Non‐negligible rate of needle tract seeding after endoscopic ultrasound‐guided fine‐needle aspiration for patients undergoing distal pancreatectomy for pancreatic cancer

Abstract

Background and aims Needle tract seeding after preoperative endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) for pancreatic body and tail cancer has been reported. This study aimed to investigate the long‐term outcomes, including the needle tract seeding ratio, of patients undergoing distal pancreatectomy for pancreatic body and tail cancer diagnosed preoperatively by EUS‐FNA. Methods This retrospective, observational cohort study assessed patients from three university hospitals and 11 tertiary referral centers. All patients who underwent distal pancreatectomy for invasive cancer of the pancreatic body and tail between January 2006 and December 2015 were identified and reviewed. Needle tract seeding rate, recurrence‐free survival (RFS), and overall survival (OS) were evaluated. Results Of the 301 total patients analyzed, 176 underwent preoperative EUS‐FNA (EUS‐FNA group) and 125 did not (non‐EUS‐FNA group). The median follow‐up periods of the EUS‐FNA group and non‐EUS‐FNA group were 32.8 and 30.1 months. Six patients (3.4%) in the EUS‐FNA group were diagnosed as having needle tract seeding. The 5‐year cumulative needle tract seeding rate estimated using Fine and Gray's method was 3.8% (95% CI 1.6–7.8%). The median RFS or OS was not significantly different between the EUS‐FNA group and the non‐EUS‐FNA group (23.7 vs 16.9 months: P = 0.205; 48.0 vs 43.9 months: P = 0.392). Conclusion Although preoperative EUS‐FNA for pancreatic body and tail cancer has no negative effect on RFS or OS, needle tract seeding after EUS‐FNA was observed to have a non‐negligible rate. (UMIN000030719)

Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition

“…On the contrary, there are some reports revealing that preoperative EUS-FNA for patients with pancreatic cancer does not affect the postoperative survival, needle tract seeding, or peritoneal recurrence[ 35 - 39 ]. For example, Yane et al[ 40 ] have assessed whether preoperative EUS-FNA in patients with pancreatic cancer increases the risk of stomach or peritoneal recurrence, and whether it affects the patient’s recurrence-free survival and overall survival in a retrospective study. In this retrospective study, there were 301 patients undergoing distal pancreatectomy due to invasive pancreatic cancer from January 2006 to December 2015.…”

“…A total of 176 patients received preoperative EUS-FNA, and 34 patients had a peritoneal recurrence (including 18 patients in the non-EUS-FNA group and 16 patients in the EUS-FNA group). Multivariate analysis did not find a significant correlation between the preoperative EUS-FNA and recurrence of stomach or peritoneal tumors[ 40 ]. To date, similar results have been obtained in the other eight retrospective studies[ 8 , 35 , 36 , 38 , 39 , 41 - 43 ].…”

“…Since the first described case of EUS-FNA-induced needle tract seeding in a patient with intraductal papillary mucinous neoplasm in 2003[ 45 ], 33 patients with needle tract seeding following EUS-FNA or EUS-FNB have been reported up to January 2020. Of these cases, 27 were found in pancreatic cancer patients after EUS-FNA[ 19 , 20 , 25 , 27 , 28 , 36 , 40 , 46 - 58 ], one in a pancreatic cancer patient after EUS-FNB[ 34 ] (Table 1 ), and five in patients with other intra-abdominal and intrathoracic tumors after EUS-FNA[ 59 - 63 ] (Table 2 ). A total of 29 cases with pancreatic body or pancreatic tail cancer had needle tract seeding caused by diagnostic FNA or FNB.…”

“…Therefore, several strategies have been proposed to reduce the tumor seeding. Yane et al[ 40 ] have reported that EUS-FNA should only be used in patients requiring a pathological diagnosis to develop more accurate treatment strategies (for example, patients with pancreatic cancer who are scheduled to undergo preoperative neoadjuvant therapy or difficult to diagnose by imaging). In addition, the distance between the endoscope and the target site should be as short as possible[ 67 ].…”

Can early diagnosis of EUS‐FNA needle tract seeding for pancreatic cancer improve patient prognosis?

“…In this issue of Digestive Endoscopy , Yane et al 9 . conducted a multicenter retrospective observational study to investigate the association between preoperative EUS‐FNA and long‐term outcomes including needle tract seeding rate in patients undergoing surgery for cancer of the pancreatic body and tail.…”