Download PDF
Endosc Int Open 2016; 04(04): E434-E438
DOI: 10.1055/s-0035-1569969
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Performance characteristic of endoscopic ultrasound-guided fine needle aspiration is unaffected by pancreatic mass size

Jayapal Ramesh
1   Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Hwasoon Kim
2   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Kartika Reddy
1   Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Isam-Eldin A. Eltoum
3   Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
› Author Affiliations
Further Information

Publication History

submitted 17 August 2015

accepted after revision 25 January 2016

Publication Date:
30 March 2016 (online)

Also available at
   Permissions and Reprints

Background and study aims: Despite a well-established tool for diagnosis of pancreatic masses, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) studies have shown suboptimal diagnostic performance at divergent mass sizes. Since the impact of gold standard follow-up and presence of on-site evaluation on this observation is unknown, we aimed to study the performance characteristics of EUS-FNA under these strict conditions.

Patients and methods: EUS-FNA results from pancreatic mass lesions performed between July 2000 and March 2013 were evaluated. All patients with histological follow-up were then stratified into four groups: Group A ( ≤ 10 mm), Group B (11 – 20 mm), Group C (21 – 40 mm), and Group D (> 40 mm). Sensitivity and diagnostic accuracy were calculated for each group and compared.

Results: A total of 612 /3832 (16 %) patients with pancreatic masses who underwent EUS-FNA had histology confirmation. Of these, 81 were excluded due to unavailable lesion size, while the rest formed the study cohort. Mean age (SD) was 65.8 years (9.3) with 51.2 % female. The mean number of passes for the entire cohort was 2.9 (SD 1.9; range 1 – 12); patients in group D had a significantly higher number of passes for on-site diagnosis (P = 0.0124). There was no significant difference between the groups for sensitivity (P = 0.1134) or diagnostic accuracy (P = 0.2111). Proportional trend analysis revealed no significant correlation between size and sensitivity (P = 0.6192). The size of lesion measured by EUS was not associated with sensitivity or specificity after adjusting for age, sex, and pancreatic location.

Conclusion: In the presence of rapid on-site cytopathology and when final histology is taken as the gold standard, pancreatic mass size does not affect the performance characteristics of EUS-FNA.

 

  • References

  • 1 Roy AK, Kim M, Hawes R et al. 196. Changing trends in tissue acquisition in pancreatic diseases. Gastrointest Endosc 2013; 77: AB134
    PubMedGoogle Scholar
  • 2 Hewitt MJ, McPhail MJ, Possamai L et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-331
    CrossrefPubMedGoogle Scholar
  • 3 Wang W, Shpaner A, Krishna SG et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73-80
    CrossrefPubMedGoogle Scholar
  • 4 Muller MF, Meyenberger C, Bertschinger P et al. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology 1994; 190: 745-751
    CrossrefPubMedGoogle Scholar
  • 5 Eltoum IA, Alston EA, Roberson J. Trends in pancreatic pathology practice before and after implementation of endoscopic ultrasound-guided fine-needle aspiration: an example of disruptive innovation effect?. Arch Pathol Lab Med 2012; 136: 447-453
    CrossrefPubMedGoogle Scholar
  • 6 Eloubeidi MA, Tamhane A. EUS-guided FNA of solid pancreatic masses: a learning curve with 300 consecutive procedures. Gastrointest Endosc 2005; 61: 700-708
    CrossrefPubMedGoogle Scholar
  • 7 Hebert-Magee S, Bae S, Varadarajulu S et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology 2013; 24: 159-171
    CrossrefPubMedGoogle Scholar
  • 8 Madhoun MF, Wani SB, Rastogi A et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis. Endoscopy 2013; 45: 86-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 2005; 62: 728-736
    CrossrefPubMedGoogle Scholar
  • 10 Suzuki R, Lee JH, Krishna SG et al. Repeat endoscopic ultrasound-guided fine needle aspiration for solid pancreatic lesions at a tertiary referral center will alter the initial inconclusive result. J Gastrointest Liver Dis 2013; 22: 183-187
    PubMedGoogle Scholar
  • 11 Sahai AV, Schembre D, Stevens PD et al. A multicenter U.S. experience with EUS-guided fine-needle aspiration using the Olympus GF-UM30P echoendoscope: safety and effectiveness. Gastrointest Endosc 1999; 50: 792-796
    CrossrefPubMedGoogle Scholar
  • 12 Siddiqui AA, Brown LJ, Hong SK et al. Relationship of pancreatic mass size and diagnostic yield of endoscopic ultrasound-guided fine needle aspiration. Dig Dis Sci 2011; 56: 3370-3375
    CrossrefPubMedGoogle Scholar
  • 13 Aso A, Ihara E, Osoegawa T et al. Key endoscopic ultrasound features of pancreatic ductal adenocarcinoma smaller than 20 mm. Scand J Gastroenterol 2014; 49: 332-338
    PubMedGoogle Scholar
  • 14 Eloubeidi MA, Luz LP, Tamhane A et al. Ratio of pancreatic duct caliber to width of pancreatic gland by endosonography is predictive of pancreatic cancer. Pancreas 2013; 42: 670-679
    CrossrefPubMedGoogle Scholar
  • 15 Eloubeidi MA, Tamhane A, Jhala N et al. Agreement between rapid onsite and final cytologic interpretations of EUS-guided FNA specimens: implications for the endosonographer and patient management. Am J Gastroenterol 2006; 101: 2841-2847
    CrossrefPubMedGoogle Scholar
  • 16 Dwivedi AK, Mallawaarachchi I, Figueroa-Casas J et al. Multinomial logistic regression approach to the evaluation of binary diagnostic test in medical research. Stat Transit New Ser 2015; 16: 1-20
    PubMedGoogle Scholar
  • 17 Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000; 51: 184-190
    CrossrefPubMedGoogle Scholar
  • 18 Bang JY, Magee SH, Ramesh J et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-450
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Ekberg O, Bergenfeldt M, Aspelin P et al. Reliability of ultrasound-guided fine-needle biopsy of pancreatic masses. Acta Radiol 1988; 29: 535-539
    CrossrefPubMedGoogle Scholar
  • 20 Ranney N, Phadnis M, Trevino J et al. Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions. Gastrointest Endosc 2012; 76: 76-83
    CrossrefPubMedGoogle Scholar
  • 21 Bang JY, Hebert-Magee S, Trevino J et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
    CrossrefPubMedGoogle Scholar
  • 22 Ramesh J, Bang JY, Hébert-Magee S et al. 1022. Multi-center randomized trial comparing the 19G and 25G needles for EUS-guided FNA of solid pancreatic mass lesions. Gastrointest Endosc 2013; 77: AB179-AB180
    PubMedGoogle Scholar
  • 23 Hasan M, Ramesh J, Bang JY et al. 100. Multi-center randomized trial comparing the 19G and 25G needles for EUS-guided FNA of large solid pancreatic mass lesions. Gastrointest Endosc 2014; 79: AB112
    PubMedGoogle Scholar