Background: During the last years, endoscopic ultrasound (EUS) has become an important imaging procedure for diagnosis and management of pancreatic diseases. The clinical interest of EUS is now enhanced by interventional procedures. Fine-needle aspiration biopsy is one of the most important contributions of EUS, in particular for the investigation of patients with pancreatic cancer and cystic tumors. EUS-guided fine-needle aspiration appears to be a safe and reliable technique to obtain tissue from pancreatic masses with a low risk of complications. However, the impact of EUS FNA confirmation of metastatic disease in patient with pancreatic tumors on treatment choice is the aim of this study. Objective: To determine the impact of pancreatic disease as determined by EUS staging on treatment choice in patients with pancreatic lesions. Design: Retrospective analysis of prospectively collected data. Setting: Tertiary university-based referral center. Patients: Patients with biopsy proven pancreatic adenocarcinoma who underwent staging EUS- FNA. The relationship of EUS nodal status and treatment was evaluated. Main Outcomes Measurements: Impact of EUS-FNA on therapy in patients with pancreatic cancer. Results: Of 22 patients with pancreatic tumor, EUS FNA confirmed metastatic disease in 72,7 % of the patients. Patients who were node positive were more likely to receive chemotherapy and/or radiation therapy and were less likely to undergo surgery compared with patients who were node negative ( p< 0,0001). Limitations: Lack of surgical reference standard in all patients. Conclusions: Patients with node positive pancreatic cancer as detected by EUS FNA are more likely to receive neoadjuvant therapy and less likely to receive surgery. Preoperative EUSFNA is a minimally invasive technique that provides important prognostic information in patient with pancreatic lesions.
Key words: endoscopic ultrasound, fine needle aspiration biopsy, pancreatic cancer, treatment