Impact of endoscopic ultrasound with fine-needle aspiration on the surgical management of pancreatic cancer

Background Endoscopic ultrasound (EUS) with EUS-guided fine-needle aspiration (EUS-FNA) enables one to visualize the pancreas and surrounding structures and can provide access for FNA of those structures that appear suspicious for tumor. Patients and methods From 1993 to 1995, 50 patients suspected of having pancreatic cancer underwent EUS/EUS-FNA and abdominal computed tomography (CT). Malignancy was found in 30 (60%) cases, which included 24 (48%) pancreatic adenocarcinomas. Results Endoscopic ultrasound/EUS-FNA identified 26 of the 30 malignancies (85%) and 21 of the 24 pancreatic adenocarcinomas (88%), with no false positives. Thirteen of the 24 pancreatic cancer patients had lymph nodes that were sampled with EUS/EUS-FNA. Seven of these 13 patients (62%) were found to have metastatic spread to lymph nodes. Operations were performed on 11 of the pancreatic cancer patients. Of these 11, the 5 that were predicted to be resectable by EUS/EUS-FNA underwent successful resection. Of the 6 predicted to be unresectable, 5 had palliative biliary bypasses, and 1 had a grossly positive margin of resection. Conclusions Endoscopic ultrasound/EUS-FNA can identify patients for curative surgical resection. It can also preoperatively identify patients with regional nodal disease for inclusion in appropriately designed clinical trials.