Identifying contraindications to resection in patients with pancreatic carcinoma: ESTABLISHING THE DIAGNOSIS Part 1

Pancreatic carcinomaThe usual technique for confirming the presence of malignant disease is percutaneous biopsy under sonographic or CT guidance. The accuracy of this method is well established. It is safe and, in patients not being considered for surgical therapy, straightforward. Concerns have been raised with respect to the potential for seeding of tumour along the needle track; therefore, percutaneous techniques should not be used for lesions that may be resectable. Over the past several years, EUS FNA has been described as a safe method of providing a cytological diagnosis of pancreatic masses. The stomach and duodenum provide an ideal acoustic window to the pancreas. Their proximity permits EUS FNA of pancreatic or peripancreatic abnormalities. EUS FNA may have several advantages, including minimizing the risk of tumour seeding. The needle track would almost always be contained within the resection margins if surgery were to be ultimately performed. Additionally, EUS FNA permits the biopsy of lesions that might not be readily visualized by other techniques.
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Several authors have described the utility of EUS FNA in diagnosing pancreatic masses. Results obtained with this technique are promising, reaching an overall sensitivity of 85% and a specificity of 100%. These results are consistent among different institutions. Gress et al recently described their experience with EUS FNA in distinguishing benign from malignant pancreatic masses. In 102 patients with pancreatic mass lesions and prior negative results on CT-guided biopsy or ERCP sampling, 61 had pancreatic cancer. EUS FNA cytology showed malignancy in 57 patients, was negative in 37, and inconclusive or nondiagnostic in eight. No false positive results were observed. The posterior probability of pancreatic cancer was at least 94.5% by a conservatively lower 95% confidence limit after a positive test result. After a definitively negative test result, the posterior probability of pancreatic cancer was 6.9%. The authors reported a high sensitivity (93%) and specificity (100%) of EUS FNA when evaluating patients with pancreatic masses in whom pancreatic cancer was suspected but prior biopsies had been negative.

Category: Pancreatic carcinoma

Tags: Biopsy, Computed tomography, Endosonography, Pancreas adenocarcinoma, Pancreas neoplasm

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