Novel and accurate method for preoperative diagnosis of pancreatic solid pseudopapillary tumor

Oct 24 2007

Given the difficulty regarding pancreatic biopsy procedures, a research group led by Dr. Chatzipantelis investigates the relatively novel preoperative and bloodless technique of image-guided fine-needle aspiration (FNA), and explores its value in diagnosing pancreatic lesions.

Endoscopic ultrasound (EUS)-guided FNA cytology can provide an accurate preoperative diagnosis of solid pseudopapillary tumor (SPTP), differentiating it from other pancreatic neoplasms with different biologic behavior and treatment. The article published in the October 14 issue of the World Journal of Gastroenterology describes the success of the above mentioned technique in the diagnostic procedure of SPTP.

EUS-FNA was conducted in the Endoscopy Department (Head: Dr. Karoumpalis I, MD), and the FNA cytologic material was interpreted by two experts (Dr. Chatzipantelis P and Dr. Salla C), who provided the final cytopathologic diagnosis.

In this study, a 17-year-old woman was admitted to our hospital with complaints of an unexplained episodic pain for 2 months and a short history of hypertension. Computed tomography scan (CT-scan) revealed a mass of the pancreatic tail, and an operation was scheduled to take place within 2 days. In order to accurately diagnose this tumor in such a young woman, we decided to perform the EUS-guided FNA procedure, preoperatively. The procedures were completed the next day.

EUS confirmed a mass, both in the body and tail of the pancreas, with distinct borders, which caused dilation of the peripheral part of the pancreatic duct. The EUS differential diagnosis included a series of benign and malignant pancreatic tumors. EUS-FNA cytology was performed using a needle, and smears of tumor cells of the pancreas were taken in the endoscopy suite for cytopathologic diagnosis. Additional immunohistochemical stains were performed. The final diagnosis of SPTP was made with great accuracy.

Based on this research, Dr. Chatzipantelis believes the performance of FNA cytopathology under EUS guidance helps us to accurately define the pancreatic lesions preoperatively, so the patient enters the operating theatre with an accurate and safe diagnosis. The value of the procedure, according to Dr. Chatzipantelis, consists of the accuracy of the preoperative diagnosis coupled with the reduction of the patient¡¯s discomfort. Therefore, it is suggested as a successful technique in diagnosing pancreatic lesions.