Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration.
BACKGROUND
We assessed the incidence and outcome of pancreaticoduodenectomy for patients with a pre-operative benign diagnosis and in patients who had an unexpected diagnosis of benign disease following resection. We have also compared how the introduction of endoscopic ultrasound fine needle aspiration (EUS-FNA) has altered our pre-operative assessment.


METHODS
Between January 1997 and April 2006, 499 patients underwent pancreaticoduodenectomy at the Queen Elizabeth Hospital. Data were collected prospectively. A further 85 patients between 2006 and 2008 had a different diagnostic approach (after imaging these patients have been also studied by EUS-FNA).


RESULTS
Overall, 78 (15.6%) patients had no malignant disease on final histology. Out of 459 patients who underwent pancreaticoduodenectomy for presumed malignancy, 49 (10.6%) had benign disease (sensitivity, 97%; positive predictive value, 89%). In a further 40 patients with a pre-operative benign diagnosis, we found 11 cases (27%) of malignancy (sensitivity, 37%; negative predictive value, 72%). Following the introduction of EUS-FNA, the sensitivity and specificity of the diagnostic work were 92% and 75%, respectively (positive predictive value, 93%; negative predictive value, 63%). The median follow-up was 35 months (range, 1-116 months).


CONCLUSIONS
Prior to the introduction of EUS-FNA, a significant number of patients, in whom pancreaticoduodenectomy is carried out for suspected benign disease, turn out to have an underlying malignancy. The use of EUS-FNA has improved the specificity of diagnostic work-up.
Manzia
Tommaso Maria
TM
The Liver Unit, Queen Elizabeth University Hospital, Birmingham, UK.
Toti
Luca
L
Lenci
Ilaria
I
Attia
Magdy
M
Tariciotti
Laura
L
Bramhall
Simon R
SR
Buckels
John A C
JA
Mirza
Darius F
DF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
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