Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Gastrointest Endosc. 2010 Nov;72(5):1076-80. doi: 10.1016/j.gie.2010.07.007. Epub 2010 Sep 25.
EUS-guided FNA (EUS-FNA) is a sensitive test for the preoperative diagnosis of pancreatic cancer. Its use for diagnosing local tumor recurrence after surgical resection has not been described.
To determine the sensitivity of EUS-FNA for this indication.
Retrospective cohort study.
Tertiary referral hospital in the United States.
Consecutive patients referred for EUS with clinical and/or radiographic suspicion of pancreatic cancer recurrence.
EUS ± FNA of retroperitoneal mass.
Sensitivity of EUS-FNA.
Seventeen patients (9 male, median age 71 years) underwent EUS at a median of 17 months (range 7-46 months) after a classic Whipple procedure (n = 7), pylorus-sparing Whipple procedure (n = 7), or distal pancreatectomy (n = 3) for suspected local recurrence of pancreatic cancer. The primary tumor (median size 2.5 cm, range 1.5-7.9 cm) was located in the head in 14 patients, the body in 1, and the tail in 2. Final surgical margins at any site were positive in only 1 of 17 patients (+ retroperitoneal margin). At the time of suspected recurrence, 4 patients (24%) were asymptomatic. EUS disclosed a mass (median size 21 mm, range 12-30 mm) in 16 of 17 patients (94%). Transgastric EUS-FNA (n = 16, median 4.5 passes, range 2-10) disclosed recurrent malignancy in 13 of 16 (79%), atypical cells in 1 of 16 (7%), and benign cytology in 2 of 16 (14%). Subsequent radiographic evidence of increasing tumor burden was seen in 1 of 2 patients with benign cytology; however, follow-up for the 2 other patients with benign biopsy specimens was not available. Depending on the status of the 2 patients without available follow-up, the sensitivity, specificity, and accuracy of EUS-FNA for the diagnosis of recurrent cancer ranged from 81% to 93%, was 100%, and ranged from 81% to 93%, respectively.
Small, single-center retrospective cohort.
EUS-FNA is sensitive for the diagnosis of retroperitoneal recurrence of pancreatic cancer after surgical resection.
EUS 引导下的细针抽吸术（EUS-FNA）是术前诊断胰腺癌的一种敏感检测方法。尚未有报道称其可用于诊断手术切除后的局部肿瘤复发。
确定 EUS-FNA 在该适应证中的敏感性。
回顾性队列研究。
美国一家三级转诊医院。
连续就诊的 EUS 患者，临床和/或影像学怀疑胰腺癌复发。
EUS 检查+腹膜后肿块细针抽吸术。
EUS-FNA 的敏感性。
17 例患者（9 例男性，中位年龄 71 岁）在接受经典胰十二指肠切除术（n = 7）、保留幽门胰十二指肠切除术（n = 7）或胰体尾切除术（n = 3）后中位时间 17 个月（范围 7-46 个月）时因疑似局部复发行 EUS 检查。原发肿瘤（中位大小 2.5cm，范围 1.5-7.9cm）位于胰头部 14 例，体部 1 例，尾部 2 例。17 例患者中仅 1 例（1/17，6%）任何部位的手术切缘均为阳性（+腹膜后切缘）。在怀疑复发时，4 例患者（24%）无症状。17 例患者中的 16 例（94%）在 EUS 中显示有肿块（中位大小 21mm，范围 12-30mm）。16 例行经胃 EUS-FNA（中位 4.5 次穿刺，范围 2-10 次），13 例（79%）显示为复发性恶性肿瘤，1 例（7%）为非典型细胞，2 例（14%）为良性细胞学。2 例良性活检标本的患者随后出现肿瘤负荷增加的影像学证据；然而，另外 2 例患者的随访结果不可用。根据 2 例无随访结果患者的情况，EUS-FNA 对复发性癌症的诊断的敏感性、特异性和准确性范围分别为 81%-93%、100%和 81%-93%。
小样本、单中心回顾性队列。
EUS-FNA 对诊断手术切除后腹膜后胰腺癌复发具有较高的敏感性。
