Can early diagnosis of EUS‐FNA needle tract seeding for pancreatic cancer improve patient prognosis?

Hatamaru, Keiichi; Kitano, Masayuki

doi:10.1111/den.13719

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…For example, the SEER-Medicare large-scale study had a mean follow-up period of 21 months, which is too short to accurately evaluate the incidence of NTS. 7,8 Therefore, the incidence of NTS reported in these studies might have been underestimated. Second, most of the studies evaluated recurrence and overall survival in patients with pancreatic cancers of the head, body, and tail.…”

Section: Consmentioning

confidence: 93%

“…Although large retrospective surveys suggest that the frequency of NTS is <0.01%, 24,35 reports of NTS following EUS-FNA for pancreatic body and tail cancer are increasing. 7,8 Theoretically, gastric implantation can occur when EUS-FNA is performed via the stomach; therefore, gastric implantation occurs following EUS-FNA targeting cancer of the pancreatic body or tail. In cancers of the pancreatic head, EUS-FNA is usually performed via the duodenal bulb; in this procedure, the puncture site is within the surgically resected area.…”

Section: Consmentioning

confidence: 99%

“…5,6 Although uncommon, one potential and serious complication of EUS-FNA is needle tract seeding (NTS). 7,8 NTS refers to the iatrogenic phenomenon of tumor cell implantation along the needle tract, which can occur during FNA biopsy. 9,10 Tumor dissemination caused by EUS-FNA was first reported in 2003 by Hirooka et al, 11 who found disseminated nodules in the puncture route during surgery for intraductal papillary mucinous carcinoma (IPMC).…”

Section: Introductionmentioning

confidence: 99%

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Clinical dilemma of endoscopic ultrasound‐guided fine needle aspiration for resectable pancreatic body and tail cancer

Kitano

Minaga

Hatamaru

et al. 2021

Digestive Endoscopy

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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a first-line procedure for definitive tissue diagnosis of pancreatic cancer because of its high accuracy and low complication rate. The overall sensitivity of EUS-FNA for the diagnosis of pancreatic cancer is approximately 90%; however, its diagnostic ability for small lesions (<10 mm) remains limited. Although EUS-FNA is a relatively safe procedure, with an overall morbidity of ≤2%, it should be noted that needle tract seeding (NTS) can occur after EUS-FNA, which may affect the patient prognosis negatively. In patients with resected pancreatic tumors, preoperative EUS-FNA is not associated with an increased risk of postoperative recurrence. However, NTS after EUS-FNA for resectable pancreatic body and tail cancer has been highlighted recently, particularly by Japanese endoscopists. Thus, the use of preoperative EUS-FNA for the diagnosis of resectable pancreatic body and tail cancer has become a clinical dilemma that challenges gastroenterologists and must be carefully considered on a caseby-case basis by weighing the benefits and risks. This review summarizes the pros and cons of performing EUS-FNA in patients with resectable pancreatic body and tail cancer and provides valuable insight for gastroenterologists treating pancreatic cancer.

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Section: Consmentioning

confidence: 93%

Section: Consmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical dilemma of endoscopic ultrasound‐guided fine needle aspiration for resectable pancreatic body and tail cancer

Kitano

Minaga

Hatamaru

et al. 2021

Digestive Endoscopy

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“…Moreover, the possibility of needle tract seeding should always be considered in patients undergoing EUS-FNA for pancreatic cancer. Long-term follow-up with imaging studies may lead to the early detection of needle tract seeding and improve prognosis [38].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration

