Accuracy of Endoscopic Ultrasound in the Evaluation of Cystic Pancreatic Neoplasms

Wright, G. Paul; Morrow, Jay Bradley; Shaheen, Michael; Goslin, Brent; Baatenburg, Lorel; Chung, Mathew H.

doi:10.1097/mpa.0000000000000057

Cited by 9 publications

(12 citation statements)

References 22 publications

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“…In our evaluation, the ability of pathologists and cytologists using EUS-FNA samples to detect IPMN showed a sensitivity of 59%, which was lower than that for PDAC (80%), but is consistent with current literature for sensitivity of detecting cystic lesions from 47% to 87% [12,15] . We found our reported specificity (100%) is consistent with other studies that report specificity between 87%-100% [12][13][14][15] . The majority of misdiagnoses that were finally diagnosed as IPMN were suggestive of other benign diagnoses (15/18).…”

Section: Discussionsupporting

confidence: 82%

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Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Beal

Shea

Witt

et al. 2015

Journal of Gastroenterology and Hepatology Research

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PPV, and 89% (82-94) NPV. Detection of neuroendocrine tumors by FNA-EUS yielded 66% (47-87) sensitivity, 100% (97-100) specificity, 94% (71-99) PPV, and 97% (94-99) NPV. Detection of IPMN by FNA-EUS yielded 59% (43-74) sensitivity, 100% (98-100) specificity, 100% (87-100) PPV, and 89% (93-99) NPV. CONCLUSIONS: Our findings are largely consistent with the current literature, confirming there is discernible potential for inappropriate treatment of patients based purely on EUS-FNA evaluation. Both accuracy and clarity of positive tests with EUS-FNA worsened for mucinous pancreatic lesions compared to solid pancreatic lesions. Limitations of this study are the appraisal at a single institution and the necessity to evaluate only cases that ultimately had surgical resection of the pancreatic lesion. INTRODUCTIONPancreatic ductal adenocarcinoma (PDAC) has the 4th highest cancer mortality rate for both men and women in the United States. The average 5 year survival rate for PDAC patients with localized disease that were able to undergo a resection is approximately 24% [1] . Prognosis is poorer for the 80-85% of patients who are unable to undergo resection due to disseminated disease or ABSTRACT BACKGROUND: The purpose of this study was to assess the clinical impact of diagnostic accuracy for EUS-FNA in evaluating pancreatic lesions, particularly Pancreatic Ductal Adenocarcinoma( PDAC), neuroendocrine tumors, and IPMN at our institution using surgical pathological review as the gold standard. METHODS: We conducted a retrospective chart review using the Clinical Cancer Research Database at Huntsman Cancer Institute. We included all cases in which pancreatic lesions were evaluated by EUS-FNA and a subsequent surgical resection was performed. Sensitivity, specificity, positive predicative value (PPV), and negative predictive value (NPV) were determined for PDAC, neuroendocrine tumors, and IPMN by comparing pathological diagnosis at EUS-FNA to diagnoses following surgery. RESULTS: Detection of PDAC by FNA-EUS yielded 87.9% (80.1-93.4 95% CI) sensitivity, 80% (72-86) specificity, 78% (70-85)

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Section: Discussionsupporting

confidence: 82%

“…Previous studies have only separately evaluated the efficiency of EUS-FNA for diagnosing neuroendocrine tumors [9][10][11] , cystic neoplasms, such as intraductal papillary mucinous neoplasms (IPMN) [12][13][14][15] , or PDAC [16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Beal

Shea

Witt

et al. 2015

Journal of Gastroenterology and Hepatology Research

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“…In addition, review of these so‐called negative specimens indicated that there were no diagnostic cells on the smears; therefore, they were considered to be sampling errors. In fact, inadequate sampling has been advocated as one of the main reasons for false‐negative or nondiagnostic samples, especially in cystic lesions . Although beyond the scope of the current report, the wide use of ancillary studies, such as molecular analysis and immunohistochemistry, also has a deep impact on the diagnostic accuracy of cytology, and an emphasis on the use of these ancillary techniques is proposed by the new Papanicolaou Society guidelines .…”

Section: Discussionmentioning

confidence: 96%

“…EUS‐FNA also appeared to be highly effective in patients who underwent a previous nondiagnostic biopsy by other methods and those who had neoplasms other than ductal adenocarcinoma. Several additional factors can also influence the diagnostic yield of EUS‐FNA pancreatic samples, such as the presence of pancreatitis, experience of the endoscopist, use of rapid on‐site assessment, needle size, and clinical characteristics of the lesion (such as cystic vs solid neoplasms) . In addition, cytologic pitfalls, such as atypia caused by inflammatory/reactive changes and scant material coupled with lack of pathologist's or clinician's experience, are main contributors to occasionally reported low sensitivity and false‐negative cases .…”

