Background and Aims
In patients with pancreatobiliary cancer, para-aortic lymph node (PALN) metastasis
is considered to be the involvement beyond the regional lymph nodes, namely, distant
metastasis. Effective methods for preoperative PALN staging, however, are not established.
This study aimed to compare the diagnostic capability for PALN metastasis between
EUS-FNA and 18F-fluorodeoxyglucose positron emission tomography with CT (PET/CT).
Methods
We performed a prospective, nonrandomized, single-center trial. Between December 2010
and March 2014, 208 patients with pancreatobiliary cancer without apparent distant
metastasis except for PALNs were assessed for study eligibility before surgery. Among
them, 52 consecutive patients with PALN enlargement were enrolled in the study. 18F-Fluorodeoxyglucose PET/CT and EUS-FNA were performed sequentially as a single combined
procedure to evaluate PALN metastases. The primary outcome was to compare the diagnostic
capability of EUS-FNA and PET/CT for PALN metastasis.
Results
Of 71 enlarged PALNs in the 52 patients, 30 (42.3%) were finally diagnosed as metastases
in 21 patients (40.4%). Of the 21 patients with PALN metastases, preoperative EUS-FNA
or PET/CT made a correct diagnosis in 20 (95.2%) or 12 (57.1%), respectively. EUS-FNA
had higher sensitivity and specificity for the diagnosis of PALN metastasis (sensitivity,
96.7% [29/30]; 95% confidence interval, 82.2%-99.9%; specificity, 100% [39/39]; 95%
confidence interval, 91.0%-100%) than PET/CT.
Conclusions
EUS-FNA is superior to PET/CT for preoperative PALN staging in patients with pancreatobiliary
cancer. Because of the clinical benefit of EUS-FNA to reduce unnecessary surgery,
it should be part of the standard preoperative examination for patients with pancreatobiliary
cancer. (UMIN clinical trials registry number: 000006408.)
Abbreviations:
AJCC (American Joint Committee on Cancer), CA (celiac axis), CHA (common hepatic artery), CI (confidence interval), FDG-PET (18F-fluorodeoxyglucose positron emission tomography), H&E (hematoxylin and eosin), LN (lymph node), MDCT (multidetector-row CT), NPV (negative predictive value), PALN (para-aortic lymph node), PET/CT (18F-fluorodeoxyglucose positron emission tomography with CT), PPV (positive predictive value), SMA (superior mesenteric artery), SUVmax (maximum standardized uptake value), UICC (Union for International Cancer Control), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2016
Accepted:
February 26,
2016
Received:
December 3,
2015
Footnotes
DISCLOSURE: Dr Kodama is supported in part by a grant from the Japanese Society for the Promotion of Science KAKENHI (25461022). All authors disclosed no financial relationships relevant to this publication.
Identification
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Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
