Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3620
Revised: December 1, 2013
Accepted: January 3, 2014
Published online: April 7, 2014
Processing time: 182 Days and 19.6 Hours
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.
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.