Difficult pancreatic mass FNA: Tips for success

Endoscopic ultrasound elastography

“…The accuracy of EUS-guided FNA has been demonstrated to be very high, with sensitivity between 80% and 85%, and specificity approaching 100% 891011121314. However, EUS-guided tissue sampling is technically demanding, and multiple punctures may be necessary to obtain a sufficient amount of tissue 1516. Furthermore, despite repeated sampling, cytohistologic assessment can be falsely negative, which is reported most frequently for solid pancreatic masses in patients with advanced chronic pancreatitis (CP) 17.…”

Diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration for suspected pancreatic malignancy in relation to the size of lesions

“…FNA for small lesions less than 20 mm may be difficult as they not only require greater targeting accuracy but also may defy FNA because of the tendency of the needle to displace the target during advancement. 13 Although there have been several studies that have investigated EUS-FNA for pancreatic lesions in relation to their size, 9,[14][15][16][17] diagnostic yield of EUS-FNA for pancreatic lesions less than 10 mm has not been reported, to our knowledge. Accurate diagnosis of pancreatic cancer while it stays small enough is of paramount importance, because it is a rapidly progressive malignancy.…”

“…Endoscopic ultrasound-guided fine needle aspiration for small pancreatic lesions has been thought to be difficult due to some technical problems. 13 Agarwal reported that the sensitivity of EUS-FNA for suspected pancreatic cancer less than 20 mm was 75%, whereas that for lesions more than 21 mm was 94%. 14 Similarly, Hwang reported the accuracies of 71% for lesions smaller than 30 mm and 90% for those greater than 30 mm.…”

Improvements and innovations in endoscopic ultrasound guided fine needle aspiration

“…This is the likely mechanism for increased specimen yield when using the largest needle primarily for histology. Certainly suction can be attempted in situations where cellularity is inadequate without suction or in fibrotic lesions [56], whereas in more vascular lesions such as lymph nodes, suction may cause more bleeding and therefore negatively affect the specimen quality [57][58][59]. Two RCTs found conflicting results in FNA of pancreatic mass lesions where one found suction resulted in higher diagnostic samples and cellularity; however, specimen bloodiness was increased [60] and the other found no difference in diagnostic yield, cellularity, or specimen bloodiness, irrespective of whether or not suction was used [61].…”