Introduction EUS FNA is accepted as the primary modality for tissue diagnosis of solid pancreatic lesions. The presence of on-site cytopathology for immediate evaluation during endoscopic ultrasound-guided fine needle aspiration (EUS FNA) has previously been shown to improve performance characteristics. Due to service pressures EUS FNA is also undertaken in the absence of in-room cytopathology assistance. This is a review of current practice.
Method We retrospectively assessed 700 consecutive EUS-FNA procedures from January 2011 to January 2016. 459 (65.5%) solid pancreatic lesions were included in the final analysis after excluding 230 for biliary strictures, hepatic lesions, lymph nodes, gastric, oesophageal lesions, pancreatic cysts and 11 for insufficient information.
Results In 399 (86.9%) cases on-site cytopathology support was available, while the remaining was unsupported. There were 228 males (57.1%) in the supported and 29 (48.3%) in the unsupported group. Mean age was 64.6(SD: 11.4) and 67.4(SD: 11.9) respectively. The mean number of passes in the two groups were 2.8 (SD: 1.12) and 1.9 (SD: 1.0) (p<0.0001). A conclusive diagnosis (malignant, benign, NET, GIST) was made in 84% (67%, 12%, 5%, 0%) of the supported group and in 38% (23%, 10%, 3%, 2%) of the unsupported (p<0.0001). The mean follow up for the entire cohort was 14.2 months (SD:14.1) and mean survival of in patients diagnosed with malignancy was 10.9 months (SD: 8.7). Overall performance characteristics of EUS FNA were Sensitivity: 90.8% Specificity: 86.9% PPV: 91.8% NPV: 85.4%
Conclusion This review confirms high performance characteristics of EUS FNA. The presence of on-site cytopathologist significantly increases the diagnostic yield.
Disclosure of Interest None Declared
- EUS FNA
- pancreatic cancer