Preoperative Diagnosis of Extrapancreatic Neural Invasion in Pancreatic Cancer

Michael J. Levy, Mark Topazian, Gary Keeney, Jonathan E. Clain, Ferga Gleeson, Elizabeth Rajan, Kenneth K. Wang, Maurits J. Wiersema, Michael Farnell, Suresh Chari

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background & Aims: Pancreatic cancer recurs in most patients after resection with curative intent. Recurrence is particularly common in patients with extrapancreatic neural invasion (EPNI), the presence of which correlates with poor prognosis. Macroscopic EPNI may be detected with conventional noninvasive imaging and endoscopic ultrasound (EUS) imaging, but microscopic EPNI has required postoperative pathologic examination of surgical specimens. We report the preoperative diagnosis of cancer infiltration into celiac ganglia. We hypothesized that microscopic pancreatic cancer metastasis to neural ganglia can be detected by EUS-guided biopsy examination. Methods: We performed a retrospective review of patients with pancreatic cancer undergoing EUS in whom celiac ganglia were sampled to exclude malignant infiltration. Results: Six patients with pancreatic cancer underwent EUS-guided fine-needle aspiration or trucut biopsy examination of presumed celiac ganglia. Metastatic cancer was found in ganglia of 2 patients. Specimen review identified adenocarcinoma and neural tissue in the absence of lymphocytes. At laparoscopy, 1 of the 2 patients with positive celiac biopsy specimens also had several unexpected peritoneal metastatic deposits. The other patient was considered to have locally advanced unresectable disease. Both patients are receiving supportive care. Conclusions: EPNI may be shown preoperatively in patients with pancreatic cancer using EUS-guided sampling of celiac ganglia. A preoperative diagnosis of EPNI has the potential to improve staging accuracy and patient outcomes.

Original languageEnglish (US)
Pages (from-to)1479-1482
Number of pages4
JournalClinical Gastroenterology and Hepatology
Issue number12
StatePublished - Dec 2006

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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