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Open Access Research article

Accuracy of endoscopic ultrasound-guided fine-needle aspiration in the suspicion of pancreatic metastases

José Celso Ardengh12*, César Vivian Lopes34, Rafael Kemp2, Filadélfio Venco5, Eder Rios de Lima-Filho6 and José Sebastião dos Santos2

Author Affiliations

1 Endoscopy Unit, Hospital 9 de Julho, São Paulo, Brazil

2 Division of Surgery and Anatomy, Ribeirão Preto Medical School – University of São Paulo, São Paulo, Brazil

3 Endoscopy Unit, Santa Casa Hospital, Porto Alegre, Brazil

4 Endoscopy Unit, Moinhos de Vento Hospital, Porto Alegre, Brazil

5 Diagnostika Pathology Unit, São Paulo, Brazil

6 General Surgery, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

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BMC Gastroenterology 2013, 13:63  doi:10.1186/1471-230X-13-63

Published: 11 April 2013

Abstract

Background

Metastases to the pancreas are rare, and usually mistaken for primary pancreatic cancers. This study aimed to describe the histology results of solid pancreatic tumours obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosis of metastases to the pancreas.

Methods

In a retrospective review, patients with pancreatic solid tumours and history of previous extrapancreatic cancer underwent EUS-FNA from January/1997 to December/2010. Most patients were followed-up until death and some of them were still alive at the end of the study. The performance of EUS-FNA for diagnosis of pancreatic metastases was analyzed. Symptoms, time frame between primary tumour diagnosis and the finding of metastases, and survival after diagnosis were also analyzed.

Results

37 patients underwent EUS-FNA for probable pancreas metastases. Most cases (65%) presented with symptoms, especially upper abdominal pain (46%). Median time between detection of the first tumour and the finding of pancreatic metastases was 36 months. Metastases were confirmed in 32 (1.6%) cases, 30 of them by EUS-FNA, and 2 by surgery. Other 5 cases were non-metastatic. Most metastases were from lymphoma, colon, lung, and kidney. Twelve (32%) patients were submitted to surgery. Median survival after diagnosis of pancreatic metastases was 9 months, with no difference of survival between surgical and non-surgical cases. Sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA with histology analysis of the specimens for diagnosis of pancreatic metastases were, respectively, 93.8%, 60%, 93.8%, 60% and 89%.

Conclusion

EUS-FNA with histology of the specimens is a sensitive and accurate method for definitive diagnosis of metastatic disease in patients with a previous history of extrapancreatic malignancies.

Keywords:
Pancreatic neoplasms; Metastasis; Endosonography; Biopsy; Fine-needle; Histology