Pancreatic metastases diagnosed by endoscopic ultrasound-guided fine-needle aspiration/biopsy: experience of a tertiary center

Aims Pancreatic metastases account for 2% of malignant solid pancreatic lesions. Clinical suspicion based on history of previous neoplasm is essential for diagnosis. Confirmation generally comes through cytological examination and immunocytochemistry tests of specimens obtained by endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB). Existing evidence on this entity is in the form of case series with a limited number of patients. The aim of our study is to evaluate the incidence of pancreatic metastases diagnosed by EUS-FNA/FNB in our centre and characterize their clinicopathological features.

Methods We retrospectively included all patients diagnosed with pancreatic metastases by EUS-FNA/FNB between January 2002 and October 2023. Data collection included primary tumour origin, time elapsed from the diagnosis of the primary tumour, symptoms, number of pancreatic lesions and presence of concomitant metastases in other locations. [1] [2] [3]

Results Out of 5,106 EUS-FNA/FNB procedures performed during the study period, pancreatic metastases were diagnosed in 57 patients (1.13%). Renal cell carcinoma was the most prevalent primary tumour (n=21; 36.8%) followed by colorectal cancer (n=10; 17.5%), small-cell lung cancer (n=6, 10.5%), breast cancer (n=5; 8.8%), melanoma (n=4; 7%), squamous cell lung carcinoma (n=2; 3.5%), lung adenocarcinoma (n=2; 3.5%), ovarian serous carcinoma (n=2; 3.5%), sarcoma (n=2; 3.5%), prostate adenocarcinoma (n=1; 1.8%), cervical cancer (n=1; 1.8) and gastric adenocarcinoma (n=1; 1.8%). Pancreatic metastases were generally diagnosed during follow-up imaging in asymptomatic patients (n=47, 82.4%). Symptomatic cases had obstructive jaundice (n=5; 8.8%), abdominal pain (n=3; 5.3%) and acute pancreatitis (n=2; 3.5%). Most patients presented with a single pancreatic metastasis (n=45; 78.9%). The median time between primary tumour diagnosis and pancreatic metastasis detection was 2.3 years (IQR: 0.5-5.8 years), with renal cell carcinoma exhibiting a longer interval (6 years; [IQR: 2-12.4 years]). Only one patient had synchronous pancreatic metastases at the time of primary tumour diagnosis. Pancreatic metastases were the sole metastatic location in half of the patients (n=30, 52.6%), whereas the remaining had concurrent extrapancreatic metastases (n=27, 47.3%). EUS-FNA/FNB with cytological examination and immunocytochemistry tests accurately diagnosed all cases (n=57, 100%).

Conclusions The pancreas may be a site for metachronous metastatic disease, even long after primary tumour diagnosis. Pancreatic metastases are generally asymptomatic, and the most frequent primary tumour is renal cell carcinoma. EUS-FNA/FNB is essential for diagnostic confirmation. Our observed incidence of pancreatic metastases is in line with what has been previously reported.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Okasha HH, Pawlak KM, Żorniak M. et al. EUS in the evaluation of metastatic lesions to the pancreas. Ultrasonido endosc 2020; 9 (03) 147-150
• 2 Sperti C, Moletta L, Patanè G. et al. Metastatic tumors to the pancreas: The role of surgery. World J Gastrointest Oncol 2014; 6 (10) 381-92
• 3 Masetti M, Zanini N, Martuzzi F. et al. Analysis of prognostic factors in metastatic tumors of the pancreas: a single-center experience and review of the literature. Pancreas. 2010; 39 (02) 135-43

Publication History

Article published online:
15 April 2024