Endoscopic ultrasound guided fine-needle aspiration cytology of pancreatic carcinoma

Abstract

BACKGROUND Endoscopic ultrasound‐guided fine‐needle aspiration biopsy (EUS‐FNAB) of small pancreatic lesions that are undetectable by computed tomography has gained wide acceptance for the procurement of cells for diagnostic purposes. However, this technique is not without difficulty. The authors examined the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of this technique in the evaluation of patients with pancreatic biliary duct strictures/masses. The authors were interested in reviewing their cases of pancreatic adenocarcinoma of ductal type and finding the sources of their false‐negative cases. METHODS A computer search was performed between January 1998 and July 2001. For the last 3 years, a total of 80 cases of suspected ductal adenocarcinoma of the pancreas was identified. Thirty‐four patients (42%) underwent a subsequent Whipple procedure or biopsy. Cytologic and histologic correlation was performed in these cases. The rest of the 23 patients (29%) considered to be positive and the 23 patients (29%) considered to be negative underwent no subsequent biopsy and were followed clinically. Cases termed “suspicious” on cytology were considered positive and those termed “atypical cytology” were considered negative in the authors' final calculation. The causes of the false‐negative diagnoses were evaluated carefully. RESULTS Of the 34 cases followed with subsequent tissue biopsy or surgery; 12 were confirmed to be positive, 12 were confirmed to be negative, and 10 were considered to be false‐negative. Previously identified cytomorphologic features of malignancy were used to review all cases. These features were: loss of the honeycomb pattern (100%), anisonucleosis (100%), nuclear contour irregularity (100%), a high nuclear/cytoplasmic ratio (100%), paranuclear chromatin clearing (77%), and the presence of prominent nucleoli in the absence of inflammatory cells (77%). The causes of the 10 false‐negative cases were technical difficulty of procuring material in 6 cases, the nature of the lesion in 2 cases, and the scarcity of lesional tissue in 2 cases. CONCLUSIONS Using strict cytoarchitectural and cytomorphologic criteria of malignancy for ductal pancreatic lesions previously described in the literature, the sensitivity of this technique at the study institution was 78% with a specificity of 100%. The PPV and NPV of this technique were 100% and 78%, respectively. The most common causes of the false‐negative results in descending order were the technical aspect of the procedure, the size and nature of the lesion, and the scarcity of lesional tissue. Cancer (Cancer Cytopathol) 2002;96:000–000. © 2002 American Cancer Society. DOI 10.1002/cncr.10759

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

“…120 Several studies have assessed EUS-FNA receiver operating characteristics by including only pancreatic cancer patients. [121][122][123][124][125][126][127][128][129][130][131][132] The initial reports showed a sensitivity of 85-95%, with a specificity close to 100%. 3, [121][122][123][124][125] The reports from the past 5 years also showed a high sensitivity of the procedure between 80% and 95%, with a specificity of 100%.…”

Accuracy of Cytotechnologist Evaluation of Specimen Adequacy and Screening Interpretation of Malignancy in Fine-Needle Aspiration of the Liver

“…While ultrasound (US) guidance can add to the overall yield and safety of the procedure, it also adds incremental costs [1,2,3,4,5]. Therefore, the importance of obtaining an adequate sample in a single procedure is much more important when radiological guidance is being used.…”

EUS – Fine- Needle Aspiration Biopsy (FNAB) in the Diagnosis of Pancreatic Adenocarcinoma: A Review

“…EUS-FNAB, with its ability to obtain a tissue diagnosis, has increased the accuracy of EUS in the diagnosis of pancreatic adenocarcinoma. The sensitivity, specificity, and accuracy of EUS-FNAB for pancreatic lesions range from 64% to 94%, 71% to 100% and 78% to 95% respectively [1][2][3][4][5][6] Thirtythree studies published between 1997-2009 with 4984 patients were included, as the pool sensitivity for malignant cytology was 85% and pooled specificity was 98%. If atypical and suspicious cytology results were included to determine true neoplasms, the sensitivity increased to 91%.…”