Identifying contraindications to resection in patients with pancreatic carcinoma: ESTABLISHING THE DIAGNOSIS Part 2
In addition to establishing a diagnosis when prior biopsy methods have failed, EUS FNA may be able to identify nonperitumoral lymph node (NPTLN) metastases. Limited information is available on the frequency of NPTLN and the sensitivity of EUS FNA in this setting. EUS with FNA of identified NPTLN, if performed in patients thought to be resectable based on helical CT, has been shown to be cost effective provided that the frequency of NPTLN involvement was greater than 4%. Prospective studies are needed to determine the sensitivity of EUS FNA for this indication.
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EUS FNA can accurately and safely provide a cytologi-cal diagnosis of pancreatic masses. This is particularly important for patients who are poor surgical candidates or have signs of locally advanced disease and, therefore, would not be considered for resection. The need for preoperative tissue diagnosis is debatable when imaging tests suggest that the lesion is resectable, and the decision is based on the current practice of the surgeon. Although they are infrequent (less than 1%), hemorrhage and pancreatitis resulting from EUS FNA can make pancreatic tumour resection more difficult. For this reason, many surgeons prefer not to biopsy the pancreatic mass if it appears to be resectable. Additionally, despite the high sensitivity of EUS FNA, a negative biopsy result does not rule out malignancy and, therefore, should not dissuade the surgeon from operating.