Endoscopic ultrasound-guided fine-needle aspiration in 179 cases

Abstract

BACKGROUND Recently, endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) has emerged as a diagnostic adjunct for small pancreatic lesions and abdominal and mediastinal lymph node diseases. DESIGN. During a 21‐month period, we performed 179 EUS‐FNAs in 166 consecutive patients; these data are the subject of this study. An average of 2.6 needle passes were obtained and aspiration was performed most commonly in the pancreas (162 cases, 91%). The FNA smears were reviewed using six diagnostic categories (negative for malignancy/nondiagnostic [NND], atypia, suspicious for malignancy, benign tumor/cyst, neuroendocrine neoplasm [NEN], and carcinoma). The review diagnosis was correlated with the histologic diagnosis made on resection or surgical biopsy specimens in 70 cases. Up to 17 months of clinical follow‐up were sought for the cases with a negative or inconclusive FNA diagnosis and no diagnostic tissue confirmation (81 cases). RESULTS The review FNA diagnoses were as follows: NND (49 cases), atypia (17 cases), suspicious for malignancy (12 cases), benign tumor/cyst excluding NEN (10 cases), NEN (6 cases), carcinoma (85 cases). Follow‐up methods included resection (49 cases), surgical biopsy (21 cases), repeat FNA or brushing cytology (28 cases), and clinical follow‐up only (81 cases). Of the 49 NND cases, 23 (47%) had positive follow‐up results (i.e., false‐negative diagnosis) that were confirmed by tissue diagnosis (resection/surgical biopsy in 11 cases [48%] and repeat FNA/brushing in 12 cases [52%]). These included pancreatic/ampullary adenocarcinoma in 20 cases, esophageal squamous carcinoma in 1 case, and NEN in 2 cases. Follow‐up also revealed carcinoma in all 12 suspicious cases and 13 pancreatic adenocarcinomas and 1 microcystic adenoma in 14 of the 17 atypical cases. Overall, repeat computed tomography (CT)‐guided FNA samples yielded a definite diagnosis in four atypical and seven NND cases, whereas EUS‐FNA results provided a definite diagnosis in three cases in which CT‐guided FNA failed and in two cases in which ampullary biopsy failed. No false‐positive cases were identified. The false‐negative rate due to inadequate sampling was 13.2%. Sensitivity (including cases with inadequate cellularity and nondiagnsotic aspirates) was 81.7% and specificity was 100%. None of the factors evaluated (lesion characteristics, aspiration site, and tumor type) significantly influenced diagnostic results. CONCLUSION EUS‐FNA is a valuable diagnostic and staging tool with high specificity and sensitivity. Negative or nondiagnostic cases on EUS‐FNA require further diagnostic work for a definitive diagnosis when clinical or radiographic findings do not correlate with the FNA results. Cancer (Cancer Cytopathol) 2002. © 2002 American Cancer Society.

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

“…[113][114][115][116][117][118][119] Even minute lesions of 5 mm can be visualized and biopsied. Contrary to what might be expected, the size of the lesions, whether small ( 25 mm) or large (>25 mm) does not influence the overall diagnostic yield, sensitivity, specificity, or accuracy of the method.…”

Impact of tumor size on survival outcome of pancreatic carcinoma following pancreatic resection: A systematic review and meta-analysis

“…Endoscopic ultrasound-guided FNA (EUS-FNA) is believed to provide cytological diagnosis with specificity of around 100%. 24,60,62 Therefore, usage of EUS-FNA whenever necessary can achieve early diagnosis and can act as a sound basis for prompt treatment and definitive management of pancreatic cancer, including PD. Other factor that is regarded highly in terms of survival outcome is tumor resection margin.…”

Vasoactive Intestinal Peptide Tumor

“…In a relatively large prospective trial evaluating the use of EUS, Anderson et al found a sensitivity of 93% in detecting pancreatic tumors with a mean tumor diameter of 1.51 cm [13]. Furthermore, EUS has showed the added utility of allowing fine needle aspiration to distinguish visualized masses further aiding in diagnosis, staging, and in determining a management strategy [14,15].…”