SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS AND EUS-FNB WITH NEW NEEDLE: A CONFIDENT PREOPERATIVE DIAGNOSIS

Background and aim: It has commonly accepted that a correct preoperative diagnosis for Solid Pseudopapillary Neoplasms (SPN) is difficult, given their rarity and pleomorphic morphology. In the literature, a definitive preoperative diagnosis with EUS-guided Fine Needle Aspiration (EUS-FNA) of SPN varies between 10% and 75%. A possible reason of these variability can be the quality of sampling. The commercialization of new needle (Echotip ProCore; Cook Endoscopy Inc), studied to obtain adequate material promises encouraging results. This case series want to analyze the roles of EUS-Fine Needle Biopsy (FNB) in preoperative diagnosis of SPN. Material and methods: We described the cases of 5 patients (1 male, meanage: 31 years) subjected to EUS-FNB which are presented to our hospital for the evalutation of mixed pancreatic masses (1 of the head, 3 of the tail and 1 of the body). All procedures were done by 2 skilled operators using 19 or 22 G procore needle. EUS-FNB was performed with technical success without complications. Were performed two passages and in two cases a expert on-site cytopathologist was present. The specimen was fixed for Papanicolaou staining end additional material was submitted for cell block preparation. In all cases immunohistochemical analysis was done and diagnosis was confirmed by surgical specimen. Results: In all patients subject to EUS-FNB using new needle was obtained a confident preoperative diagnosis of SPN, with adequate assessment. In 4 cases a laparoscopic distal pancreatectomy was planned preoperatively and was successfully completed, 1 patient underwent pancreaticoduodenectomy. There is no evidence of recurrence with a mean follow up period of 14 months (range 6–24). Conclusions: This case series report that EUS guided FNB with procore leads to a conclusive preoperative diagnosis, also in “atypical” cases for localization (head) and gender (male). The adequacy of the sample allows immunostain analysis, essential for confident diagnosis. These approach guide the choice of a less invasive surgery improving the management of patients with SNP. Future studied are needed to validate these results.