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Thématique :
- Endoscopie/Imagerie
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Originalité :
Intermédiaire
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Dans certains cas
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Nom du veilleur :
Docteur Florian ROSTAIN
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Gastrointestinal Endoscopy
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2016/04
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2016 Mar 10. pii: S0016-5107(16)00236-4
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doi: 10.1016/j.gie.2016.02.045
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Impact of EUS-FNA for preoperative para-aortic lymph node staging in patients with pancreatobiliary cancer.
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Kurita A, Kodama Y, Nakamoto Y, Isoda H, Minamiguchi S, Yoshimura K, Kuriyama K, Sawai Y, Uza N, Hatano E, Uemoto S, Togashi K, Haga H, Chiba T
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http://www.ncbi.nlm.nih.gov/pubmed/?term=impact+of+eus-fna+for+preoperative+para-aortic
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BACKGROUND AND AIMS:
In patients with pancreatobiliary cancers, para-aortic lymph node (PALN) metastasis is considered as 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 endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) and 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (PET/CT).
METHODS:
We performed a prospective, nonrandomized single-center trial. Between December 2010 and March 2014, 208 patients with pancreatobiliary cancers 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. PET/CT and EUS-FNA were performed sequentially as a single combined procedure to evaluate PALN metastases. 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 PALNs (42.3%) were finally diagnosed as metastases in 21 patients (40.4%). In the 21 patients with PALN metastases, preoperative EUS-FNA or PET/CT made a correct diagnosis in 20 (95.2%) or 12 (57.1%) patients, 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%, and 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 cancers. Because of the clinical benefits of EUS-FNA to reduce unnecessary surgery, it should be part of the standard preoperative examination for patients with pancreatobiliary cancers. (UMIN clinical trials registry number: 000006408.).
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Comparer l’efficacité de la ponction à l’aiguille fine sous écho-endoscopie (EUS-FNA) versus le TEP-scanner (TEP-CT) pour l’évaluation pré-opératoire du statut des ganglions lymphatiques para-aortiques dans les cancers du pancréas.
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Etude prospective mono-centrique non randomisée sur 52 patients ayant un cancer du pancréas sans métastase à distance visible mais avec une suspicion d’envahissement des ganglions para-aortiques.
Tous les patients ont eu l’EUS-FNA et le TEP-CT.
Des métastases ganglionnaires para-aortiques ont été diagnostiquées chez 21 des 52 patients. Parmi ces 21 patients, l’EUS-FNA a permis le diagnostic chez 20 patients (95,2%), le TEP-CT chez 12 patients (57,1%).
L’EUS-FNA avait une sensibilité et une spécificité supérieures au TEP-CT pour le diagnostic des métastases ganglionnaires para-aortiques.
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L’écho-endoscopie avec ponction semble plus efficace que le TEP-scanner dans l’evaluation du statut des ganglions para-aortiques en cas de cancer du pancréas. Elle pourrait devenir un standard si sa supériorité au TEP-scanner est confirmée dans d’autres études.
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