Prognostic influence of endoscopic ultrasound-guided fine needle aspiration in IPMN-derived invasive adenocarcinoma

Abstract

BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for mucinous cystic neoplasm of the pancreas carries a potential risk of inducing peritoneal tumor cell dissemination. We investigated the diagnostic yield and safety of EUS-FNA-based cytology of cells obtained from the pancreatic invasion site of intraductal papillary-mucinous neoplasm-derived adenocarcinoma (IPMC).MethodsWe included 22 surgically resected IPMCs and 84 pancreatic ductal adenocarcinomas (PDACs). Among the IPMC cases, 14 did not undergo EUS-FNA before surgical resection. The diagnostic yield of EUS-FNA was compared between IPMC and PDAC. Additionally, prognosis (relapse-free and overall survival time after resection) and the rate of peritoneal dissemination were compared among IPMC with EUS-FNA, IPMC without EUS-FNA, and PDAC. A survival analysis was performed using the Kaplan-Meier method and log-rank test.Results(EUS-FNA diagnosis) There were no significant differences in the number of needle passages (PDAC 2.5 vs. IPMC 2.0 passages, P = 0.84) or puncture route (stomach/duodenum: 2/6 vs. 45/39, P = 0.29). However, the correct diagnosis rate was significantly higher in PDAC (92.9%) than in IPMC (62.5%) (P = 0.03). No procedure-related adverse events occurred. Peritoneal lavage cytology performed during the operation was negative in all cases. (Prognosis) Among IPMC with EUS-FNA, IPMC without EUS-FNA, and PDAC, there were no significant differences in relapse-free survival (21.0 vs. 22.4 vs. 12.5 months, respectively; P = 0.64) or overall survival time (35.5 vs. 53.1 vs. 35.9 months, respectively; P = 0.42), and peritoneal dissemination was detected during the observation period in 25%, 28.5%, and 21.4% cases, respectively (P = 0.82).ConclusionEven though a correct diagnosis was more difficult to obtain in IPMC than in PDAC, IPMC allows specimens to be obtained without influencing the rate of recurrence and prognosis.

Needle Tract Seeding after Endoscopic Ultrasound Tissue Acquisition of Pancreatic Lesions: A Systematic Review and Meta-Analysis

“…As shown in Figure 1 , of 89 studies initially identified, after the exclusion of articles not fulfilling the inclusion criteria and of 2 duplicate studies [ 16 , 17 ], 10 studies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] with 13,238 patients were included in the meta-analysis. Of 10 included studies, 8 were retrospective case–control studies, of which 6 compared EUS-TA vs. non-sampling [ 19 , 20 , 22 , 24 , 26 , 27 ], 1 study compared EUS-TA vs. percutaneous FNA [ 21 ], and 1 study compared EUS-TA vs. ERCP [ 23 ]. The other two included studies were a nationwide survey [ 18 ] and a retrospective single cohort study [ 25 ].…”

“…The recruitment period ranged from 1995 to 2018. Seven studies were conducted in Asia [ 18 , 19 , 23 , 24 , 25 , 26 , 27 ] and three studies in the USA [ 20 , 21 , 22 ]. The majority of treated patients were male, and the mean lesion size ranged from 2.3 to 4.7 cm.…”

“…The majority of treated patients were male, and the mean lesion size ranged from 2.3 to 4.7 cm. Seven studies included only patients with resectable solid lesions [ 18 , 19 , 21 , 23 , 24 , 25 , 27 ]; two studies included both patients with solid lesions and resectable PCLs [ 20 , 26 ], and one study included only patients with IPMN with indication of surgery [ 22 ]. The vast majority of sampled lesions were PDAC.…”

“…Median follow-up length ranged from 599 days to 56.9 months. Quality was deemed moderate to high in seven studies [ 18 , 19 , 20 , 22 , 24 , 26 , 27 ], whereas three studies [ 21 , 23 , 25 ] were rated as low-quality articles, mainly due to incomplete outcome reporting. Details on the quality assessment of the included articles are shown in Supplementary Table S1 .…”

Intraductal Papillary Mucinous Neoplasia of the Pancreas - Pathologic Features and Molecular Markers - A Review

“…In the diagnosis of cystic lesions of the pancreas, cytology has a pivotal role. EUS-FNA approach is safe, with high diagnostic accuracy with low seeding risk (usually the seeding track is removed with the surgical specimen), and can be performed on a pure cystic lesion or in the solid component in order to assess IPMN associated carcinoma (19).…”