Research Report
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 7, 2014; 20(13): 3620-3627
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3620
Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance
Taiki Kudo, Hiroshi Kawakami, Masaki Kuwatani, Kazunori Eto, Shuhei Kawahata, Yoko Abe, Manabu Onodera, Nobuyuki Ehira, Hiroaki Yamato, Shin Haba, Kazumichi Kawakubo, Naoya Sakamoto
Taiki Kudo, Hiroshi Kawakami, Masaki Kuwatani, Kazunori Eto, Shuhei Kawahata, Yoko Abe, Manabu Onodera, Nobuyuki Ehira, Hiroaki Yamato, Shin Haba, Kazumichi Kawakubo, Naoya Sakamoto, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
Author contributions: Kudo T and Kawakami H contributed equally to this work; Kawakami H managed the patient, performed the endoscopic examination, designed the research and provided discussion; Kudo T and Kawakami H analysed the data; Kuwatani M, Eto K, Kawahata S, Abe Y, Onodera M, Ehira N, Yamato H, Haba S and Kawakubo K collected the data and provided clinical advice; Kudo T and Kawakami H collected the data and wrote the paper; Kawakami H and Kuwatani M revised the paper; Sakamoto N supervised the research; all authors approved the final manuscript for publication.
Correspondence to: Hiroshi Kawakami, MD, PhD, Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan. hiropon@med.hokudai.ac.jp
Telephone: +81-11-7161161-5920 Fax: +81-11-7067867
Received: October 3, 2013
Revised: December 1, 2013
Accepted: January 3, 2014
Published online: April 7, 2014
Abstract

AIM: To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients.

METHODS: Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011, 82 were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings. Of these, 54 underwent EUS-FNA before surgery (FNA+ group) and 28 underwent surgery without preoperative EUS-FNA (FNA- group).

RESULTS: All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology findings was 98.1% (53/54) and 77.8% (42/54), respectively, and the total accuracy was 98.1% (53/54). One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+ and FNA- groups, the median relapse-free survival (RFS) was 742 and 265 d, respectively (P = 0.0099), and the median overall survival (OS) was 1042 and 557 d, respectively (P = 0.0071). RFS and OS were therefore not inferior in the FNA+ group. These data indicate that the use of EUS-FNA did not influence RFS or OS, nor did it increase the risk of peritoneal recurrence.

CONCLUSION: In patients with resectable pancreatic cancer, preoperative EUS-FNA is a safe and accurate diagnostic method.

Keywords: Pancreatic cancer, Diagnosis, Biopsy, Endoscopic ultrasound-guided fine-needle aspiration, Preoperative diagnosis

Core tip: Whether preoperative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is safe and effective for resectable pancreatic cancer has not yet been established. In the present study, patients who underwent EUS-FNA had better relapse-free survival and overall survival than did those who did not, although it should be noted that more patients in the FNA before surgery group received adjuvant chemotherapy. Our findings suggest that preoperative EUS-FNA does not adversely affect surgery or prognosis in patients with resectable pancreatic cancer. EUS-FNA can also potentially reduce the inappropriate performance of pancreatic surgery by facilitating an accurate diagnosis. These findings are important because the use of preoperative EUS-FNA is becoming more widespread.