Micames Carlos, Jowell Paul S, White Rebekah, Paulson Erik, Nelson Rendon, Morse Michael, Hurwitz Herbert, Pappas Theodore, Tyler Douglas, McGrath Kevin
Duke University Medical Center, Department of Medicine, Durham, North Carolina 27710, USA.
Gastrointest Endosc. 2003 Nov;58(5):690-5. doi: 10.1016/s0016-5107(03)02009-1.
Studies have suggested an increased risk of peritoneal seeding in patients with pancreatic cancer diagnosed by percutaneous FNA. EUS-FNA is an alternate method of diagnosis. The aim of this study was to compare the frequency of peritoneal carcinomatosis as a treatment failure pattern in patients with pancreatic cancer diagnosed by EUS-FNA vs. percutaneous FNA.
Retrospective review of patients with non-metastatic pancreatic cancer identified 46 patients in whom the diagnosis was made by EUS-FNA and 43 with the diagnosis established by percutaneous FNA. All had neoadjuvant chemoradiation. Patients underwent restaging CT after completion of therapy, followed by attempted surgical resection if there was no evidence of disease progression.
There were no significant differences in tumor characteristics between the two study groups. In the EUS-FNA group, one patient had developed peritoneal carcinomatosis compared with 7 in the percutaneous FNA group (2.2% vs. 16.3%; p<0.025). No patient with a potentially resectable tumor in the EUS-FNA group had developed peritoneal carcinomatosis.
Peritoneal carcinomatosis may occur more frequently in patients who undergo percutaneous FNA compared with those who have EUS-FNA for the diagnosis of pancreatic cancer. A concern for peritoneal seeding of pancreatic cancer via percutaneous FNA is warranted. EUS-guided FNA is recommended as the method of choice for diagnosis in patients with potentially resectable pancreatic cancer.
研究表明，经皮细针穿刺抽吸活检（FNA）诊断的胰腺癌患者发生腹膜种植的风险增加。超声内镜引导下细针穿刺抽吸活检（EUS-FNA）是另一种诊断方法。本研究的目的是比较EUS-FNA与经皮FNA诊断的胰腺癌患者中作为治疗失败模式的腹膜癌转移的发生率。
对非转移性胰腺癌患者进行回顾性研究，确定46例经EUS-FNA确诊的患者和43例经皮FNA确诊的患者。所有患者均接受新辅助放化疗。治疗结束后患者接受重新分期CT检查，若没有疾病进展的证据则尝试手术切除。
两个研究组的肿瘤特征无显著差异。在EUS-FNA组中，1例患者发生了腹膜癌转移，而经皮FNA组有7例（2.2%对16.3%；p<0.025）。EUS-FNA组中没有潜在可切除肿瘤的患者发生腹膜癌转移。
与接受EUS-FNA诊断胰腺癌的患者相比，接受经皮FNA的患者腹膜癌转移可能更频繁发生。经皮FNA导致胰腺癌腹膜种植的担忧是有道理的。对于潜在可切除的胰腺癌患者，推荐EUS引导下FNA作为诊断的首选方法。
