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Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Local Recurrence of Pancreaticobiliary Cancer after Surgical Resection

Gut and Liver 2020년 14권 5호 p.652 ~ 658
Matsumoto Kazuyuki, Kato Hironari, Horiguchi Shigeru, Tomoda Takeshi, Matsumi Akihiro, Ishihara Yuki, Saragai Yosuke, Takada Saimon, Muro Shinichiro, Uchida Daisuke, Okada Hiroyuki,
소속 상세정보
 ( Matsumoto Kazuyuki ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Kato Hironari ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Horiguchi Shigeru ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Tomoda Takeshi ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Matsumi Akihiro ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Ishihara Yuki ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Saragai Yosuke ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Takada Saimon ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Muro Shinichiro ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Uchida Daisuke ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology
 ( Okada Hiroyuki ) - Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterology and Hepatology

Abstract


Background/Aims: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA; EUS-FNA) allows for diagnostic tissue specimens from various regions to be analyzed. However, diagnosing recurrent pancreaticobiliary cancer after surgery is sometimes difficult. We evaluated the efficacy of EUS-FNA in the diagnosis of local recurrence of pancreaticobiliary cancer and analyzed the factors associated with falsenegative results.

Methods: Fifty-one consecutive patients who underwent EUS-FNA due to suspected recurrence of pancreaticobiliary cancer after surgery in an academic center were retrospectively analyzed. The criteria for EUS-FNA were a resected margin or remnant pancreas mass, round swollen lymph node (≥10 mm in diameter), and soft-tissue enhancement around a major artery. Patients with suspected liver metastasis or malignant ascites were excluded.

Results: Thirty-nine of the 51 patients had pancreatic cancer; the remaining 12 had biliary cancer. The target sites for EUS-FNA were the soft tissue around a major artery (n=22, 43%), the resected margin or remnant pancreas (n=12, 24%), and the lymph nodes (n=17, 33%). The median size of the suspected recurrent lesions was 15 mm (range, 8 to 40 mm). The overall sensitivity, specificity and accuracy of EUS-FNA for the diagnosis of recurrence was 84% (32/38), 100% (13/13), and 88% (45/51), respectively. FNA of the soft tissue around major arteries (odds ratio, 8.23; 95% confidence interval, 1.2 to 166.7; p=0.033) was significantly associated with a falsenegative diagnosis in the multivariate analysis.

Conclusions: EUS-FNA is useful for diagnosing recurrent cancer, even after pancreaticobiliary surgery. The diagnoses of recurrence at soft-tissue sites should be interpreted with caution.

키워드

Endoscopic ultrasound-guided fine needle aspiration; Pancreaticobiliary cancer; Neoplasm recurrence

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