et al. 2021

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Background A pathological diagnosis of pancreatic cancer should be performed as much as possible to determine the appropriate treatment strategy, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the primary method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified. Aims To evaluate the diagnostic ability of EUS-FNA and its effect on the preoperative diagnosis, surgical outcome, and prognosis of pancreatic cancer. Methods Between January 2005 and June 2017, 293 patients who underwent surgical resection for pancreatic cancer were retrospectively evaluated. The outcomes of interest were the diagnostic ability of EUS-FNA and its influence on the surgical results and prognosis. Results The diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than that of endoscopic retrograde cholangiopancreatography (ERCP) (45.5%) (p < 0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p = 0.001). Patients were divided into FNA group (N = 160) and non-FNA group (N = 133) for each preoperative diagnostic method. In the study of surgical curability R0 between the two groups, there was no significant difference in FNA group (65.0% [104/160]) and non-FNA group (64.7% [86/133], p = 1.000). In the prognostic study, 256 patients with curative R0 or R1 had a recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in the non-FNA group. Moreover peritoneal dissemination occurred in 34.3% (24/70) in the FNA group and in 21.9% (16/73) in the non-FNA group, neither of which showed a significant difference. The median survival times of the FNA and non-FNA groups were 955 days and 799 days, respectively, and there was no significant difference between the two groups (log-rank p = 0.735). In the Cox proportional hazards model, factors influencing prognosis, staging, curability, and adjuvant chemotherapy were the dominant factors, but the preoperative diagnostic method (EUS-FNA) itself was not. Conclusions EUS-FNA is a safe procedure with a high diagnostic ability for the preoperative examination of pancreatic cancer. It was considered the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.

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“…While EUS-FNA is considered a safe procedure, it still has a possibility of false-negative results and the risk of adverse complications such as bleeding or pancreatitis due to needle puncture [13]. Moreover, needle tract seeding was reported in patients who underwent EUS-FNA for pancreatic cancer [14,15]. Ideally, the diagnosis should be made with more accurate imaging studies that do not use needle puncture.…”

Section: Backgroundsmentioning

confidence: 99%

Automatic Segmentation of Pancreatic Tumors Using Deep Learning on a Video Image of Contrast-Enhanced Endoscopic Ultrasound

Iwasa

Iwashita

Takeuchi

et al. 2021

JCM

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Background: Contrast-enhanced endoscopic ultrasound (CE-EUS) is useful for the differentiation of pancreatic tumors. Using deep learning for the segmentation and classification of pancreatic tumors might further improve the diagnostic capability of CE-EUS. Aims: The aim of this study was to evaluate the capability of deep learning for the automatic segmentation of pancreatic tumors on CE-EUS video images and possible factors affecting the automatic segmentation. Methods: This retrospective study included 100 patients who underwent CE-EUS for pancreatic tumors. The CE-EUS video images were converted from the originals to 90-second segments with six frames per second. Manual segmentation of pancreatic tumors from B-mode images was performed as ground truth. Automatic segmentation was performed using U-Net with 100 epochs and was evaluated with 4-fold cross-validation. The degree of respiratory movement (RM) and tumor boundary (TB) were divided into 3-degree intervals in each patient and evaluated as possible factors affecting the segmentation. The concordance rate was calculated using the intersection over union (IoU). Results: The median IoU of all cases was 0.77. The median IoUs in TB-1 (clear around), TB-2, and TB-3 (unclear more than half) were 0.80, 0.76, and 0.69, respectively. The IoU for TB-1 was significantly higher than that of TB-3 (p < 0.01). However, there was no significant difference between the degrees of RM. Conclusion: Automatic segmentation of pancreatic tumors using U-Net on CE-EUS video images showed a decent concordance rate. The concordance rate was lowered by an unclear TB but was not affected by RM.

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Can early diagnosis of EUS‐FNA needle tract seeding for pancreatic cancer improve patient prognosis?

Abstract: This Editorial refers to the article by Yane et al., p 801–811 of this issue.

Cited by 8 publications

References 9 publications

Clinical dilemma of endoscopic ultrasound‐guided fine needle aspiration for resectable pancreatic body and tail cancer

Clinical dilemma of endoscopic ultrasound‐guided fine needle aspiration for resectable pancreatic body and tail cancer

Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration

Automatic Segmentation of Pancreatic Tumors Using Deep Learning on a Video Image of Contrast-Enhanced Endoscopic Ultrasound

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