Advantages and disadvantages of EUS-FNA/B for pancreatic tumors from a gastroenterological surgeon's perspective

Abstract

The indications for preoperative diagnosis of pancreatic tumors by EUS-FNA/B have been extended in recent years. Preoperative or pre-treatment differentiation of common pancreatic cancer from comparatively rare low-grade tumors or unusual pancreatic cancer by EUS-FNA allows selection of an appropriate treatment strategy and surgical procedure. However, EUS-FNA/B for pancreatic tail cancer should be performed carefully due to the possibility of needle tract seeding. EUS-FNA for cystic tumors of the pancreas is rarely performed in Japan due to concerns about peritoneal seeding and cyst rupture. In contrast, in Europe and the United States, the intracystic fluid is commonly used for malignant diagnosis and differential diagnosis. For neuroendocrine tumors, preoperative grade prediction has been reported to have a diagnostic accuracy rate of around 85% in the last 10 years. EUS-FNA for solid pseudopapillary neoplasms is useful in differentiating them from neuroendocrine tumors and pancreatic acinar cell carcinoma. However, it must be performed with extreme caution due to reports of peritoneal dissemination and tumor rupture.