Elsevier

Gastrointestinal Endoscopy

Volume 47, Issue 2, February 1998, Pages 121-127
Gastrointestinal Endoscopy

Endoscopic ultrasound–guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope,☆☆,

https://doi.org/10.1016/S0016-5107(98)70343-8Get rights and content

Abstract

Background: Previous studies have reported on endoscopic ultrasound–guided, fine needle aspiration biopsy using 22- to 25-gauge needles. We evaluated the histologic and cytologic yield of endoscopic ultrasound–guided, fine needle aspiration biopsy of the pancreas using an 18-gauge, Menghini-type core needle. Methods: Fine needle aspiration biopsy was performed in conjunction with a prototype 2.8 mm channel convex array echoendoscope. The core specimen was placed in formalin for cell block, and residual material was expelled on slides for cytology. Definitive diagnosis was established by surgery or clinical follow-up. Results: Of 45 patients who underwent fine needle aspiration biopsy, the needle failed to penetrate indurated pancreatic lesions in five. An average of 2.6 passes were performed in the remaining patients. Sufficient material for a histologic and/or cytologic diagnosis was obtained in 40 patients (histologic and cytologic yield of 68% and 75%, respectively). Combining the results of histology and cytology, the sensitivity and specificity for detection of malignancy was 76% and 100%, respectively. Histology confirmed the cytologic findings in 35 patients, providing additional tissue specific information. In three cases histology established a diagnosis of malignancy where cytology was not conclusively malignant. However, in three cases of surgically confirmed malignancy histology failed to detect malignancy, whereas cytology showed suspicious or malignant cells. The sensitivity of histology and cytology alone in detecting malignancy was 53% and 70%, respectively. Mild pancreatitis occurred after pancreatic fine needle aspiration biopsy in one patient. Conclusion: Core specimens for histology can be safely obtained using an 18-gauge needle. Histology provides tissue-specific information that complements cytology, but histology is less sensitive than cytology in detecting malignancy. (Gastrointest Endosc 1998;47:121-7)

Section snippets

Patients

During a 10-month period between August 1995 and June 1996, 45 patients (mean age 62 years, range 26 to 77 years) underwent FNAB of the pancreas. Patients were selected to undergo EUS-guided FNAB on the basis of their clinical history and findings of a mass lesion on preliminary endosonographic evaluation using an Olympus 360-degree radial scanning echoendoscope (GF-UM20; Olympus Optical, Inc., Tokyo, Japan). In all patients FNAB was judged to have potential impact on treatment strategy. Before

Results

FNAB of pancreatic lesions was attempted in 45 patients. Lesions were located in the head in 28 patients, the body in 12 patients, and the tail of the pancreas in 5 patients. In 5 patients the needle failed to penetrate indurated lesions despite repeated attempts using different sites and angles to access the lesion. Four of these five patients subsequently underwent surgery; the surgical pathology demonstrated chronic calcifying pancreatitis in two patients and malignancy associated with

Discussion

Several studies have reported on EUS-guided aspiration to obtain tissue specimens for cytologic diagnosis of pancreatic lesions.1, 2, 3, 4, 5 The investigators in these studies used 22- or 25-gauge needles that were inserted through the 2.0 mm working channel of the Pentax FG 32 UA convex array echoendoscope. The reported yield for adequate cytologic specimens has ranged from 82% to 91%. Two studies1, 3 mentioned that core biopsy specimens were occasionally obtained, but specific data regarding

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From the University Hospital Eppendorf, Department of Endoscopic Surgery, Hamburg, Germany.

☆☆

Reprint requests: K. F. Binmoeller, MD, University Hospital, Department of Endoscopic Surgery, Martinistrasse 52, 20246 Hamburg, Germany.

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