Abstract
Endoscopic ultrasound (EUS) is routinely used for fiducial marker placement (FMP) to guide stereotactic radiation of pancreatic tumors, but EUS-FMP explicitly to guide surgery has not been studied in a prospective, controlled manner. Multipurpose EUS systems have been developed that facilitate simultaneous EUS-FMP at the time of biopsy. We aimed to evaluate the feasibility of EUS-FMP to guide pancreatic resection. In this prospective trial, we enrolled patients with resectable pancreas masses undergoing tissue sampling and placed preloaded fiducials immediately after biopsy. Intraprocedure confirmation of carcinoma, neuroendocrine, and nonlymphomatous neoplasia by rapid on-site evaluation and lesion size <4 cm was required. The main outcomes were the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales. In 20 patients, EUS-FMP was successful before planned surgery and placement was technically straightforward (Likert Scale: 9.1 ± 1.3; range: 1, most challenging to 10, most facile). Intraoperative detection was feasible and improved when compared with a pre-established comparator of 5 representing an equivalent lesion without a marker (Likert Scale: 7.8 ± 2.2; range: 1, most difficult to 10, most facile; P = 0.011). The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm. EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.
Overview
- The study aims to evaluate the feasibility and ease of preoperative placement and intraoperative detection of fiducial markers using EUS-FMP in patients with resectable pancreatic tumors undergoing tissue sampling. The study uses multipurpose EUS systems that facilitate simultaneous EUS-FMP at the time of biopsy. The main outcomes are the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales. The study enrolled 20 patients and found that EUS-FMP was successful before planned surgery and placement was technically straightforward. Intraoperative detection was feasible and improved when compared with a pre-established comparator. The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm. The study concludes that EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.
Comparative Analysis & Findings
- The study compared the outcomes observed under different experimental conditions or interventions detailed in the study. The study found that EUS-FMP was successful before planned surgery and placement was technically straightforward. Intraoperative detection was feasible and improved when compared with a pre-established comparator. The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm. The study concludes that EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS-fine needle biopsy.
Implications and Future Directions
- The study's findings suggest that EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. The study's findings may have implications for clinical practice and future research. The study's limitations include a small sample size and the need for further research to validate the findings. Future research could explore the use of EUS-FMP in other types of pancreatic tumors and in combination with other imaging modalities. The study's findings may also have implications for the development of new technologies and devices for EUS-FMP.