Comparative study of diagnostic value of cytologic sampling by endoscopic ultrasonography‐guided fine‐needle aspiration and that by endoscopic retrograde pancreatography for the management of pancreatic mass without biliary stricture

Abstract

Endoscopic ultrasonography-guided fine-needle aspiration is safer and more accurate for the cytopathological diagnosis of suspected pancreatic masses without a biliary stricture as compared with cytology during ERP. Endoscopic ultrasonography with FNA should be considered a preferred test (prior to attempting endoscopic retrograde cholangiopancreatography) when a cytological diagnosis of a pancreatic mass is required, especially when there is no biliary obstruction, or when emergent decompression of an obstructed biliary tree is not considered clinically necessary due to lack of signs and symptoms of cholangitis.

Characteristics of Small Pancreatic Carcinoma: Neural Invasion is Associated with Tumor Recurrence

“…ERCP detected almost all cases of dilatation of the main pancreatic duct. However, the sensitivity and specificity of this method were not high, and there were frequent false-positive cases [17]. The positive rate of abrasive cytology was 45.2% in our study, and when considering complications such as pancreatitis in ERCP, the necessity for execution of ERCP in TS1 pancreatic carcinoma would be lower.…”

Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists

“…The following characteristics were compared between the two groups: (1) clinical characteristics of patients (2) final diagnosis (3) number of needle passes and specimen collection rate (4) comparison between cytopathological diagnoses and final diagnosis (5) accuracy in diagnosing benign and malignant masses, and (6) complications.…”

“…Since then, EUS-FNA of pancreatic masses has been performed in many institutions and shown to have not only a high diagnostic accuracy (80-90% or more) but also a low rate of complications (0-2.5% for solid pancreatic masses) [2,12,20,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Thus, EUS-FNA is regarded today as superior to endoscopic retrograde cholangiopancreatography (ERCP), US-guided biopsy, or computed tomography (CT)-guided biopsy for cytological diagnosis of pancreatic masses [2,12,19,20,[27][28][29].…”

“…If they are diagnostic, the procedure is stopped; if not, more needle passes are performed. Logrono and Waxman [32] suggested that ROSE has three major purposes: (1) assessment of the adequacy of aspirates to ensure that the target organ has been appropriately sampled, that is, that cells have been collected in sufficient numbers for reliable cytological evaluation; (2) assessment of the nature of the disease process affecting the organ sampled to determine the most appropriate immediate course of action, including additional needle passes for ancillary studies when smears suggest lymphoma, and special histochemical and immunochemical stains for further characterization of pancreatic tumors; and (3) a preliminary diagnosis or at least a differential diagnosis rendered in much the same manner as an immediate diagnosis based on evaluation of frozen sections obtained at surgery. Appropriate use of a cytology service for these three purposes reduces the probability of false-negative and unsatisfactory aspiration.…”

Accurate discrimination of pancreatic ductal adenocarcinoma and chronic pancreatitis using multimarker expression data and samples obtained by minimally invasive fine needle aspiration

“…4 At present, the most sensitive method for nonsurgical detection of PDAC involves obtaining pancreatic specimens through minimally invasive endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), followed by cytopathological examination. 5,6 EUS-FNA is especially well-suited to visualize small lesions, and unlike other methods, the entire pancreas is readily imaged. [7][8][9] Although the accuracy of EUS-FNA for detection of PDAC is relatively high due to the improvement of endoscopes and on site cytological assessment, there is still a relatively large number of cases in which the diagnosis remains problematic due to sample inadequacy, nondefinitive (suspicious) diagnosis or discordance in pathological interpretation.…”