Incidence of Benign Disease in Patients that Underwent Resection for Presumed Pancreatic Cancer Diagnosed by Endoscopic Ultrasonography (EUS) and Fine-Needle Aspiration (FNA)

Fuente, Sebastián G. de la; Ceppa, Eugene P.; Reddy, Srinevas K.; Clary, Bryan M.; Tyler, Douglas S.; Pappas, Theodore N.

doi:10.1007/s11605-010-1196-9

Cited by 38 publications

(16 citation statements)

References 31 publications

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“…25,43 Furthermore, recent studies have shown that, in the pancreas, benign tumors with inflammatory findings are often misinterpreted radiologically as having vascular invasion and that 5% to 13% of pancreatic resections with a clinical diagnosis of "cancer" prove to be benign, and, in the majority, radiologic "vascular invasion" was the primary cause of the erroneous cancer classification. [56][57][58] We suspect that the latter phenomenon is most likely in play in these cases. In fact 5% of our SCNs were also thought to be "malignant on imaging" but did not show any evidence of malignancy by histology or behavior.…”

Section: Discussionmentioning

confidence: 89%

Serous Neoplasms of the Pancreas

Reid¹,

Choi

Memiş³

et al. 2015

American Journal of Surgical Pathology

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The literature on "variants" and "malignant" counterparts of pancreatic serous cystic neoplasms (SCNs) is highly conflicted. Clinicopathologic characteristics of 193 SCNs were investigated, along with a critical literature review. For the macrocystic (oligocystic) variant, in this largest series, a demographic profile in contrast to current literature was elucidated, with 21% frequency, predominance in female individuals (4:1), body/tail location (1.7×), younger age of patients (mean age, 50 y), and frequent radiologic misdiagnosis as other megacystic neoplasms. Solid SCNs were rare (n=4, 2%) and often misinterpreted radiologically as neuroendocrine tumors. Available fine-needle aspiration in 11 cases was diagnostic in only 1. Radiologic impression was "malignancy" in 5%. Associated secondary tumors were detected in 13% of resections, mostly neuroendocrine. Secondary "infiltration" (direct adhesion/penetration) of spleen, stomach, colon, and/or adjacent nodes was seen in 6 (3%) fairly large SCNs (mean, 11 cm) with no distant metastasis. Three SCNs recurred locally, but completeness of original resection could not be verified. Our only hepatic SCN lacked a concurrent pancreatic tumor. Literature appraisal revealed that there are virtually no deaths that are directly attributable to dissemination/malignant behavior of SCNs, and most cases reported as "malignant" in fact would no longer fulfill the more recent World Health Organization criteria but instead would represent either (1) local adhesion/persistence of tumor, (2) cases with no histologic verification of malignancy, or (3) liver SCNs with benevolent behavior (likely representing multifocality, rather than true metastasis, especially considering there was no fatality related to this and no reported metastases to other remote sites). In conclusion, in contrast to the literature, the clinicopathologic characteristics of solid and macrocystic SCN variants are similar to their microcystic counterpart, although their radiologic diagnosis is challenging. Recurrence/secondary invasion of neighboring organs occurs rarely in larger SCNs but seems innocuous. An SCN should not be classified as "malignant" unless there is clear-cut evidence of histologic malignancy or documented distant metastasis.

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Section: Discussionmentioning

confidence: 89%

Serous Neoplasms of the Pancreas

Reid¹,

Choi

Memiş³

et al. 2015

American Journal of Surgical Pathology

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“…On subsequent analysis, they reported a 2.2% rate for surgical-cytologic discordance for pancreatic parenchymal lesions. Similarly, de la Fuente et al 13 found that 7% of patients with pancreatic lesions detected by EUS and/or EUS-FNA actually had benign disease on a pancreaticoduodenectomy. Interestingly enough, findings in the Gleeson et al trial closely mirrored our results, in that, on review of discordant cases, the main cause for FP results was interpretation errors by the pathologist in the setting of chronic pancreatitis.…”

Section: Discussionmentioning

confidence: 89%

False-positive EUS-guided FNA cytology for solid pancreatic lesions

Siddiqui¹,

Kowalski²,

Shahid³

et al. 2011

Gastrointestinal Endoscopy

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“…A report from Duke University reported 494 patients who underwent Whipple procedure for suspected malignancy between 1992 and 2007 and showed that despite the use of aggressive preoperative work-up for pancreatic cancer, up to 7% of patients that undergo resection will have benign disease on postoperative pathologic examination. All of these patients had findings concerning for malignancy on both CT scanning and endosonography preoperatively [16]. In 2 more recent European studies, prevalence of benign disease in patients who underwent pancreatoduodenectomy for presumed malignancy reported to be 8.4% [17] and 15.6% [6].…”

Section: Discussionmentioning

confidence: 99%

Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound

Yarandi

Runge

Wang

et al. 2014

Diagnostic and Therapeutic Endoscopy

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Despite using imaging studies, tissue sampling, and serologic tests about 5–10% of surgeries done for presumed pancreatic malignancies will have benign findings on final pathology. Endoscopic ultrasound (EUS) is used with increasing frequency to study pancreatic masses. The aim of this study is to examine the effect of EUS on prevalence of benign diseases undergoing Whipple over the last decade. Patients who underwent Whipple procedure for presumed malignancy at Emory University Hospital from 1998 to 2011 were selected. Demographic data, history of smoking and drinking, history of diabetes and pancreatitis, imaging data, pathology reports, and tumor markers were extracted. 878 patients were found. 95 (10.82%) patients had benign disease. Prevalence of benign finding had increased over the recent years despite using more EUS. Logistic regression models showed that abdominal pain (OR: 5.829, 95% CI 2.681–12.674, P ≤ 0.001) and alcohol abuse (OR: 3.221, CI 95%: 1.362–7.261, P: 0.002) were predictors of benign diseases. Jaundice (OR: 0.221, 95% CI: 0.084–0.58, P: 0.002), mass (OR: 0.145, 95% CI: 0.043–0.485, P: 0.008), and ductal dilation (OR: 0.297, 95% CI 0.134–0.657, P: 0.003) were associated with malignancy. Use of imaging studies, ERCP, and EUS has not decreased the percentage of benign findings after surgery for presumed pancreatic malignancy.

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Incidence of Benign Disease in Patients that Underwent Resection for Presumed Pancreatic Cancer Diagnosed by Endoscopic Ultrasonography (EUS) and Fine-Needle Aspiration (FNA)

Abstract: Even with aggressive use of preoperative evaluation, there is still a small subset of patients where malignancy cannot be excluded without pancreaticoduodenectomy.

Cited by 38 publications

References 31 publications

Serous Neoplasms of the Pancreas

Serous Neoplasms of the Pancreas

False-positive EUS-guided FNA cytology for solid pancreatic lesions

Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound

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