OBJECTIVE: Organ preserving pancreatic resections are considered whenever malignant disease is ruled out. In tumors of low malignant potential such as cystadenomas and neuroendocrine tumors, the diagnosis is rarely established preoperatively. We studied the feasibility of cytodiagnosis using endosonography-guided fine-needle aspiration in determining the operative approach. METHODS: A total of 78 patients (16 female, 62 male; mean age 61.4 yr, range 31-82 yr) with focal pancreatic lesions underwent EUS-FNA. Final diagnosis was confirmed by histology, cytology, or clinical follow up (>9 months). Patients with tumors of low malignant potential were managed by customized pancreatic resections. RESULTS: Final diagnosis was malignant tumors in 36 patients, tumors of low malignant potential in nine (six, neuroendocrine, two, borderline mucinous cystadenomas, one, borderline adenocarcinoma), and benign in 31 (two inadequate smears). No complications occurred. With six false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 92%, 84%, 100%, 100%, and 86%, respectively. Five patients with low malignant tumors underwent duodenum-preserving pancreatic head resection, three mid segment resection, and one pylorus-preserving pancreatoduodenectomy. CONCLUSIONS: EUS-FNA is useful in the preoperative cytodiagnosis of pancreatic tumors of low malignant potential. It extends the indication for organ-preserving pancreatic resections and avoids the unnecessary sacrifice of adjacent organs.
OBJECTIVE: Organ preserving pancreatic resections are considered whenever malignant disease is ruled out. In tumors of low malignant potential such as cystadenomas and neuroendocrine tumors, the diagnosis is rarely established preoperatively. We studied the feasibility of cytodiagnosis using endosonography-guided fine-needle aspiration in determining the operative approach. METHODS: A total of 78 patients (16 female, 62 male; mean age 61.4 yr, range 31-82 yr) with focal pancreatic lesions underwent EUS-FNA. Final diagnosis was confirmed by histology, cytology, or clinical follow up (>9 months). Patients with tumors of low malignant potential were managed by customized pancreatic resections. RESULTS: Final diagnosis was malignant tumors in 36 patients, tumors of low malignant potential in nine (six, neuroendocrine, two, borderline mucinous cystadenomas, one, borderline adenocarcinoma), and benign in 31 (two inadequate smears). No complications occurred. With six false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 92%, 84%, 100%, 100%, and 86%, respectively. Five patients with low malignant tumors underwent duodenum-preserving pancreatic head resection, three mid segment resection, and one pylorus-preserving pancreatoduodenectomy. CONCLUSIONS: EUS-FNA is useful in the preoperative cytodiagnosis of pancreatic tumors of low malignant potential. It extends the indication for organ-preserving pancreatic resections and avoids the unnecessary sacrifice of adjacent organs.
Authors: Chiang J Tyng; Maria Fernanda A Almeida; Paula N V Barbosa; Almir G V Bitencourt; José Augusto A G Berg; Macello S Maciel; Felipe J F Coimbra; Luiz Henrique O Schiavon; Maria Dirlei Begnami; Marcos D Guimarães; Charles E Zurstrassen; Rubens Chojniak Journal: World J Gastroenterol Date: 2015-03-28 Impact factor: 5.742
Authors: Paulus G Schurr; Tim Strate; Kim Rese; Jussuf T Kaifi; Uta Reichelt; Susanne Petri; Helge Kleinhans; Emre F Yekebas; Jakob R Izbicki Journal: Ann Surg Date: 2007-02 Impact factor: 12.969
Authors: Kyung W Noh; Timothy A Woodward; Massimo Raimondo; Alan D Savoy; Surakit Pungpapong; Joy D Hardee; Michael B Wallace Journal: Dig Dis Sci Date: 2007-03-01 Impact factor: 3.199
Authors: Peter Herbert Kann; Roland Moll; Detlef Bartsch; Andreas Pfützner; Thomas Forst; Gianluca Tamagno; Joachim N Goebel; Verena Fourkiotis; Simona Raluca Bergmann; Maike Collienne Journal: Endocrine Date: 2016-11-30 Impact factor: 3.633