Accuracy and other quality indicators of solid pancreatic mass endoscopic ultrasound-guided fine needle aspiration and biopsy in two academic endoscopy centers

Abstract

Background and aims : Endoscopic ultrasound fine-needleaspiration/biopsy (EUS-FNA/FNB) is highly accurate, but dis-crepancies between cytological and surgical diagnoses are stillobserved. We aimed to determine its accuracy and monitor qualityindicators in our facilities. Patients and methods : We performed a retrospective review ofall cases of pancreatic solid lesions evaluated by EUS-FNA/FNB,between July 2015 and June 2018, in two centers. Cytologicaland surgical findings were categorized into five groups: benign,malignant, suspect of malignancy, undetermined and insufficientfor diagnosis. Final diagnosis was based on surgical diagnosis and,in patients who did not undergo surgery, on clinical outcome after6 months follow-up. Results : Altogether, 142 patients were included. FNA was thepreferred tissue acquisition method (88%), with a predilection forthe FNA 22G needle (57%). Cytology was insufficient for diagnosisin 2 cases, therefore a full diagnostic sample was available in 98.6%of the patients (>90%, ESGE target). Fifty-five (38.7%) patientsunderwent surgery. In term of cancer diagnosis, comparison withfinal surgical pathology (n=55) revealed 89% true positives, 5.5%true negatives, 3.6% false positives and 1.8% false negatives. Whencombining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was92.3% (74.9-99.1), positive predictive value was 98.2% (93.6-99.5),negative predictive value was 88.9% (72.3-96.1) and accuracy was96.4% (91.9-98.8). Post-procedural acute pancreatitis was reportedin 2 patients (1.4%). Conclusions : These results reveal a performance for diagnostictissue sampling well above the ESGE proposed target standard.Also, the uncommon high specificity illustrates the determiningrole of the pathologist’s final interpretation and diagnosis.

A morphological and immunohistochemical study of the endoscopic ultrasound–fine-needle biopsy samples from solid pancreatic masses: a single center study

“…EUS–FNB could bridge the gap between endoscopic tissue acquisition, immunohistochemistry (IHC), and oncological therapy, thus providing new possible therapeutic targets. However, there are relatively few studies that assess diagnostic yield of the EUS–FNB in this aspect and even fewer that further immunoassay and discuss PAC samples [ 10 , 11 ].…”