Endoscopic Ultrasound Fine-Needle Aspiration Characteristics of Primary Adenocarcinoma versus Other Malignant Neoplasms of The Pancreas
| Autor: | Deepak V. Gopal, Michael Einstein, Ryan J DeLee, Patrick R. Pfau, Mary J. Lindstrom, Siobhan Byrne, Rashmi Agni, Courtney Barancin, Veronika Gagovic, Terrence J. Frick, Josephine Harter, Bret J. Spier, Anurag Soni |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Endoscopic ultrasound medicine.medical_specialty Adenocarcinoma Primary adenocarcinoma medicine Carcinoma Humans lcsh:RC799-869 Endoscopic Ultrasound-Guided Fine Needle Aspiration Aged medicine.diagnostic_test business.industry Gastroenterology General Medicine Middle Aged medicine.disease digestive system diseases Carcinoma Neuroendocrine Pancreatic Neoplasms medicine.anatomical_structure Fine-needle aspiration Female Original Article lcsh:Diseases of the digestive system. Gastroenterology Radiology Pancreas business |
| Zdroj: | Canadian Journal of Gastroenterology, Vol 26, Iss 10, Pp 691-696 (2012) |
| ISSN: | 0835-7900 |
| DOI: | 10.1155/2012/761721 |
| Popis: | BACKGROUND: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is often used to assist in the evaluation of pancreatic lesions and may help to diagnose benign versus malignant neoplasms. However, there is a paucity of literature regarding comparative EUS characteristics of various malignant pancreatic neoplasms (primary and metastatic).OBJECTIVE: To compare and characterize primary pancreatic adenocarcinoma versus other malignant neoplasms, hereafter referred to as nonprimary pancreatic adenocarcinoma (NPPA), diagnosed by EUS-guided FNA.METHODS: The present study was a retrospective analysis of a prospectively maintained database. The setting was a tertiary care, academic medical centre. Patients referred for suspected pancreatic neoplasms were evaluated. Based on EUS-FNA characteristics, primary pancreatic adenocarcinoma was differentiated from other malignant neoplasms. The subset of other neoplasms was defined as malignant lesions that were ‘NPPAs’ (ie, predominantly solid or solid/cystic based on EUS appearance and primary malignant lesions or metastatic lesions to the pancreas). Pancreatic masses that were benign cystic lesions (pseudocyst, simple cyst, serous cystadenoma) and focal inflammatory lesions (acute, chronic and autoimmune pancreatitis) were excluded.RESULTS: A total of 230 patients were evaluated using EUS-FNA for suspected pancreatic mass lesions. Thirty-eight patients were excluded because they were diagnosed with inflammatory lesions or had purely benign cysts. One hundred ninety-two patients had confirmed malignant pancreatic neoplasms (ie, pancreatic adenocarcinoma [n=144], NPPA [n=48]). When comparing adenocarcinoma with NPPA lesions, there was no significant difference in mean age (P=0.0675), sex (P=0.3595) or average lesion size (P=0.3801). On average, four FNA passes were necessary to establish a cytological diagnosis in both lesion subtypes (P=0.396). Adenocarcinomas were more likely to be located in the pancreatic head (P=0.0198), whereas masses in the tail were more likely to be NPPAs (P=0.0006). Adenocarcinomas were also more likely to exhibit vascular invasion (OR 4.37; P=0.0011), malignant lymphadenopathy (P=0.0006), pancreatic duct dilation (OR 2.4; P=0.022) and common bile duct dilation (OR 2.87; P=0.039).CONCLUSIONS: Adenocarcinoma was more likely to be present in the head of the pancreas, have lymph node and vascular involvement, as well as evidence of pancreatic duct and common bile duct obstruction. Of all malignant pancreatic lesions analyzed by EUS-FNA, 25% were NPPA, suggesting that FNA is crucial in establishing a diagnosis and may be helpful in preoperative planning. |
| Databáze: | OpenAIRE |
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