Endoscopic Ultrasonography–Guided Fine-Needle Aspiration Biopsy of Suspected Pancreatic Cancer

Abstract

A 50-year-old man was referred to our hospital for the further evaluation of a pancreatic mass. Contrast-enhanced computed abdominal tomography (CE-CT) showed a 35-mm solid mass in the pancreatic body with soft tissue around the tumor extending to the celiac plexus. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for the pancreatic mass was performed (21-G needle, 3 passes) via the trans-gastric approach, confirming the diagnosis of adenocarcinoma. CE-CT indicated celiac plexus invasion , and chemotherapy was administered for 8 months, during which the tumor size was reduced. However, CE-CT showed soft tissue density (arrow) between the stomach and pancreatic tumor (T) (1). EUS also showed soft tissue (ar-row) from the stomach serosa (asterisk) to the pancreatic tumor (T) (2). Possible needle tract seeding was considered. We therefore planned distal pancreatectomy and partial stomach resection. The pathological findings of the resected specimen showed a pancreatic adenocarcinoma 25 mm in

Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma

“…20 In the current study, 10.9% of pancreatic aspirates were reported as either atypical or suspicious. This compares with 7.8% 23 and an 8% rate of atypical/suspicious diagnosis from other centers. 20 All suspicious cytologic diagnoses were confirmed subsequently to be malignant.…”

“…13,17 EUS-FNAB can be utilized as a rescue modality when other techniques fail. 23 Increased yield and cellularity, which are required for adequate interpretation, are a consequence of the technique utilized, the operator, and the presence of a cytopathologist in the EUS suite. In one study, the diagnostic accuracy of neuroendocrine tumors by EUS-FNAB in the absence of a cytopathologist on site was only 47%.…”

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

“…120 Several studies have assessed EUS-FNA receiver operating characteristics by including only pancreatic cancer patients. [121][122][123][124][125][126][127][128][129][130][131][132] The initial reports showed a sensitivity of 85-95%, with a specificity close to 100%. 3, [121][122][123][124][125] The reports from the past 5 years also showed a high sensitivity of the procedure between 80% and 95%, with a specificity of 100%.…”

Immunogene Zelltodmarker HMGB1 und sRAGE als neue prädiktive und prognostische Serum Biomarker bei Tumorerkrankungen/Immunogenic cell death markers HMGB1 and sRAGE as new predictive and prognostic serum biomarkers in cancer disease

“…Allerdings unterliegt auch die Beurteilung des Therapieansprechens in den bildgebenden Verfahren relevanten Einschr ä nkungen: Die Sonografie ist stark Untersucher-abh ä ngig und in Schnittbildverfahren k ö nnen Umgebungsreaktionen wie z.B. eine desmoplastische Stromareaktion oder Bestrahlungsnarben die Gr ö ß enbestimmung einer Tumorl ä sion erschweren [6,7] . Die in den RECIST-Kriterien verwendete eindimensionale Ausmessung des Tumors kann f ä lschlicherweise auch zur Untersch ä tzung des Therapieansprechens f ü hren, wenn der Tumor inhomogen einschmilzt, abgestorbenes Tumorgewebe nicht abger ä umt wird oder der Tumor bei stabilem Volumen nur an metabolischer Aktivit ä t verliert [8] .…”