Sa1551 The Diagnostic Value of Repeat Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) for Solid Pancreatic Lesions: A Tertiary Referral Center Experience

Suzuki, Rei; Bhutani, Manoop S.; Ramireddy, Srinivas; Krishna, Somashekar G.; Weston, Brian; Ross, William A.; Lee, Jeffrey H.

doi:10.1016/j.gie.2012.04.340

Cited by 25 publications

(39 citation statements)

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“…This study demonstrated that repeat FNA yields an altered diagnosis in 71% of patients. This is similar to previous studies, where the ability of a second EUS-FNA to alter initial diagnosis has been reported to range from 63% [14] to 82% [13]. As in previous research studies on this topic, the reason for repeated EUS-FNA in our study was uniformly due to inconclusive pathology on initial EUS-FNA in patients with a high degree of clinical suspicion for pancreatic cancer (indeterminate, negative, or atypical cytopathology) [13].…”

Section: Discussionsupporting

confidence: 91%

“…This is similar to previous studies, where the ability of a second EUS-FNA to alter initial diagnosis has been reported to range from 63% [14] to 82% [13]. As in previous research studies on this topic, the reason for repeated EUS-FNA in our study was uniformly due to inconclusive pathology on initial EUS-FNA in patients with a high degree of clinical suspicion for pancreatic cancer (indeterminate, negative, or atypical cytopathology) [13]. Importantly, 59% of patients with initially nonconclusive pathology (indeterminate or atypical) have conclusive pathology (benign, likely adenocarcinoma, definitive adenocarcinoma, NET, and lymphoma) on repeat EUS-FNA, while 31% of patients in this study had a likely diagnosis of pancreatic adenocarcinoma or other malignancy (class IV or V pathology, NET, and lymphoma) on repeat EUS-FNA, with 24% of patients having a definite diagnosis (class V pathology, NET, and lymphoma).…”

Section: Discussionsupporting

confidence: 91%

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Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

Mitchell

Stanger

Shuster

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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Background. There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions. To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required. The utility of repeat EUS-FNA is not well established. Methods. A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology. The wait times to the second procedure and to decisions regarding therapy were calculated. Results. Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions. Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%). Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA. The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%). The median time interval between first and second EUS-FNA was 31 (7–175) days. Conclusions. A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

Mitchell

Stanger

Shuster

et al. 2016

Canadian Journal of Gastroenterology and Hepatology

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“…The positive impact of EUS‐FNA, whether initial or repeat, in the management of solid pancreatic masses has been focused in the literature . The impact of an inconclusive EUS‐FNA, however, has been less well elucidated, especially when pancreatic malignancy is highly suspected.…”

Section: Discussionmentioning

confidence: 99%

“…The average interval time (13 days) in our study appeared shorter than has been reported in some previous studies. For example, a second EUS‐FNA was carried out a median 24 days after the index procedure in a study conducted by DeWitt et al ., and Suzuki et al . reported a mean interval of 45.2 days between the index and repeat EUS‐FNA carried out at two different medical centers.…”

Section: Discussionmentioning

confidence: 99%

“…Combining EUS‐FNA with K‐ras gene mutation analysis or fluorescence in situ hybridization may further improve the sensitivity of EUS‐FNA for malignant masses . Despite this, in approximately 5–15% of cases, EUS‐FNA does not lead to conclusive cytological diagnosis because of technical difficulty, coexisting pancreatitis, difficult cytology or pathologist's interobserver variation . Several studies have revealed that repeating EUS‐FNA after a non‐diagnostic initial cytological result could increase diagnostic yield in patients having suspected pancreatic malignancy with an overall accuracy varying from 61% to 92.9% .…”

Section: Introductionmentioning

confidence: 99%

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Impact of inconclusive endoscopic ultrasound‐guided fine‐needle aspiration results in the management and outcome of patients with solid pancreatic masses

Sun

Yang

et al. 2014

Digestive Endoscopy

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Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: A review

Pitman

Layfield

2014

Cancer Cytopathology

102

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The newest installment on state-of-the-art standards of practice in cytopathology from the Papanicolaou Society of Cytopathology (PSC) focuses on the pancreaticobiliary system. Similar to the National Cancer Institute recommendations for aspiration cytology of the thyroid, the PSC guidelines for pancreaticobiliary cytology addresses indications, techniques, terminology and nomenclature, ancillary studies, and postprocedure management. Each committee was composed of a multidisciplinary group of experts in diagnosing, managing, and treating patients with pancreaticobiliary disease. Draft documents were posted on an interactive Web-based forum hosted by the PSC Web site (www.papsociety.org) and the topics of terminology, ancillary testing, and management were presented at national and international meetings over an 18-month period for discussion and feedback from practicing pathologists around the world. This review provides a synopsis of these guidelines. Cancer (Cancer Cytopathol) 2014;122:399-411.

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Sa1551 The Diagnostic Value of Repeat Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) for Solid Pancreatic Lesions: A Tertiary Referral Center Experience

Cited by 25 publications

References 0 publications

Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

Impact of inconclusive endoscopic ultrasound‐guided fine‐needle aspiration results in the management and outcome of patients with solid pancreatic masses

Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: A review

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