A decade’s experience of managing suspected pancreatic adenocarcinoma at a tertiary cancer center

Authors Ikenna K. Emelogu, Donald R. Campbell, Gandhi Lanke, Abraham C. Yu, Graciela Nogueras-Gonzalez, Phillip Lum, Emmanuel Coronel, Phillip S. Ge, William A. Ross, Brian R. Weston, Matthew H. Katz, Jeffrey H. Lee.

Abstract

Background We present our experience and established management strategy for endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) in diagnosing suspected pancreatic neoplasms at a tertiary referral cancer hospital.


Method Relevant data were extracted from our database for patients who underwent EUS-FNA for suspected pancreatic neoplasms at our institution between 2007 and 2016.


Results Among the 309 patients, the median age was 67 years and 56% were men. The most common presenting symptoms were abdominal pain (37%) and jaundice (29%). Concordance between radiographic diagnosis and final pathology was 89%. The mean lesion size was 34.9 mm on computed tomography and 31.5 mm on EUS. There were 197 patients (64%) with localized disease, of whom 115 (58%) had resectable lesions, 61 (31%) had borderline resectable, and 21 (11%) had unresectable lesions (mean CA 19-9 levels 1705 U/mL, 2490 U/mL, and 479 U/mL, respectively). A median of 3 FNA passes were performed to establish a pathologic diagnosis. Two patients (1%) had postprocedural adverse events. Median overall survival was 47 months in those who underwent surgery after EUS and 12 months in those who did not (P<0.001).


Conclusions A multidisciplinary approach is employed for management of suspected pancreatic neoplasm at our tertiary cancer center. A combination of cross-sectional imaging and EUS-FNA serves as a highly effective duo in establishing a tissue diagnosis and staging with a low adverse event rate. Counterintuitively, CA 19-9 is not necessarily higher with resectable lesions than with unresectable lesions, indicating the limitation of CA 19-9 as a pancreatic tumor marker.


Keywords Endoscopic ultrasound, fine-needle aspiration, pancreatic adenocarcinoma, CA 19-9, cross-sectional imaging Ann Gastroenterol 2023; 36 (1): 81-86

Published
2022-12-25
Section
Original Articles