EUS-guided FNA of local recurrence of pancreatic cancer after surgical resection

John DeWitt, Stuart Sherman, Mohammad Al-Haddad, Lee McHenry, Gregory A. Cote, Julia K. Leblanc

Research output: Contribution to journalArticle

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Abstract

Background 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. Objective To determine the sensitivity of EUS-FNA for this indication. Design Retrospective cohort study. Setting Tertiary referral hospital in the United States. Patients Consecutive patients referred for EUS with clinical and/or radiographic suspicion of pancreatic cancer recurrence. Interventions EUS ± FNA of retroperitoneal mass. Main Outcome Measurement Sensitivity of EUS-FNA. Results 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. Limitations Small, single-center retrospective cohort. Conclusions EUS-FNA is sensitive for the diagnosis of retroperitoneal recurrence of pancreatic cancer after surgical resection.

Original languageEnglish
Pages (from-to)1076-1080
Number of pages5
JournalGastrointestinal Endoscopy
Volume72
Issue number5
DOIs
StatePublished - Nov 2010

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreatic Neoplasms
Recurrence
Cell Biology
Neoplasms
Pancreatectomy
Pylorus
Tumor Burden
Tertiary Care Centers
Cohort Studies
Retrospective Studies
Head

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

EUS-guided FNA of local recurrence of pancreatic cancer after surgical resection. / DeWitt, John; Sherman, Stuart; Al-Haddad, Mohammad; McHenry, Lee; Cote, Gregory A.; Leblanc, Julia K.

In: Gastrointestinal Endoscopy, Vol. 72, No. 5, 11.2010, p. 1076-1080.

Research output: Contribution to journalArticle

DeWitt, John ; Sherman, Stuart ; Al-Haddad, Mohammad ; McHenry, Lee ; Cote, Gregory A. ; Leblanc, Julia K. / EUS-guided FNA of local recurrence of pancreatic cancer after surgical resection. In: Gastrointestinal Endoscopy. 2010 ; Vol. 72, No. 5. pp. 1076-1080.
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abstract = "Background 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. Objective To determine the sensitivity of EUS-FNA for this indication. Design Retrospective cohort study. Setting Tertiary referral hospital in the United States. Patients Consecutive patients referred for EUS with clinical and/or radiographic suspicion of pancreatic cancer recurrence. Interventions EUS ± FNA of retroperitoneal mass. Main Outcome Measurement Sensitivity of EUS-FNA. Results 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. Limitations Small, single-center retrospective cohort. Conclusions EUS-FNA is sensitive for the diagnosis of retroperitoneal recurrence of pancreatic cancer after surgical resection.",
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T1 - EUS-guided FNA of local recurrence of pancreatic cancer after surgical resection

AU - DeWitt, John

AU - Sherman, Stuart

AU - Al-Haddad, Mohammad

AU - McHenry, Lee

AU - Cote, Gregory A.

AU - Leblanc, Julia K.

PY - 2010/11

Y1 - 2010/11

N2 - Background 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. Objective To determine the sensitivity of EUS-FNA for this indication. Design Retrospective cohort study. Setting Tertiary referral hospital in the United States. Patients Consecutive patients referred for EUS with clinical and/or radiographic suspicion of pancreatic cancer recurrence. Interventions EUS ± FNA of retroperitoneal mass. Main Outcome Measurement Sensitivity of EUS-FNA. Results 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. Limitations Small, single-center retrospective cohort. Conclusions EUS-FNA is sensitive for the diagnosis of retroperitoneal recurrence of pancreatic cancer after surgical resection.

AB - Background 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. Objective To determine the sensitivity of EUS-FNA for this indication. Design Retrospective cohort study. Setting Tertiary referral hospital in the United States. Patients Consecutive patients referred for EUS with clinical and/or radiographic suspicion of pancreatic cancer recurrence. Interventions EUS ± FNA of retroperitoneal mass. Main Outcome Measurement Sensitivity of EUS-FNA. Results 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. Limitations Small, single-center retrospective cohort. Conclusions EUS-FNA is sensitive for the diagnosis of retroperitoneal recurrence of pancreatic cancer after surgical resection.

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