Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: a tertiary oncology center experience

Krishna, Somashekar G.; Li, Feng; Bhattacharya, Abhik; Ladha, Harshad; Porter, Kyle; Singh, Akanksha; Bhutani, Manoop S.; Lee, Jeffrey H.

doi:10.1016/j.gie.2014.08.023

Cited by 17 publications

(9 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 34 false negative tests 38% had a final diagnosis of benign lesions and 62% had a diagnosis of another malignancy at the time of surgical resection. Additionally, when the presence of atypical cells were considered a negative test, specificity was includingcomparable to the literature (90%), but the sensitivity of diagnosing PDAC when utilizing EUS-FNA was significantly lower (68.2%) compared to commonly reported sensitivities of 80-85% [4][5][16][17][18] . Another study reported very low incidence of false positive diagnosis (0-5%) when using EUS-FNA as a diagnostic tool for PDAC [12] .…”

Section: Discussionmentioning

confidence: 66%

See 1 more Smart Citation

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Beal

Shea

Witt

et al. 2015

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

PPV, and 89% (82-94) NPV. Detection of neuroendocrine tumors by FNA-EUS yielded 66% (47-87) sensitivity, 100% (97-100) specificity, 94% (71-99) PPV, and 97% (94-99) NPV. Detection of IPMN by FNA-EUS yielded 59% (43-74) sensitivity, 100% (98-100) specificity, 100% (87-100) PPV, and 89% (93-99) NPV. CONCLUSIONS: Our findings are largely consistent with the current literature, confirming there is discernible potential for inappropriate treatment of patients based purely on EUS-FNA evaluation. Both accuracy and clarity of positive tests with EUS-FNA worsened for mucinous pancreatic lesions compared to solid pancreatic lesions. Limitations of this study are the appraisal at a single institution and the necessity to evaluate only cases that ultimately had surgical resection of the pancreatic lesion. INTRODUCTIONPancreatic ductal adenocarcinoma (PDAC) has the 4th highest cancer mortality rate for both men and women in the United States. The average 5 year survival rate for PDAC patients with localized disease that were able to undergo a resection is approximately 24% [1] . Prognosis is poorer for the 80-85% of patients who are unable to undergo resection due to disseminated disease or ABSTRACT BACKGROUND: The purpose of this study was to assess the clinical impact of diagnostic accuracy for EUS-FNA in evaluating pancreatic lesions, particularly Pancreatic Ductal Adenocarcinoma( PDAC), neuroendocrine tumors, and IPMN at our institution using surgical pathological review as the gold standard. METHODS: We conducted a retrospective chart review using the Clinical Cancer Research Database at Huntsman Cancer Institute. We included all cases in which pancreatic lesions were evaluated by EUS-FNA and a subsequent surgical resection was performed. Sensitivity, specificity, positive predicative value (PPV), and negative predictive value (NPV) were determined for PDAC, neuroendocrine tumors, and IPMN by comparing pathological diagnosis at EUS-FNA to diagnoses following surgery. RESULTS: Detection of PDAC by FNA-EUS yielded 87.9% (80.1-93.4 95% CI) sensitivity, 80% (72-86) specificity, 78% (70-85)

show abstract

Section: Discussionmentioning

confidence: 66%

“…Previous studies have only separately evaluated the efficiency of EUS-FNA for diagnosing neuroendocrine tumors [9][10][11] , cystic neoplasms, such as intraductal papillary mucinous neoplasms (IPMN) [12][13][14][15] , or PDAC [16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Beal

Shea

Witt

et al. 2015

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

show abstract

“…Further observation of 3 separate periods of 100 pancreatic EUS-FNA following basic skills acquisition demonstrated further improvement in terms of a decreasing number of diagnostic needle passes 7 and decreasing adverse events in period 3 compared to periods 1 and 2 [144]. A 7-year experience in pancreatic EUS-FNA showed a significant correlation between years of operator experience and the mean of annual EUS examinations in the preceding 3 years with fewer needle passes [146,147]. A similar effect of cumulative EUS-FNA experience over a 13-year period on the diagnostic accuracy of pancreatic EUS-FNA was also reported, representing a joint learning curve of both endosonographers and cytopathologists [148].…”

Section: Learning Curve and Minimum Number Of Supervised Proceduresmentioning

confidence: 89%

“…In specialized tertiary referral centers for EUS-FNA, 13 % [148] to 21 % [194] of focal pancreatic lesions referred for cytopathological diagnosis turn out to be benign, often focal chronic and autoimmune pancreatitis. In the case of solid pancreatic neoplasms, 12 % to 25 % turn out to be non-PDAC (e. g. neuroendocrine tumors, pancreatic metastases, mesenchymal tumors, lymphoma, solid pseudopapillary neoplasia) [146,148,194,596]. The ratio of non-PDAC to PDAC is inversely related to the diameter of the tumor.…”

Section: Solid Pancreatic Lesionsmentioning

confidence: 99%

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)

et al. 2015

View full text Add to dashboard Cite

The fourth part of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines on Interventional Ultrasound describes general aspects of endoscopic ultrasound-guided diagnostic and therapeutic interventions and assesses the evidence for endoscopic ultrasound-guided sampling. Endoscopic ultrasound combines the most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and safe and effective fine needle based tissue acquisition from these lesions. The guideline addresses the indications, contraindications, techniques, adverse events, training and clinical impact of EUS-guided sampling. Advantages and drawbacks are weighed in comparison with image-guided percutaneous biopsy. Based on the most current evidence, clinical practice recommendations are given for crucial preconditions and steps of EUS-guided sampling as well as for safe performance. Additionally, the guideline deals with the principles and reliability of cytopathological reporting in endoscopic ultrasound-guided sampling (long version).

show abstract

“…Pancreatic ductal adenocarcinoma accounts for nearly 90% of solid pancreatic masses. The remaining 10–15% is comprised of PanNET and metastases to the pancreas from other sites . EUS‐guided FNA has become routine in the work up of newly identified pancreatic masses (solid or cystic).…”

Section: Discussionmentioning

confidence: 99%

Two unusual variants of pancreatic neuroendocrine tumor and their potential pitfalls on fine‐needle aspiration cytology

Richmond

Mehrotra

2017

Diagnostic Cytopathology

View full text Add to dashboard Cite

Endoscopic ultrasound-guided fine-needle aspiration is increasingly utilized for the diagnosis of pancreatic lesions. Although operator dependent, the procedure has good overall performance characteristics and is minimally invasive; however, accuracy and sensitivity are reportedly lower for pancreatic neuroendocrine tumor (PanNET) compared with the more common pancreatic ductal adenocarcinoma (pACA). The underperformance is further exacerbated by the unusual cases of PanNET presenting with variant cytomorphology. We report two separate diagnostically challenging cases: a pigmented PanNET and a clear cell PanNET. We briefly review the literature and emphasize the importance of recognizing these uncommon variants when encountered in aspirate material. Diagn. Cytopathol. 2017;45:371-378. © 2016 Wiley Periodicals, Inc.

show abstract

Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: a tertiary oncology center experience

Cited by 17 publications

References 48 publications

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)

Two unusual variants of pancreatic neuroendocrine tumor and their potential pitfalls on fine‐needle aspiration cytology

Contact Info

Product

Resources

About