Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

Abstract

The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions.

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…In cases of pancreatic body and tail lesions, no significant difference among the three types of needle has been found . FNA needles have different echogenicity . In a multicenter study evaluating 10 different EUS needles, the polymeric‐coated needle showed the highest echogenicity …”

“…47 FNA needles have different echogenicity. [49][50][51] In a multicenter study evaluating 10 different EUS needles, the polymeric-coated needle showed the highest echogenicity. 52 Consistent tissue core acquisition with EUS-guided biopsy has recently been achieved through the development of new side-and end-cutting EUS needles, with different mechanisms, calibers and design.…”

Team work and cytopathology molecular diagnosis of solid pancreatic lesions

“…Recent papers have shown that evidence‐based techniques to increase the diagnostic yield during EUS‐FNA of pancreatic masses include the use of general anesthesia, smaller (22‐G or 25‐G) needles for transduodenal FNA and 19‐G or core biopsy needles if histology is required. Moreover, it is suggested to use the suction and the ‘fanning’ technique or to perform seven needle passes …”

Combined microRNA and mRNA microfluidic TaqMan array cards for the diagnosis of malignancy of multiple types of pancreatico-biliary tumors in fine-needle aspiration material

“…In centers providing special requirements such as highly trained endoscopists proficient in EUS-guided biopsy approaches, equipment and on-site cytology will reach specificity of up to 96% and sensitivity of up to 87% as reported by recent systematic meta-analyses [ 7 ], [ 8 ]. However, specificity for the diagnosis of malignancy reported in the literature ranges between 80 and 100%, while sensitivity is much more variable with an overall low and variable negative predictive value (33-85%) [ 9 ]. Many factors can impact the diagnostic yield of EUS-FNA including the experience of both the endosonographer and cytologist, availability of on-site cytology, and the inherent limitations of the procedure to identify cytomorphologic features characteristic of well-differentiated cancer, in particular in the setting of chronic pancreatitis (CP).…”