Risk of peritoneal carcinomatosis by endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer.
BACKGROUND
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an accurate method for cytological confirmation of pancreatic malignancy, but peritoneal dissemination caused by EUS-FNA could be a matter of concern because it may lead to poorer prognosis. Our aim was to estimate the risk of peritoneal carcinomatosis by EUS-FNA for pancreatic cancer.


METHODS
Two hundred and seventeen patients with cytopathologically proven pancreatic cancer in a tertiary referral center were retrospectively reviewed. They were divided into two groups: 161 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) alone (ERCP group), and 56 patients who had ever undergone EUS-FNA (EUS-FNA group). Peritoneal carcinomatosis was diagnosed by computed tomography and/or cytology during follow-up. Hazard ratios of factors including EUS-FNA for the development of peritoneal carcinomatosis were analyzed by the Cox proportional hazard model.


RESULTS
There was no significant difference in baseline characteristics between ERCP and EUS-FNA groups. Peritoneal carcinomatosis developed in 14.9 % (24/161) during an average follow-up period of 545 days, and 17.9 % (10/56) during 599 days among ERCP and EUS-FNA group, respectively. The EUS-FNA was not identified as a significant risk factor with hazard ratios (HR) of 1.07 [95 % confidence interval (CI) 0.51-2.25, p = 0.85] by univariate analysis and 1.35 (95 % CI 0.62-2.95, p = 0.45) by multivariate analysis. Nodal involvement (HR 2.19, 95 % CI 1.03-4.63, p = 0.04) and non-resection (HR 2.64, 95 % CI 1.11-6.25, p = 0.03) were shown to be statistically significant risk factors by multivariate analysis.


CONCLUSIONS
EUS-FNA for pancreatic cancer did not significantly increase the risk of peritoneal carcinomatosis.
Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. ikezawakenji@gh.med.osaka-u.ac.jp
Kenji
K
Ikezawa
Hiroyuki
H
Uehara
Arata
A
Sakai
Nobuyasu
N
Fukutake
Kazuho
K
Imanaka
Kazuyoshi
K
Ohkawa
Rena
R
Tanakura
Tatsuya
T
Ioka
Sachiko
S
Tanaka
Osamu
O
Ishikawa
Kazuhiro
K
Katayama
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009366:Neoplasm Seeding; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed