Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

Abstract

Hypothesis: Endoscopic ultrasound (EUS) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are accurate for the preoperative staging of pancreatic ductal carcinoma.Design: Retrospective medical record review.Patients: A prospective registry of 98 patients having EUS-FNA for peripancreatic masses from April 1994 to April 1998 was analyzed.Main Outcome Measure: The accuracy of EUS-FNA for preoperative diagnosis and staging of peripancreatic neoplasms.Results: Ninety-eight patients, aged 41 to 91 years (mean age, 67 years) with peripancreatic masses were evaluated by EUS-FNA. All patients had initial computed tomography scanning with a mass seen in 49 patients, "fullness" to the pancreas in 28 patients, and no mass seen in 21 pa-tients. Evaluation with EUS-FNA revealed 22 benign lesions, 18 T2 masses, 37 T3 masses, 1 T4 mass, and 20 masses representing nonpancreatic tumors. Results of EUS-FNA of adjacent lymph nodes were positive in 27 patients. Twenty-seven patients had surgical resection or palliation permitting operative and pathologic staging. On comparison of EUS-FNA staging with surgical staging, 12 patients were the same stage, 14 patients were upstaged, and 1 patient was downstaged. The remaining patients who did not have surgery have been followed up for a mean of 15 months. Overall accuracy of EUS-FNA for differentiating benign from malignant masses was 96%.Conclusions: Endoscopic ultrasound-guided fine needle aspiration is a useful technique for the evaluation of pancreatic masses. It is highly accurate for differentiating between benign and malignant lesions and for predicting T stage, but is limited for predicting nodal status.

Clinical usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by means of endosonography‐guided fine‐needle aspiration biopsy

“…The results of our study confirm that the cytological evaluation of aspirates obtained by endosonographyguided fine-needle aspiration biopsy constitutes the most precise single strategy for the diagnosis of pancreatic carcinoma. In fact, the effectiveness of this technique, in accordance with that previously reported (70-95%), [7][8][9][10][11] is significantly higher than that obtained by other procedures, such as percutaneous biopsy (55-70%) [15][16][17] or endoscopic retrograde cholangiopancreatography (30-45%).…”

“…21 On the other hand, the usefulness of KRAS mutational analysis has only been evaluated partially by Tada et al, 22 suggesting that it might increase the effectiveness of conventional cytology. However, it should be noted that the cytology results were poorer than those reported previously, [7][8][9][10][11] probably reflecting the fact that this study was performed without on-site examination and with a limited number of passes.…”

“…2,6 Recently, endosonography-guided fine-needle aspiration biopsy has been identified as a feasible, safe and highly effective diagnostic technique for pancreatic cancer. [7][8][9][10][11][12][13][14] Although endosonography-guided fineneedle aspiration biopsy has been reported to be superior to percutaneous biopsy performed under ultrasonography or computed tomography guidance, [15][16][17] and its specificity generally reaches 100%, the amount of aspirated specimen is sometimes not sufficient to obtain a pathological diagnosis (sensitivity, 80-90%). 11 Different approaches have been proposed to overcome this limitation, including the use of needles with a larger diameter or tru-cut capability, 18,19 increasing the number of passes, the presence of a cytopathologist to improve the yield of satisfactory specimens 20,21 and the introduction of KRAS mutational analysis.…”

Primary squamous cell carcinoma of pancreas diagnosed by EUS-FNA: A case report

“…Since the introduction of EUS-FNA for investigating pancreatic cancer in the 1990s [18] , it has now become the standard procedure for pancreatic lesions. Cytopathological confirmation can be obtained with EUS-FNA, so as to avoid unnecessary pancreatic resection [19] . From our knowledge, this is the first case report in the literature utilizing EUS-FNA for a celltype specific diagnosis of primary pancreatic squamous cell carcinoma with a liver metastasis.…”

Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma

“…A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. [1][2][3] Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and highfrequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach.…”