Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

doi:10.3748/wjg.v20.i13.3620

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Apr 7, 2014; 20(13): 3620-3627
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3620

Table 1 Patient characteristics

	FNA+	FNA-
Number of patients	54	28
Median age (range), yr	68 (43-82)	70 (45-84)	NS¹
Gender (M/F)	34/20	16/12	NS²
Location (Ph/Pb/Pt)	33/17/4	20/6/2	NS²
Median CEA (95%CI), ng/mL	4.89 (3.6-5.3)	5.18 (-0.6-45.1)	NS¹
Median CA19-9 (95%CI), U/mL	46.1 (71.5-248.9)	96.7 (-158.9-1,661.9)	NS¹
Median SPan-1 (95%CI), U/mL	33.65 (40.3-191.0)	64.5 (-58.3-945.3)	NS¹
Median DU-PAN-2 (95%CI), U/mL	129 (215-726)	303 (211-630)	NS¹

¹Mann-Whitney U test;

²Fisher’s exact test. FNA+: The patient group who underwent endoscopic ultrasound-guided fine-needle aspiration before surgery; FNA-: The patient group who did not undergo endoscopic ultrasound-guided fine-needle aspiration before surgery; NS: No significant difference; Ph: Pancreas head; Pb: Pancreas body; Pt: Pancreas tail; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9.

Table 2 Endoscopic ultrasound-guided fine-needle aspiration procedure and its diagnostic accuracy

Puncture position	Stomach/duodenum	25/29
Needle size	19-gauge	5
	22-gauge	43
	25-gauge	9
Puncture number, range (mean)		1-5 (2.6)
Mean duration from EUS-FNA to surgery (d)		22.3
Accuracy of cytology diagnosis		98.1% (53/54)
Accuracy of histology diagnosis		77.8% (42/54)

EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration.

Table 3 Operative method, outcome, tumor size, histological type, pathological stage, and adjuvant chemotherapy

	FNA+	FNA-
Number of patients	54	28
Operative method (%)
PD	59.3 (32/54)	75 (21/28)	NS¹
DP	38.9 (21/54)	17.9 (5/28)
TP	1.9 (1/54)	3.6 (1/28)
Partial resection	1.9 (1/54)	3.6 (1/28)
Outcome (%)
R0	96.3 (52/54)	96.4 (27/28)	NS¹
R1	3.7 (2/54)	3.6 (1/28)
R2	0 (0/54)	0 (0/28)
Tumor size (mm)	30.0 ± 1.9 SD	29.5 ± 2.5 SD	NS¹
Histological type
Adenocarcinoma	53	26	NS¹
Adenosquamous carcinoma	1	0
IPMC	0	2
UICC (%)
0	0 (0/54)	3.6 (1/28)	NS¹
IA	3.7 (2/54)	7.1 (2/28)
IB	1.9 (1/54)	0 (0/28)
IIA	48.1 (26/54)	21.4 (6/28)
IIB	38.9 (21/54)	53.6 (15/28)
III	3.7 (2/54)	3.6 (1/28)
IV	3.7 (2/54)	10.7 (3/28)
AC administration (%)	74.1 (40/54)	50 (14/28)	P < 0.05¹

¹Pearson’s χ² test. FNA+: The patient group who underwent endoscopic ultrasound-guided fine-needle aspiration before surgery; FNA-: The patient group who did not undergo endoscopic ultrasound-guided fine-needle aspiration before surgery; PD: Pancreatoduodenectomy; DP: Distal pancreatectomy; TP: Total pancreatectomy; SD: Standard deviation; IPMC: Intraductal papillary mucinous carcinoma of the pancreas; UICC: Pathological stage of the Union Internationale Contre le Cancer; AC: Adjuvant chemotherapy.

