Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Gastroenterology, Reinier de Graaf Group, Delft, the Netherlands.
HPB (Oxford). 2023 Oct;25(10):1161-1168. doi: 10.1016/j.hpb.2023.04.018. Epub 2023 May 4.
Neoadjuvant treatment for pancreatic ductal adenocarcinoma (PDAC) has increased, necessitating histopathologic confirmation of cancer. This study evaluates the performance of endoscopic tissue acquisition (TA) procedures for borderline resectable and resectable PDAC.
Pathology reports of patients included in two nationwide randomized controlled trials (PREOPANC and PREOPANC-2) were reviewed. The primary outcome was sensitivity for malignancy (SFM), considering both "suspicious for" and "malignant" as positive. Secondary outcomes were rate of adequate sampling (RAS) and diagnoses other than PDAC.
Overall, 892 endoscopic procedures were performed in 617 patients, including endoscopic ultrasonography (EUS)-guided TA in 550 (89.1%), endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology in 188 (30.5%), and periampullary biopsies in 61 patients (9.9%). The SFM was 85.2% for EUS, 88.2% for repeat EUS, 52.7% for ERCP, and 37.7% for periampullary biopsies. The RAS ranged 94-100%. Diagnoses other than PDAC were other periampullary cancers in 24 (5.4%), premalignant disease in five (1.1%), and pancreatitis in three patients (0.7%).
EUS-guided TA of patients with borderline resectable and resectable PDAC included in RCTs had an SFM above 85% for both first and repeat procedures, meeting international standards. Two percent had false positive result for malignancy and 5% had other (non-PDAC) periampullary cancers.
新辅助治疗胰腺导管腺癌（PDAC）的应用增加，这使得有必要通过组织病理学确认癌症。本研究评估了内镜组织获取（TA）程序在边界可切除和可切除 PDAC 中的性能。
回顾了两项全国性随机对照试验（PREOPANC 和 PREOPANC-2）中纳入的患者的病理报告。主要结局是恶性肿瘤的敏感度（SFM），将“疑似”和“恶性”均视为阳性。次要结局是充分采样率（RAS）和 PDAC 以外的其他诊断。
总体而言，在 617 名患者中进行了 892 次内镜检查，包括 550 次超声内镜（EUS）引导下 TA（89.1%）、188 次内镜逆行胰胆管造影（ERCP）引导下刷检细胞学检查（30.5%）和 61 次胰胆管造影术（ERCP）引导下活检（9.9%）。EUS 的 SFM 为 85.2%，重复 EUS 的 SFM 为 88.2%，ERCP 的 SFM 为 52.7%，胰胆管造影术的 SFM 为 37.7%。RAS 范围为 94-100%。PDAC 以外的其他诊断为 24 例（5.4%）其他壶腹周围癌、5 例（1.1%）癌前病变和 3 例（0.7%）胰腺炎。
纳入 RCT 的边界可切除和可切除 PDAC 患者的 EUS 引导 TA 无论是首次还是重复检查，SFM 均超过 85%，符合国际标准。2%的患者恶性肿瘤检测呈假阳性，5%的患者有其他（非 PDAC）壶腹周围癌。
