ENDOSCOPIC ULTRASOUND FOR PERIPANCREATIC MASSES

BACKGROUND: Pancreatic neoplasms can be difficult to diagnose and stag e preoperatively. Accurate staging allows the surgeon to select which patients can benefit from resection versus palliative therapy. Endosco pic ultrasound (EUS) with endoscopic ultrasound-guided fine needle asp iration (EUS-FNA) is a diagnostic modality that provides visualization of peripancreatic tumors and their relationship to the surrounding st ructures as well as enabling cytologic diagnosis of the tumor and adja cent lymphadenopathy. METHODS: TO define the role of this technique, a retrospective study was performed on 20 patients in the past year wit h peripancreatic tumors. RESULTS: Twelve men and 8 women ranging in ag e from 28 to 84 years (mean 67) were included in the study. Each patie nt underwent computed tomography followed by EUS-FNA, and the results were compared with operative findings or clinical course. The EUS-FNA findings included 10 pancreatic ductal carcinomas (50%), 5 pancreatiti s (25%), 2 spindle cell neoplasms (10%), 1 cholangiocarcinoma (5%), 1 cystadenoma (5%), and 1 metastatic breast carcinoma (5%). Overall, EUS -FNA led to a significant change in the management of 12 patients (60% ) through either diagnosing benign pathology, upstaging of the carcino ma, or determination that the peripancreatic mass represented a metast atic lesion. Five patients underwent resection of their peripancreatic tumors, and 3 patients had palliative procedures, Operative findings corresponded with EUS-FNA in all 8 patients. The 5 patients diagnosed with pancreatitis continued to be followed up for the possibility of a false negative FNA, but to date none have developed malignancy. CONCL USIONS: EUS-FNA is a useful tool for the imaging and staging of peripa ncreatic tumors and will aid in the proper preoperative selection of p atients who will benefit from resectional therapy. (C) 1997 by Excerpt a Medica, Inc.