Table 4 Univariate and multivariate analyses of factors affecting overall survival

	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Age (over 65 years old)	0.95	0.8640	0.98	0.9460
Age (over 65 years old)	(0.53-1.73)	0.8640	(0.48-2.01)	0.9460
CEA ≥ 3.85 ng/mL	1.72	0.0827	1.49	0.2650
CEA ≥ 3.85 ng/mL	(0.93-3.28)	0.0827	(0.74-3.07)	0.2650
CA19-9 ≥ 56.8 U/mL	2.61	0.0030	1.98	0.0798
CA19-9 ≥ 56.8 U/mL	(1.38-5.15)	0.0030	(0.92-4.36)	0.0798
Tumor size (> 20 mm)	1.46	0.2420	3.27	0.0283
Tumor size (> 20 mm)	(0.78-2.88)	0.2420	(1.13-10.1)	0.0283
Portal vein invasion	1.88	0.0487	0.67	0.3640
Portal vein invasion	(1.00-3.49)	0.0487	(0.28-1.59)	0.3640
UICC ≥ IIB	1.57	0.1210	0.78	0.5030
UICC ≥ IIB	(0.89-2.88)	0.1210	(0.37-1.62)	0.5030
R1/R0	2.59	0.2590	2.29	0.3460
R1/R0	(0.41-8.96)	0.2590	(0.36-9.38)	0.3460
Adjuvant chemotherapy	0.68	0.2040	0.46	0.0312
Adjuvant chemotherapy	(0.38-1.24)	0.2040	(0.23-0.93)	0.0312
EUS-FNA	0.46	0.0093	0.44	0.0365
EUS-FNA	(0.26-0.83)	0.0093	(0.20-0.95)	0.0365

UICC: Pathological stage of the Union Internationale Contre le Cancer; EUS-FNA: Endoscopic-ultrasound-guided fine-needle aspiration.

Table 5 Univariate and multivariate analyses of factors affecting relapse-free survival after surgery

	Univariate		Multivariate
	HR (95%CI)	P value	HR (95%CI)	P value
Age (over 65 years old)	0.81	0.8640	0.84	0.6300
Age (over 65 years old)	(0.47-1.43)	0.8640	(0.42-1.68)	0.6300
CEA ≥ 3.85 ng/mL	1.28	0.0827	1.12	0.7360
CEA ≥ 3.85 ng/mL	(0.72-2.28)	0.0827	(0.57-2.19)	0.7360
CA19-9 ≥ 56.8 U/mL	2.58	0.0030	2.34	0.0798
CA19-9 ≥ 56.8 U/mL	(1.43-4.82)	0.0030	(1.14-4.92)	0.0798
Tumor size (> 20 mm)	1.67	0.2420	3.31	0.0254
Tumor size (> 20 mm)	(0.92-2.28)	0.2420	(1.15-10.3)	0.0254
Portal vein invasion	2.12	0.0123	0.61	0.2752
Portal vein invasion	(1.18-3.78)	0.0123	(0.24-1.47)	0.2752
UICC ≥ IIB	2.44	0.0016	1.97	0.0588
UICC ≥ IIB	(1.39-4.42)	0.0016	(0.98-4.16)	0.0588
R1/R0	1.98	0.2590	1.96	0.4266
R1/R0	(0.32-6.54)	0.2590	(0.29-7.60)	0.4266
Adjuvant chemotherapy	0.78	0.2040	0.43	0.0168
Adjuvant chemotherapy	(0.44-1.40)	0.2040	(0.22-0.85)	0.0168
EUS-FNA	0.5	0.0150	0.46	0.0606
EUS-FNA	(0.29-0.87)	0.0150	(0.20-1.03)	0.0606

UICC: Pathological stage of the Union Internationale Contre le Cancer; EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration.

Citation: Kudo T, Kawakami H, Kuwatani M, Eto K, Kawahata S, Abe Y, Onodera M, Ehira N, Yamato H, Haba S, Kawakubo K, Sakamoto N. Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance. World J Gastroenterol 2014; 20(13): 3620-3627
URL: https://www.wjgnet.com/1007-9327/full/v20/i13/3620.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i13.3620