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Loveček M, Skalický P, Urban O, Tesaříková J, Kliment M, Psár R, Švébišová H, Urban K, Mohelníková-Duchoňová B, Klos D, Stašek M. Isolated Gastric Metastases of Pancreatic Ductal Adenocarcinoma following Radical Resection—Impact of Endosonography-Guided Fine Needle Aspiration Tract Seeding. Biomedicines 2022; 10:biomedicines10061392. [PMID: 35740414 PMCID: PMC9220227 DOI: 10.3390/biomedicines10061392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Endosonography-guided fine needle aspiration biopsy (EUS-FNA)-associated metachronous gastric seeding metastases (GSM) of pancreatic ductal adenocarcinoma (PDAC) represent a serious condition with insufficient evidence. Methods: Retrospective analysis of PDAC resections with a curative-intent, proven pathological diagnosis of PDAC, preoperative EUS-FNA and post-resection follow-up of at least 60 months. The systematic literature search of published data was used for the GSM growth evaluation using Pearson correlation and the linear regression analyses. Results: The inclusion criteria met 59/134 cases, 16 (27%) had retained needle tract (15 following distal pancreatectomy, 1 following pylorus-sparing head resection). In total, 3/16 cases (19%) developed identical solitary GSM (10–26th month following primary surgery) and were radically resected. A total of 30 published cases of PDAC GSM following EUS-FNA were identified. Lesion was resected in 20 distal pancreatectomy cases with complete information in 14 cases. A correlation between the metastasis size and time (r = 0.612) was proven. The regression coefficient b = 0.72 expresses the growth of 0.72 mm per month. Conclusions: The GSM represent a preventable and curable condition. A remarkably high number of GSM following EUS-FNA was identified, leading to follow-up recommendation of EUS-FNA sampled patients. Multimodal management (gastric resection, adjuvant chemotherapy) may prolong survival.
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Affiliation(s)
- Martin Loveček
- Department of Surgery I, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic; (M.L.); (P.S.); (J.T.); (D.K.)
| | - Pavel Skalický
- Department of Surgery I, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic; (M.L.); (P.S.); (J.T.); (D.K.)
| | - Ondřej Urban
- Department of Internal Medicine II—Gastroentrology and Geriatrics, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic;
| | - Jana Tesaříková
- Department of Surgery I, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic; (M.L.); (P.S.); (J.T.); (D.K.)
| | - Martin Kliment
- Helios Kliniken Schwerin, Klinik für Gastroenterologie und Infektiologie, Wismarsche Strasse 393-397, 19055 Schwerin, Germany;
| | - Róbert Psár
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hněvotínská 976/3, 77900 Olomouc, Czech Republic;
| | - Hana Švébišová
- Department of Oncology, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic;
| | - Kateřina Urban
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Hněvotínská 1333/5, 77900 Olomouc, Czech Republic; (K.U.); (B.M.-D.)
| | - Beatrice Mohelníková-Duchoňová
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Hněvotínská 1333/5, 77900 Olomouc, Czech Republic; (K.U.); (B.M.-D.)
- Department of Oncology, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 976/3, 77900 Olomouc, Czech Republic
| | - Dušan Klos
- Department of Surgery I, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic; (M.L.); (P.S.); (J.T.); (D.K.)
| | - Martin Stašek
- Department of Surgery I, University Hospital Olomouc, I.P. Pavlova 185/6, 77900 Olomouc, Czech Republic; (M.L.); (P.S.); (J.T.); (D.K.)
- Correspondence: ; Tel.: +42-058-844-2962
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Nakatsubo R, Yamamoto K, Itoi T, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Mukai S, Nagai K, Yamaguchi H, Nagakawa Y. Histopathological evaluation of needle tract seeding caused by EUS-fine-needle biopsy based on resected specimens from patients with solid pancreatic masses: An analysis of 73 consecutive cases. Endosc Ultrasound 2021; 10:207-213. [PMID: 33586689 PMCID: PMC8248312 DOI: 10.4103/eus-d-20-00174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives: EUS-guided fine-needle biopsy (EUS-FNB) is considered a safe and useful method for preoperative diagnosis of resectable solid pancreatic masses. However, needle tract seeding (NTS) after EUS-FNB has recently been reported, which may affect long-term outcome. The aim of this study was to evaluate NTS after EUS-FNB. Materials and Methods: We reviewed 73 resected cases that underwent preoperative EUS-FNB for a pancreatic tumor from April 2014 to March 2016 and evaluated the utility and adverse events of EUS-FNB based on consecutively resected pathological specimens. Results: The final diagnoses were pancreatic ductal adenocarcinoma (n = 67), neuroendocrine neoplasm (n = 5), and acinar cell carcinoma (n = 1). The diagnostic accuracy of preoperative EUS-FNB was 98.6%. Clinical adverse events were observed in 4.1% of cases (bleeding, n = 2; acute pancreatitis, n = 1) and abnormal pathological findings in 4.1% (NTS, n = 2; acute focal pancreatitis, n = 1). Conclusions: Although EUS-FNB is useful for preoperative diagnosis of pancreatic tumors, we may need to reconsider the risk of NTS and use of EUS-FNB in patients with a resectable solid pancreatic mass unless the tract itself is planned to be resected.
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Affiliation(s)
- Ryosuke Nakatsubo
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kazumasa Nagai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Yuichi Nagakawa
- Third Department of Surgery, Tokyo Medical University, Tokyo, Japan
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