety, accuracy and clinical utility of EUS-FNA for T, N and TN staging and vascular injury assessment in proven ductal pancreatic carcinoma.


METHODS
Fifty-two consecutive patients (29 women and 23 men) with histologically ductal pancreatic carcinoma, with an excellent possibility of mass resection assessed by helical computerized tomography, were studied. Mean age was 62.4 years (range: 27-82 years). Tumor locations were in the head (43 cases), body (5 cases) and tail (4 cases) of the pancreas. Mean tumor size from EUS was 3.7 cm (range: 0.8-6.2 cm).


METHODS
We reviewed medical records and abdominal ultrasound, CT, EUS-FNA and the results were compared to surgical and histological findings.


RESULTS
Ultrasound identified pancreatic abnormalities in 38 out of 52 patients (73.1%): pancreatic mass (25 cases), pancreatic head enlargement (8 cases), dilation of main pancreatic duct (3 cases), pancreatic cyst (1 case) and pancreatic calcification (1 case). CT showed a pancreatic mass (30 cases), pancreatic enlargement (17 cases), pancreatic cystic lesion (2 cases) and pancreatic calcification (1 case) in 50 out of 52 patients (96.2%). EUS-FNA found a clear pancreatic tumor image in all patients (100%). The accuracy of EUS for evaluating portal blood vessels, superior mesenteric artery, T alone, N alone and combined TN staging was 86.5%, 94.2%, 84.7%, 67.3% and 55.8%, respectively. In addition to cytological material from 50 patients, microfragments from 43 patients were sent for histological analysis. Two patients (3.8%) showed minor complications: self-limited bleeding and acute pancreatitis.


CONCLUSIONS
EUS-FNA is safe, and can help gastroenterologists and surgeons make surgical decisions regarding pancreatic carcinoma patients.
Ardengh
José Celso
JC
Division of Anatomy and Surgery, Ribeirão Preto School of Medicine, University of São Paulo, Hospital 9 de Julho, São Paulo, Brazil. jcelso@uol.com.br
Malheiros
Carlos Alberto
CA
Pereira
Victor
V
Coelho
Djalma Ernesto
DE
Coelho
José Flávio
JF
Rahal
Fares
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000601:surgery*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010179:Pancreas / Q000098:blood supply / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed