INTRODUCTION: 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.
INTRODUCTION: 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: Gavin C Harewood; Lisa M Wiersema; Amy C Halling; Gary L Keeney; Diva R Salamao; Maurits J Wiersema Journal: Gastrointest Endosc Date: 2002-05 Impact factor: 9.427
Authors: John Dewitt; Benedict M Devereaux; Glen A Lehman; Stuart Sherman; Thomas F Imperiale Journal: Clin Gastroenterol Hepatol Date: 2006-05-03 Impact factor: 11.382
Authors: M Barthet; P Hastier; M J Buckley; J P Bernard; B Sastre; J L Baroni; J Salducci; J Delmont Journal: Pancreas Date: 1998-11 Impact factor: 3.327
Authors: Naoki Takahashi; Joel G Fletcher; David M Hough; Jeff L Fidler; Akira Kawashima; Jayawant N Mandrekar; Suresh T Chari Journal: AJR Am J Roentgenol Date: 2009-08 Impact factor: 3.959
Authors: Marianne J van Heerde; J Buijs; B E Hansen; M de Waart; C H J van Eijck; G Kazemier; C J Pek; J W Poley; M J Bruno; E J Kuipers; H R van Buuren Journal: Dig Dis Sci Date: 2014-01-03 Impact factor: 3.199
Authors: Yi Dong; Mirko D'Onofrio; Michael Hocke; Christian Jenssen; Andrej Potthoff; Nathan Atkinson; Andre Ignee; Christoph F Dietrich Journal: Endosc Ultrasound Date: 2018 May-Jun Impact factor: 5.628
Authors: M J van Heerde; K Biermann; P E Zondervan; G Kazemier; C H J van Eijck; C Pek; E J Kuipers; H R van Buuren Journal: Dig Dis Sci Date: 2012-05-16 Impact factor: 3.199
Authors: Shadi S Yarandi; Thomas Runge; Lei Wang; Zhijian Liu; Yueping Jiang; Saurabh Chawla; Kevin E Woods; Steven Keilin; Field F Willingham; Hong Xu; Qiang Cai Journal: Diagn Ther Endosc Date: 2014-06-05
Authors: Muhammad Nadeem Yousaf; Fizah S Chaudhary; Amrat Ehsan; Alejandro L Suarez; Thiruvengadam Muniraj; Priya Jamidar; Harry R Aslanian; James J Farrell Journal: BMJ Open Gastroenterol Date: 2020-05