Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration:A case report and literature review

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity.Although needle-tract seeding caused by EUS-FNA has been recently reported,dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis.However,the frequency of dissemination and needle-tract seeding appears to have been underestimated.We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.CASE SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening.Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma;hence laparoscopic distal pancreatectomy with lymphadenectomy was performed.No intraoperative peritoneal dissemination and liver metastasis were visually detected,and pelvic lavage cytology was negative for carcinoma cells.The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin;however,pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site,and the cells were suspected to be disseminated via EUSFNA.Hence,the patient received adjuvant therapy with S-1(tegafur,gimeracil,and oteracil potassium);however,computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis.The patient received palliative therapy and died 8 mo after the operation.CONCLUSION The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination,especially for cancers in the pancreatic body or tail.

多巴胺转运体SPECT显像中显像剂分布的定量分析有助于图像的客观解读

目的多巴胺转运体（DAT） SPECT显像时，显像剂分布的定量分析能在视觉分析的基础上增加其客观性。该研究旨在评估显像剂分布的定量指标——分形维数（FD）的诊断作用，并将其与常规定量指标——特异性结合率（SBR）进行比较；同时评估SBR/FD组合指标（SBR除以FD）的诊断价值。方法行临床研究和模型研究。临床研究纳入150例患者，其中110例帕金森综合征（PS）患者和40例非PS患者。模型研究采用纹状体模型，将纹状体腔分为尾状核和壳核。计算SBR、FD和SBR/FD，并与数据库进行比较，以评估其诊断价值。采用Mann-Whitney检验和受试者工作特征（ROC）曲线分析法分析数据。结果ROC曲线分析表明，FD具有较高的诊断效能[曲线下面积（AUC）为0.943]，其与SBR和FD （SBR/FD）联合应用比单独使用SBR有更高的诊断效能（AUC：0.964与0.899; P〈0.001）。SBR的灵敏度、特异性和准确性分别为79.1%、85.0%和80.7%，FD对应为84.5%、97.5%和88.0%，SBR/FD对应为92.7%、87.5%和91.3%。结论FD是反映DAT SPECT显像时显像剂分布的有价值的诊断指标。FD与SBR联合应用比单独应用的诊断价值更高。