Postoperative recurrence from tract seeding after use of EUS–FNA for preoperative diagnosis of cancer in pancreatic tail

Abstract

A 50-year-old male underwent abdominal computed tomography at a city hospital in Japan, which revealed a tumor 38 mm in diameter in the tail of the pancreas. Based on findings from endoscopic ultrasonography-guided fine needle aspiration using a 22-gauge needle with a side hole, the tumor was diagnosed as an invasive ductal carcinoma. The patient was referred to our hospital and underwent a distal pancreatectomy. Esophagogastroduodenoscopy performed as part of a medical checkup at another hospital 2 years later revealed a 20-mm-sized submucosal tumor in the posterior wall of the upper body of the stomach. Examination of a biopsy specimen obtained from the top of the lesion revealed adenocarcinoma. Partial resection of the stomach was performed and pathological findings showed an adenocarcinoma in all layers of the stomach wall, consistent with recurrence derived from needle tract seeding of the previously excised cancerous tumor from the pancreatic tail. Additional experimentation performed for confirmation with an agar model showed that agar on the deep side leaked to the shallow side following puncture with a needle with a side hole used with a slow-pull technique.

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

“…[27][28][29] However, there have been an increasing number of case reports on needle tract seeding in recent years. [7][8][9][10][11][12][13][14][15][16] Theoretically, needle tract seeding tends to occur after transgastric EUS-FNA for pancreatic body or tail cancer. In the case of transduodenal EUS-FNA for pancreatic head cancer, the puncture route is usually excised by subsequent surgery.…”

“…In addition, EGD showed a submucosal tumor-like protruding lesion in the posterior wall of the gastric body in all the patients. Sakamoto et al 16 encountered a case in which needle tract seeding could not be demonstrated by CT, but was successfully diagnosed by EGD. Therefore, it may be Figure 3 Cumulative needle tract seeding rate estimated using Fine and Gray's method in which other recurrences and death prior to recurrence were considered as competing risks in the endoscopic ultrasound-guided fineneedle aspiration group.…”

“…Notably, in all 10 previously reported cases, the tumors were located in the pancreatic body or tail and transgastric EUS-FNA was performed. [7][8][9][10][11][12][13][14][15][16] On the other hand, a number of studies have shown that EUS-FNA neither increased the risk of peritoneal recurrence nor impaired the survival of patients. [17][18][19][20][21][22] In addition, there were no reports of needle tract seeding after preoperative EUS-FNA in these studies.…”

Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy: a case report and literature review

“…To the best of our knowledge, this is the first report of a gastric submucosal tumor arising from needle tract seeding along with paragastric lymph node metastasis. Since the first case was reported by Hirooka et al in 2003, a total of 18 cases including the present case have been described, and 13 cases were reported within the last 5 years (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Among these cases, there was no pancreatic tumor located in the head of the pancreas.…”

“…Therefore, CA19-9 might be useful for the early detection of recurrence due to needle tract seeding during the postoperative followup of patients. Although several reports have suggested that the translocation of malignant cells is associated with EUS-FNA [18,25], the developmental process of needle tract seeding is unclear. Because the number of reports is significantly small, it remains unknown whether tumor factors or fine needle aspiration procedure factors such as needle size, the number of puncture sites, and the number of needle passes are significantly associated on the occurrence of needle tract seeding.…”