Role of ERCP in the era of EUS-FNA for preoperative cytological confirmation of resectable pancreatic ductal adenocarcinoma.
OBJECTIVE
In patients with pancreatic ductal carcinoma (PDAC), EUS-FNA carries a risk of cancer seeding. To avoid this risk, we attempted to obtain preoperative cytological confirmation of adenocarcinoma by ERCP. The aim of this study was to assess the validity of our diagnostic strategy.


METHODS
The medical records of 124 consecutive patients who were investigated for potentially resectable PDAC were retrospectively reviewed, and the ability to detect adenocarcinoma by ERCP was evaluated.


RESULTS
ERCP was performed in 115 patients, 69 of whom had positive cytology results. Thirty-four patients underwent EUS-FNA, 29 of whom had positive cytology results. A total of 98 patients (79 %), therefore, had preoperative cytological confirmation of adenocarcinoma, which was more frequent in patients with lesions of the head of the pancreas than in those with lesions of the body or tail of the pancreas. The postoperative pathological diagnosis demonstrated malignant pancreatic neoplasms in 122 patients (98 %), including 111 with PDAC. EUS-FNA did not affect the rate of postoperative peritoneal dissemination.


CONCLUSIONS
Our strategy using ERCP as the initial diagnostic modality for obtaining cytological confirmation of potentially resectable PDAC seems to be adequate, yielding a high rate of positive cytology, especially in cases with tumors of the head of the pancreas.
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, takao-o@surg1.med.kyushu-u.ac.jp.
Takao
T
Ohtsuka
Koji
K
Tamura
Noboru
N
Ideno
Teppei
T
Aso
Yosuke
Y
Nagayoshi
Hiroshi
H
Kono
Junji
J
Ueda
Shunichi
S
Takahata
Akira
A
Aso
Hisato
H
Igarashi
Tetsuhide
T
Ito
Yasuhiro
Y
Ushijima
Fumihiko
F
Ookubo
Yoshinao
Y
Oda
Kazuhiro
K
Mizumoto
Masao
M
Tanaka
D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003581:Cytodiagnosis / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012306:Risk