Preoperative Diagnosis of Extrapancreatic Neural Invasion in Pancreatic Cancer

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

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

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
Volume4
Issue number12
DOIs
StatePublished - Dec 2006

Fingerprint

Pancreatic Neoplasms
Sympathetic Ganglia
Biopsy
Ganglia
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Abdomen
Laparoscopy
Ultrasonography
Neoplasms
Adenocarcinoma
Lymphocytes
Neoplasm Metastasis
Recurrence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Preoperative Diagnosis of Extrapancreatic Neural Invasion in Pancreatic Cancer. / Levy, Michael J.; Topazian, Mark; Keeney, Gary; Clain, Jonathan E.; Gleeson, Ferga; Rajan, Elizabeth; Wang, Kenneth Ke Ning; Wiersema, Maurits J.; Farnell, Michael; Chari, Suresh T.

In: Clinical Gastroenterology and Hepatology, Vol. 4, No. 12, 12.2006, p. 1479-1482.

Research output: Contribution to journalArticle

Levy, Michael J. ; Topazian, Mark ; Keeney, Gary ; Clain, Jonathan E. ; Gleeson, Ferga ; Rajan, Elizabeth ; Wang, Kenneth Ke Ning ; Wiersema, Maurits J. ; Farnell, Michael ; Chari, Suresh T. / Preoperative Diagnosis of Extrapancreatic Neural Invasion in Pancreatic Cancer. In: Clinical Gastroenterology and Hepatology. 2006 ; Vol. 4, No. 12. pp. 1479-1482.
@article{7c3290574c144f64b74214ca83da544e,
title = "Preoperative Diagnosis of Extrapancreatic Neural Invasion in Pancreatic Cancer",
abstract = "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.",
author = "Levy, {Michael J.} and Mark Topazian and Gary Keeney and Clain, {Jonathan E.} and Ferga Gleeson and Elizabeth Rajan and Wang, {Kenneth Ke Ning} and Wiersema, {Maurits J.} and Michael Farnell and Chari, {Suresh T}",
year = "2006",
month = "12",
doi = "10.1016/j.cgh.2006.08.012",
language = "English (US)",
volume = "4",
pages = "1479--1482",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
publisher = "W.B. Saunders Ltd",
number = "12",

}

TY - JOUR

T1 - Preoperative Diagnosis of Extrapancreatic Neural Invasion in Pancreatic Cancer

AU - Levy, Michael J.

AU - Topazian, Mark

AU - Keeney, Gary

AU - Clain, Jonathan E.

AU - Gleeson, Ferga

AU - Rajan, Elizabeth

AU - Wang, Kenneth Ke Ning

AU - Wiersema, Maurits J.

AU - Farnell, Michael

AU - Chari, Suresh T

PY - 2006/12

Y1 - 2006/12

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=33845307279&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33845307279&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2006.08.012

DO - 10.1016/j.cgh.2006.08.012

M3 - Article

C2 - 17101297

AN - SCOPUS:33845307279

VL - 4

SP - 1479

EP - 1482

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 12

ER -