Published online Jan 21, 2021. doi: 10.3748/wjg.v27.i3.294
Peer-review started: December 5, 2020
First decision: December 17, 2020
Revised: December 28, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: January 21, 2021
Processing time: 39 Days and 21.7 Hours
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity. Although needle-tract seeding caused by EUS-FNA has been recently reported, dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis. However, the frequency of dissemination and needle-tract seeding appears to have been underestimated. We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.
An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening. Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma; hence laparoscopic distal pancreatectomy with lympha-denectomy was performed. No intraoperative peritoneal dissemination and liver metastasis were visually detected, and pelvic lavage cytology was negative for carcinoma cells. The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin; however, pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site, and the cells were suspected to be disseminated via EUS- FNA. Hence, the patient received adjuvant therapy with S-1 (tegafur, gimeracil, and oteracil potassium); however, computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis. The patient received palliative therapy and died 8 mo after the operation.
The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination, especially for cancers in the pancreatic body or tail.
Core Tip: Along with the development of preoperative chemotherapy, there is an increasing need for tissue sample collection using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Peritoneal dissemination and needle-tract seeding caused by EUS-FNA were previously considered rare events with minimal prognostic impact. However, we experienced a case of peritoneal dissemination of pancreatic cancer—secondary to EUS-FNA—that markedly affected postoperative survival. We provide suggestions for the use of EUS-FNA along with a review of literature.