The Utility of EUS-FNA to Determine Surgical Candidacy in Patients with Pancreatic Cancer after Neoadjuvant Therapy
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ORIGINAL ARTICLE
The Utility of EUS-FNA to Determine Surgical Candidacy in Patients with Pancreatic Cancer after Neoadjuvant Therapy Dean Ehrlich 1,2,3 & Nimah Ather 3 & Harman Rahal 1 & Timothy R. Donahue 4 & O. Joe Hines 5 & Stephen Kim 3 & Alireza Sedarat 3 & V. Raman Muthusamy 3 & Rabindra Watson 3 Received: 8 May 2019 / Accepted: 16 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background In patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who undergo neoadjuvant therapy, CT imaging is the standard of care for restaging. However, differentiating residual tumor from post-treatment inflammation with CT is unreliable. The diagnosis of periarterial soft tissue cuffing (PSTC) near major vessels is key to guiding resectability. The goal of this study was to assess the utility of EUS-FNA in determining the etiology of PSTC in BRPC or LAPC after neoadjuvant treatment. Methods We performed a retrospective analysis of patients referred for EUS-FNA of PSTC following downstaging therapy for LAPC or BRPC at our tertiary medical center. Negative EUS-FNA cytology results were compared with surgical pathology after resection. Patients with positive EUS-FNA cytology results were either followed clinically or results were compared to surgical pathology if surgery was attempted despite the positive cytology. Results Fourteen patients were included in the study of whom four had positive cytology. Two of these patients had progression of disease, and two had attempted resection with positive surgical pathology (100% true positives). All ten patients with negative cytology underwent attempted surgical resection. Nine patients (90%) achieved negative margins, and one patient (10%) had a positive surgical margin. The sensitivity, specificity, and accuracy of EUS-FNA for determining resectability were 80%, 100%, and 92.9%, respectively. Conclusions In this series of patients with BRPC or LAPC and persistent PSTC after downstaging neoadjuvant treatment, EUSFNA accurately determined surgical resectability and should be considered as part of the evaluation of such patients. Keywords Pancreas . Surgery . Adenocarcinoma . Endoscopy . Ultrasound
* Dean Ehrlich [email protected] 1
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
2
UCLA Medical Center, 757 Westwood Plaza, Suite 7501, Los Angeles, CA 90095-7417, USA
3
Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
4
Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
5
Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Abbreviations EUS Endoscopic ultrasound FNA Fine-needle aspiration BRPC Borderline resectable pancreatic cancer LAPC Locally advanced pancreatic cancer PSTC Periarterial soft tissue cuffing SMA Superior mesenteric artery CA Celiac artery C
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