BACKGROUND: Management of small and potentially resectable "mass" lesions encountered on CT/MRI scans in patients without obstructive jaundice (ObJ) is rather empirical since there is scant data on likelihood of neoplasm to formulate treatment strategies. We evaluated (1) the prevalence of neoplasm and (2) performance characteristics of EUS-FNA for diagnosing neoplasm in above-mentioned subset of patients. PATIENTS: This is a retrospective analysis of 232 patients (without ObJ) with a focal pancreatic lesion, ≤ 25 mm and potentially resectable on CT/MRI who underwent EUS-FNA from 2002 to 2009. RESULTS: Seventy-five patients (32.3%, 95% CI 26.6, 38.6) were finally diagnosed to have a neoplasm. Four of 92 (4.3%) lesions ≤ 15 mm, 13 of 57(22.8%) lesions 16-20 mm, and 35 of 83 (42.1%) lesions 21-25 mm had an adenocarcinoma. Larger lesion size, older patient age, and h/o recent weight loss significantly increased the likelihood of adenocarcinoma. EUS-FNA had 98.2% overall accuracy and 98.1% NPV with no significant differences based on lesion size. CONCLUSIONS: In nonjaundiced patient with a potentially resectable pancreatic lesion ≤25 mm in size noted on CT/MRI scanning, EUS-FNA can provide useful adjunctive information to optimize the use of surgery and can potentially obviate the need for "wait and watch approach" with repeat imaging in their clinical management.
BACKGROUND: Management of small and potentially resectable "mass" lesions encountered on CT/MRI scans in patients without obstructive jaundice (ObJ) is rather empirical since there is scant data on likelihood of neoplasm to formulate treatment strategies. We evaluated (1) the prevalence of neoplasm and (2) performance characteristics of EUS-FNA for diagnosing neoplasm in above-mentioned subset of patients. PATIENTS: This is a retrospective analysis of 232 patients (without ObJ) with a focal pancreatic lesion, ≤ 25 mm and potentially resectable on CT/MRI who underwent EUS-FNA from 2002 to 2009. RESULTS: Seventy-five patients (32.3%, 95% CI 26.6, 38.6) were finally diagnosed to have a neoplasm. Four of 92 (4.3%) lesions ≤ 15 mm, 13 of 57(22.8%) lesions 16-20 mm, and 35 of 83 (42.1%) lesions 21-25 mm had an adenocarcinoma. Larger lesion size, older patient age, and h/o recent weight loss significantly increased the likelihood of adenocarcinoma. EUS-FNA had 98.2% overall accuracy and 98.1% NPV with no significant differences based on lesion size. CONCLUSIONS: In nonjaundiced patient with a potentially resectable pancreatic lesion ≤25 mm in size noted on CT/MRI scanning, EUS-FNA can provide useful adjunctive information to optimize the use of surgery and can potentially obviate the need for "wait and watch approach" with repeat imaging in their clinical management.
Authors: Jordan M Winter; John L Cameron; Keith D Lillemoe; Kurtis A Campbell; David Chang; Taylor S Riall; Joann Coleman; Patricia K Sauter; Marcia Canto; Ralph H Hruban; Richard D Schulick; Michael A Choti; Charles J Yeo Journal: Ann Surg Date: 2006-05 Impact factor: 12.969
Authors: Marc F Catalano; Anand Sahai; Michael Levy; Joseph Romagnuolo; Maurits Wiersema; William Brugge; Martin Freeman; Kenji Yamao; Marcia Canto; Lyndon V Hernandez Journal: Gastrointest Endosc Date: 2009-02-24 Impact factor: 9.427
Authors: G W Boland; M E O'Malley; M Saez; C Fernandez-del-Castillo; A L Warshaw; P R Mueller Journal: AJR Am J Roentgenol Date: 1999-03 Impact factor: 3.959
Authors: Carlos Micames; Paul S Jowell; Rebekah White; Erik Paulson; Rendon Nelson; Michael Morse; Herbert Hurwitz; Theodore Pappas; Douglas Tyler; Kevin McGrath Journal: Gastrointest Endosc Date: 2003-11 Impact factor: 9.427
Authors: M S Bhutani; F G Gress; M Giovannini; R A Erickson; M F Catalano; A Chak; P H Deprez; D O Faigel; C C Nguyen Journal: Endoscopy Date: 2004-05 Impact factor: 10.093
Authors: A V Sahai; M Zimmerman; L Aabakken; P R Tarnasky; J T Cunningham; A van Velse; R H Hawes; B J Hoffman Journal: Gastrointest Endosc Date: 1998-07 Impact factor: 9.427
Authors: Lawrence Mj Best; Vishal Rawji; Stephen P Pereira; Brian R Davidson; Kurinchi Selvan Gurusamy Journal: Cochrane Database Syst Rev Date: 2017-04-17