title: Incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA).
abstract: BACKGROUND
  The lack of accurate markers makes preoperative differentiation between pancreatic cancer and non-malignant head lesions clinically challenging. In this study, we investigated the incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by EUS and EUS-guided FNA.
  
  
  METHODS
  Medical records of consecutive patients who underwent pancreaticoduodenectomy at Duke University were reviewed. Demographics, clinicopathologic characteristics, preoperative imaging, EUS, EUS-guided FNA, and postoperative outcomes were analyzed.
  
  
  RESULTS
  Seven percent of the total 494 patients studied were found to have benign disease on postoperative pathology. Fifty-nine percent of these patients with benign disease underwent preoperative EUS. EUS was positive for a head mass in 70%, demonstrated enlarged lymph nodes in 27%, and showed signs concerning for vascular invasion in 13%. FNA was suspicious or indeterminate for cancer in 63% of patients. Postoperative complications occurred in 47% and one patient died after surgery. The overall pancreatic leak rate was 15%.
  
  
  CONCLUSIONS
  Even with aggressive use of preoperative evaluation, there is still a small subset of patients where malignancy cannot be excluded without pancreaticoduodenectomy.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. delaf002@mc.duke.edu
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: de la Fuente
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Pappas
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D057234:Preoperative Period