Introduction Endoscopic ultrasound (EUS) guided sampling of advanced malignant pancreatic lesions is increasingly being performed in order to confirm malignancy prior to chemotherapy and/or radiotherapy. The Royal Hampshire County Hospital provides EUS services for central and north Hampshire. Prior to mid-2013 there was no facility for examination of cytological specimens during EUS procedures. In line with national commissioning guidelines, a real time pathology service allowing cytological examination during the EUS procedure was instigated from 1st July 2013. The aim of this study was to assess the impact of real time cytological examination on the yield of EUS guided sampling of suspected malignant pancreatic mass lesions.
Methods All patients with suspected pancreatic malignancy undergoing EUS guided tissue sampling over a 1 year period from 1st January 2013 to 31st December 2013 were prospectively audited. Note was made of whether real time cytological examination was perfomed by a technician ± histopathologist. Other data collected included type of needle used, number of passes made with the biopsy needle and total duration of procedure. The diagnostic yield of EUS guided pancreatic sampling was compared with and without real time cytological examination.
Results Twenty-seven procedures were performed over the 12 month period. The majority (25 procedures) were performed using Procore™ fine needle biopsy (FNB) needles. Seventeen procedures were performed without real time cytological examination. Of these, 14 (82%) yielded positive cytology, 1 yielded negative cytology (6%) and there was insufficient tissue in 2 (12%) cases. Ten procedures were performed with real time cytological examination and of these all yielded positive cytology. Median number of passes made with the biopsy needle was 2 (range 2–3) without real time cytological examination versus 2 (range 1–4) with real time cytological examination. Mean procedure duration was 30 (±12) min without real time cytological examination versus 36 (±15) min with real time cytological examination.
Conclusion In our centre, the diagnostic yield of EUS guided sampling of suspected malignant pancreatic mass lesions without real time cytological examination was 82% which is in line with published data 1 However, the addition of real time cytological examination improved yield to 100% without significantly lengthening the procedure duration.
Reference 1 Hewitt MJ et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75(2):319–31
Disclosure of Interest None Declared.