Elsevier

Gastrointestinal Endoscopy

Volume 51, Issue 2, February 2000, Pages 184-190
Gastrointestinal Endoscopy

Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies,☆☆

Presented in part at the Digestive Disease Week meeting, May 1998, New Orleans, La.
https://doi.org/10.1016/S0016-5107(00)70416-0Get rights and content

Abstract

Background:  The factors that affect the number of needle passes needed to diagnose pancreatic malignancies using endoscopic ultrasound (EUS) –guided fine-needle aspiration are unknown. Methods:  Patient and endosonographic data were prospectively recorded on 121 consecutive patients with pancreatic malignancy. Of these, 110 underwent EUS-guided fine-needle aspiration. A cytopathologist was in attendance for all aspiration procedures. Results:  Initial EUS detected a pancreatic mass in 96% of cases; 23% of these were not seen by computed tomography. EUS-guided fine-needle aspiration was performed in 109 of 110 (99%) patients, including 95 masses, 7 lymph nodes, and 7 hepatic metastases. EUS-guided fine-needle aspiration provided a cytologic diagnosis of malignancy in 104 of 110 (95%). Only tumor differentiation and the site of aspiration affected the number of passes. Conclusions:  With the participation of a cytopathologist, EUS-guided fine-needle aspiration can diagnose pancreatic malignancies with a high degree of accuracy. Only the aspiration site (mass versus node/liver metastasis) can be used to direct the number of passes if a cytopathologist is not present. Without a cytopathologist in attendance, 5 to 6 passes should be made for pancreatic masses and 2 to 3 for liver metastases or lymph nodes; however, this approach will be associated with a 10% to 15% reduction in definitive cytologic diagnoses, extra procedure time, increased risk and additional needles. (Gastrointest Endosc 2000;51:184-90.)

Section snippets

PATIENTS AND METHODS

One hundred twenty-one consecutive patients referred for EUS between June 1995 and March 1999 and ultimately diagnosed with pancreatic cancer were evaluated. Fifty-six percent of the patients were men and the average age of all patients was 68.4 years, with a range of 34 to 91 years. A final diagnosis of a pancreatic malignancy was confirmed in all patients either cytologically by EUS or CT-guided FNA or histologically by CT-guided biopsy or operation. Diagnostic EUS and any subsequent

RESULTS

Of the 121 patients eventually found to have pancreatic cancer, 116 (96%) had a pancreatic mass detected on initial EUS. Three patients had chronic pancreatitis seen on initial EUS and no definite mass. Two of these had a mass detected on follow-up EUS 1 month and 4 months later, respectively. The other had an unresectable pancreatic carcinoma found at operation 3 months after EUS. Another 46-year-old patient had a distal bile duct stricture with choledocholithiasis and sludge that precluded

DISCUSSION

This study confirms that EUS can detect almost all pancreatic neoplasms except in the difficult clinical setting of underlying chronic pancreatitis.1, 3, 5, 13, 28 This study also confirms the superiority of EUS compared with CT for detecting pancreatic malignancies. Our results are similar to those of a multicenter trial in which CT either did not detect a lesion or found only nonspecific pancreatic enlargement in 56% of 103 patients with pancreatic cancer examined by EUS-guided FNA.29 When a

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Reprint requests: Richard A. Erickson, MD, Gastroenterology Division, Scott & White, 2401 S. 31st St., Temple, TX 76508.

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0016-5107/2000/$12.00 + 0   37/1/102792

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