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David Mittleman
David Mittleman
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Pancreatic Cancer – False Positives Can Kill You

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Pancreatic Cancer can go undetected until it has advance to the point where successful treatment is unlikely.  Pancreatic cancer is notorious for its poor prognosis, with a low overall 5-year survival rate of only 8.7%.  Early detection gives you the best chance of survival, but the diagnosis of cancer by fine needle aspiration, due to misinterpretation and misdiagnosis by a pathologist can lead to a death sentence not from cancer, but the poison of unnecessary chemotherapy, radiation, and surgeries.

If your doctor suspects pancreatic cancer, the following tests are available:

  • Imaging tests that create pictures of your internal organs, CT, MRI, PET, and ERCP;
  • Using a scope to create ultrasound pictures of your pancreas, EUS, angiography;
  • Removing a tissue sample for testing, biopsy, FNA;
  • Blood tests, specific proteins, tumor markers.

You should always get at least an endoscopic ultrasound (EUS) and other diagnostic testing, including a biopsy, to confirm a lesion is cancer before considering a radical surgery such as a Whipple resection.  If treatment such as chemotherapy and/or radiation is considered before surgery, an accurately interpreted biopsy is needed first to be sure of the diagnosis.  Just as the failure to timely detect or a false negative interpretation is likely a death sentence, the over-read or false positive can be as well.

Although atypical or suspicious cytology may support a clinical diagnosis of a cancer, it is not sufficient for the implementation of treatment for a patient.  Endoscopic ultrasound – guided fine-needle aspiration biopsy (EUS-FNAB) has been around for approximately 2 decades and can assist in obtaining cytology samples and decrease the number of atypical/suspicious diagnosis.  While EUS-FNAB is a safe and highly accurate method for tissue diagnosis of patients with solid pancreatic lesions, patients with suspicious and atypical EUS-FNAB aspirates deserve further clinical evaluation.