Complications and pathological changes of pancreas tumor after EUS-FNA

Objective: Recently EUS-FNA is increasingly performed in preoperative cases to acquire the pathological evidence in our center. However EUS-FNA is a safe technique, some problems remain such as hemorrhage, pancreatitis, and tumor dissemination. Also histological changes after EUS-FNA are still uncertain. The aim of this study is to assess the intraoperative and pathological changes after EUS-FNA.

Patients and Methods: The subject was 25 cases of pancreas tumor in which operation was performed after EUS-FNA in our center until March 2010. There were pancreatic cancer in 19 cases, pancreatic neuroendocrine tumor in 5, and metastatic pancreatic cancer from renal cell carcinoma in 1. Average tumor size was 31.0mm (6–80). Tumor locations were Pancreas head in 14, body and tail in 11. Duration from EUS-FNA to operation was average 42 days (3–636). The following points were evaluated: 1) clinical complications, 2) intraoperative and pathological changes which thought to be influence of FNA.

Results: 1) Clinical complications occurred in 3 cases (12%); pancreatitis (1), peritonitis (1) and hematoma (1). All these cases could be managed with conservative treatment. 3) Intraoperative findings after EUS-FNA were that adhesion around pancreas was found in 5 cases. Two of five cases occurred clinical complications. Pathological findings were revealed in 11 cases (44%); fibrosis (4), abscess (2), bleeding (2), abscess and bleeding (1), abscess and fibrosis (1), tumor in puncture line (1).

Conclusions: Complication rate of EUS-FNA for operative pancreas tumor was rather high. EUS-FNA might have affected intraoperative findings in 20% (5/25) and pathological findings in 44% (11/25). Further study is required to evaluate how EUS-FNA affects with the cases of operative pancreas tumor.