Masayuki Kitano1, Makoto Yoshida2, Reiko Ashida3, Emiri Kita4, Akio Katanuma5, Takao Itoi6, Rintaro Mikata7, Kenichiro Nishikawa8, Hiroyuki Matsubayashi9, Yukiko Takayama10, Hironari Kato11, Mamoru Takenaka12, Toru Ueki13, Yohei Kawashima14, Yousuke Nakai15, Shinichi Hashimoto16, Minoru Shigekawa17, Hiroko Nebiki18, Hidetaka Tsumura19, Yosinobu Okabe20, Shomei Ryozawa21, Yoshiyuki Harada22, Akira Mitoro23, Tamito Sasaki24, Hiroaki Yasuda25, Natsuki Miura26, Tetsuya Ikemoto27, Eisuke Ozawa28, Kazuhiko Shioji29, Atsushi Yamaguchi30, Toru Okuzono31, Ichiro Moriyama32, Hiroyuki Hisai33, Koichi Fujita34, Takuma Goto35, Nakao Shirahata36, Yoshinori Iwata37, Yoshihiro Okabe38, Kazuo Hara39, Yusuke Hashimoto40, Masaki Kuwatani41, Hiroyuki Isayama42, Nao Fujimori43, Atsushi Masamune44, Keiichi Hatamaru1, Toshio Shimokawa45, Kazuichi Okazaki46, Yoshifumi Takeyama47, Hiroki Yamaue48. 1. Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan. 2. Medical Oncology, Sapporo Medical University Hospital, Hokkaido, Japan. 3. Departments of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan. 4. Gastroenterology, Chiba Cancer Center, Chiba, Japan. 5. Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan. 6. Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 7. Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan. 8. Department of Gastroenterology, Matsusaka Municipal Hospital, Mie, Japan. 9. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 10. Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan. 11. Gastroenterology, Okayama University Hospital, Okayama, Japan. 12. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan. 13. Internal Medicine, Fukuyama City Hospital, Hiroshima, Japan. 14. Division of Gastroenterology, Tokai University School of Medicine, Kanagawa, Japan. 15. Department of Gastroenterology, The University of Tokyo Hospital, Tokyo, Japan. 16. Digestive and Lifestyle Diseases, Kagoshima University, Kagoshima, Japan. 17. Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan. 18. Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan. 19. Gastroenterological Oncology, Hyogo Cancer Center, Hyogo, Japan. 20. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan. 21. Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan. 22. Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 23. Gastroenterology, Nara Medical University, Nara, Japan. 24. Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan. 25. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 26. Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. 27. Department of Digestive and Transplant Surgery, Tokushima University Hospital, Tokushima, Japan. 28. Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan. 29. Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan. 30. Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan. 31. Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan. 32. Department of Medical Oncology, Shimane University Hospital, Shimane, Japan. 33. Department of Gastroenterology, Japanese Red Cross Date Hospital, Hokkaido, Japan. 34. Department of Gastroenterology and Hepatology, Yodogawa Christian Hospital, Osaka, Japan. 35. Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan. 36. Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan. 37. Division of Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan. 38. Department of Gastroenterology, Kakogawa Central City Hospital, Hyogo, Japan. 39. Gastroenterology, Aichi Cancer Center, Aichi, Japan. 40. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center hospital East, Chiba, Japan. 41. Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Hokkaido, Japan. 42. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan. 43. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 44. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan. 45. Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan. 46. Director, Kansai Medical University Kori Hospital, Osaka, Japan. 47. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan. 48. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Abstract
OBJECTIVES: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. METHODS: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. RESULTS: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P=0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P=0.037). CONCLUSIONS: NTS appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy. This article is protected by copyright. All rights reserved.
OBJECTIVES: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. METHODS: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. RESULTS: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P=0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P=0.037). CONCLUSIONS: NTS appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy. This article is protected by copyright. All rights reserved.