Section: Introductionmentioning

confidence: 99%

The impact of the new proposed Papanicolaou Society of Cytopathology terminology for pancreaticobiliary cytology in endoscopic US‐FNA: A single‐Institutional experience

Saieg

Munson

Colletti

et al. 2015

Cancer Cytopathology

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cytohistologic disagreement were reviewed to assess the reasons for discrepancies. The sensitivity and specificity of EUS-FNA specimens were assessed using the Pearson chi-square test. RESULTS: One hundred fifty-five pancreatic FNA specimens were retrieved. The median patient age was 70 years (range, 25-93 years). Eleven specimens previously classified as negative and 3 previously classified as non-diagnostic were reclassified as neoplastic:other, as well as all specimens primarily classified as atypical or positive for neoplasm and half the specimens primarily classified as suspicious. All positive specimens remained within their same categories in the revised classification. Sixteen patients (10.3%) had surgical resection specimens available, and complete or partial agreement with FNA results was achieved in 13 of those surgical specimens (81.2%). Reasons for discrepancy comprised sampling errors in 5 specimens and an interpretation error in 1 specimen. Overall, sensitivity was 66.7%, specificity was 66.7%, the positive predictive value was 88.9%, and the negative predictive value was 33.3%. CONCLUSIONS: The application of the new proposed terminology for pancreaticobiliary cytology had a greater impact among specimens that were previously classified as atypical and suspicious. EUS-FNA of the pancreas is a highly accurate method, and its use, allied with the new proposed terminology, may ultimately contribute to better outcomes. Cancer (Cancer Cytopathol) 2015;123:488-94.

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“…Recent studies have found that the preoperative diagnostic accuracy for specific cyst type ranged from 47% to 68% compared to surgical pathology [55,56] ; accuracy improved to 73% when cysts were categorized as benign, premalignant and malignant [56] . A retrospective study of 118 patients in a community setting suggested a higher accuracy for EUS (87%) in distinguishing benign, premalignant, and malignant cysts; however, this study is limited because 65% of patients were diagnosed mainly by CT radiologic surveillance with a median follow-up of only 337 d [57] . Therefore, in light of the limitations of current diagnostic tools, novel diagnostic biomarkers have received considerable interest [58] .…”

Section: Eus-fnamentioning

confidence: 92%

Endosonography in the diagnosis and management of pancreatic cysts

Kadiyala

Lee

2015

WJGE

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Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no risk of malignancy, neoplastic non-mucinous serous cystadenomas with little or no risk of malignancy, as well as neoplastic mucinous cysts and solid pseudopapillary neoplasms both with varying risk of malignancy. Accurate diagnosis is imperative as management is guided by symptoms and risk of malignancy. Endoscopic ultrasound (EUS) allows high resolution evaluation of cyst morphology and precise guidance for fine needle aspiration (FNA) of cyst fluid for cytological, chemical and molecular analysis. Initially, clinical evaluation and radiologic imaging, preferably with magnetic resonance imaging of the pancreas and magnetic resonance cholangiopancreatography, are performed. In asymptomatic patients where diagnosis is unclear and malignant risk is indeterminate, EUS-FNA should be used to confirm the presence or absence of high-risk features, differentiate mucinous from non-mucinous lesions, and diagnose malignancy. After analyzing the cyst fluid for viscosity, cyst fluid carcinoembryonic antigen, amylase, and cyst wall cytology should be obtained. DNA analysis may add useful information in diagnosing mucinous cysts when the previous studies are indeterminate. New molecular biomarkers are being investigated to improve diagnostic capabilities and management decisions in these challenging cystic lesions. Current guidelines recommend surgical pancreatic resection as the standard of care for symptomatic cysts and those with high-risk features associated with malignancy. EUS-guided cyst ablation is a promising minimally invasive, relatively low-risk alternative to both surgery and surveillance.

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Accuracy of Endoscopic Ultrasound in the Evaluation of Cystic Pancreatic Neoplasms

Abstract: Endoscopic ultrasound is a valuable diagnostic modality in the evaluation of cystic pancreatic neoplasms in a community hospital setting.

Cited by 9 publications

References 22 publications

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

The impact of the new proposed Papanicolaou Society of Cytopathology terminology for pancreaticobiliary cytology in endoscopic US‐FNA: A single‐Institutional experience

Endosonography in the diagnosis and management of pancreatic cysts

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