The role of EUS-FNA for plexus invasion in pancreatobiliary cancer

Abstract

Pancreatobiliary cancer often causes plexus invasion, so diagnosing perivascular invasion is important for deciding the treatment indication. Endoscopic ultrasound (EUS) clearly demonstrates low echoic areas with high spatial resolution, and specimens can be collected via EUS-fine-needle aspiration (FNA) to differentiate benign and malignant lesions. The present study examined the usefulness of EUS-FNA for diagnosing plexus invasion. Twenty-one EUS-FNA procedures in 19 patients diagnosed with perivascular invasion by multi-detector-row computed tomography were selected for our study. The primary lesions were pancreatic cancer in 14 cases, cholangiocarcinoma in 3 cases, gallbladder cancer in 1 case, and residual pancreatic cancer in 1 case. The target puncture sites were low echoic areas around the common hepatic artery in 9 cases, celiac artery in 5 cases, superior mesenteric artery in 3 cases, splenic artery in 2 cases, proper hepatic artery in 1 case, and right hepatic artery in 1 case. The accuracy of diagnosing plexus invasion with EUS-FNA was 76.2% (16/21), and 5 cases failed to reach the diagnosis. The only adverse event was gastrointestinal bleeding in one case. Accurately diagnosing plexus invasion is important, as it is often associated with therapeutic strategies, such as surgical indications and post-chemotherapy evaluations.