A Prospective Evaluation of an Algorithm Incorporating Routine Preoperative Endoscopic Ultrasound-Guided Fine Needle Aspiration in Suspected Pancreatic Cancer

Abstract

EUS-FNA is a safe and highly accurate method for tissue diagnosis in suspected pancreatic cancer. This approach allows for preoperative counseling of patients, minimizing surgeon's operative time in cases of unresectable disease, and avoids surgical biopsies in the majority of patients with inoperable disease. In addition, it allows for conservative management of patients with benign biopsies. We still, however, recommend exploration of patients with clinical scenario suspicious for pancreatic cancer, a mass found on EUS or CT, but inconclusive or negative cytology.

¿Cuál es el tamaño normal del conducto biliar común?

“…Desde su introducción en la práctica clínica en la década de 1980, la USE se ha utilizado para diagnosticar y estadificar trastornos benignos y malignos gastrointestinales y pancreatobiliares, y estudios comparativos han demostrado que la USE es más precisa que la ET, TC y la resonancia magnética (RM) en la detección y estadificación de lesiones del tracto gastrointestinal (TGI) y extraluminales (20)(21)(22). La USE combina la visualización endoscópica con la imagen ultrasonográfica y dada la proximidad de la vía biliar extrahepática al duodeno proximal le permite tener una evaluación privilegiada a este nivel; 2 metaaná-Abstract Traditionally, the common bile duct (CBD) has been said to measure up to 6 mm in patients with gallbladders and up to 8 mm in cholecystectomized patients.…”

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“…Our study results indicate a significantly greater diagnostic yield with EUS-FNB of non-pancreatic lesions of 88.2 % compared to 54.5 % with EUS-FNA (P = 0.006), suggesting that EUS-FNB is the optimal modality for tissue acquisition in non-pancreatic masses. The role of EUS-FNA for pancreatic mass lesions is well established with diagnostic yield greater than 90 % [39]. The pooled sensitivity from five meta-analyses on EUS-FNA for solid pancreatic mass lesions is 85 % to 89 %, with higher diagnostic accuracy in prospective, multicenter studies [10, 40 -42].…”

Endoscopic Management of Pancreatic Cancer: From Diagnosis to Palliative Therapy

“…(Al-Haddad & Eloubeidi, 2010;Yasuda et al, 1988;DeWitt et al, 2004;Chhieng et al, 2002;Eloubeidi & Tamhane, 2005) The operating characteristics of EUS-FNA of solid pancreatic masses in 547 patients were: sensitivity 95%, specificity 92%, positive predictive value 98% and negative predictive value 80%, with and overall accuracy of 94.1%. (Eloubeidi et al, 2007) Such accuracy numbers allow for preoperative counseling of patients, minimizing surgeon's operative time in cases of unresectable disease, and avoiding surgical biopsies in those with inoperable disease, also allowing for conservative management of patients with benign pathology results. (Eloubeidi et al, 2007) To compare the diagnostic yield and complication rates of 22 gauge and 25 gauge needles during EUS-FNA of solid pancreatic masses, a group prospectively randomized 131 patients with suspected pancreatic lesions.…”

“…(Eloubeidi et al, 2007) Such accuracy numbers allow for preoperative counseling of patients, minimizing surgeon's operative time in cases of unresectable disease, and avoiding surgical biopsies in those with inoperable disease, also allowing for conservative management of patients with benign pathology results. (Eloubeidi et al, 2007) To compare the diagnostic yield and complication rates of 22 gauge and 25 gauge needles during EUS-FNA of solid pancreatic masses, a group prospectively randomized 131 patients with suspected pancreatic lesions. (Siddiqui et al, 2009) EUS-FNA with 22 gauge needle was performed in 64 patients and 25 gauge needle was used in 67 patients.…”