EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement

Savides, Thomas J.; Donohue, Michael; Hunt, Gordon C.; Al-Haddad, Mohammed; Aslanian, Harry R.; Ben–Menachem, Tamir; Chen, Victor K.; Coyle, Walter; Deutsch, John C.; DeWitt, John M.; Dhawan, Manish; Eckardt, Alexander J.; Eloubeidi, Mohamad A.; Esker, Alec; Gordon, Stuart R.; Gress, Frank G.; Ikenberry, Steven O.; Joyce, Ann Marie; Klapman, Jason; Lo, Simon K.; Maluf‐Filho, Fauze; Nickl, Nicholas; Singh, Virmeet; Wills, Jason C.; Behling, Cynthia

doi:10.1016/j.gie.2007.01.017

Cited by 147 publications

(94 citation statements)

References 12 publications

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“…Bile duct brushings (in the event of a biliary stricture) only have a yield of 23% to 41% (3,4). The diagnostic rate of EUS (endoscopic ultrasound)-guided biopsies for pancreatic masses is only about 71% (5). Although their sensitivity is about 85%, negative predictive value is only about 64% (6).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Identifying Pancreatic Cancer Based on Serum Metabolomics

Bathe

Shaykhutdinov

Kopciuk

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

147

125

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Section: Introductionmentioning

confidence: 99%

Feasibility of Identifying Pancreatic Cancer Based on Serum Metabolomics

Bathe

Shaykhutdinov

Kopciuk

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

147

125

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“…The proportions of 'suspicious' or 'atypical' cases were different in various studies. Previous studies reported that the frequency of the 'atypical' cases was 1-14%, 19,20 and that of 'suspicious' cases was 3-5%. 13,19 These wide variations between studies were attributed to on-site cytopathologists, reference standards, study type, and mass size and site.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies reported that the frequency of the 'atypical' cases was 1-14%, 19,20 and that of 'suspicious' cases was 3-5%. 13,19 These wide variations between studies were attributed to on-site cytopathologists, reference standards, study type, and mass size and site. 20 This study showed similar frequencies of 'suspicious' (7.2%) and 'atypical' (5.2%) categories compared to previous studies.…”

Section: Discussionmentioning

confidence: 94%

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Predictors of Malignancies in Patients with Inconclusive or Negative Results of Endoscopic Ultrasound-guided Fine-needle Aspiration for Solid Pancreatic Masses

Jeong

Park

Kim

et al. 2018

Korean J Gastroenterol

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Background/Aims: This study analyzed the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic solid masses in patients with or without chronic pancreatitis as well as the clinical parameters relevant to a malignancy when EUS-FNA was negative or inconclusive. Methods: A total of 97 patients, who underwent EUS-FNA for solid pancreatic masses over 2 years at a single institution, were evaluated. All patients underwent EUS-FNA for 3-5 passes with 22 or 25 G needles without an on-site cytopathologist. The final diagnosis was obtained by surgery or compatible clinical outcomes for a more than 12 month follow-up. The diagnostic yields in the patients with or without chronic pancreatitis were compared and the histories and laboratory data relevant to pancreatic ductal adenocarcinoma (PDAC) or pseudo-tumor were analyzed. Results: The final diagnoses were adenocarcinoma in 88 patients (90.7%) and inflammatory pseudo-tumor in 9 (9.3%). The results of EUS-FNA were adenocarcinoma (74), suspicious (7), atypical (5), negative (10), and inadequate specimen (1). The diagnostic accuracies were 76.9% and 91.6% in patients with or without chronic pancreatitis, respectively. Among the 23 cases with non-diagnostic results of EUS-FNA, PDAC was finally diagnosed in 5 out of 7 suspicious, 3 out of 5 atypical, and 5 out of 10 negative cytology cases. The clinical parameters related to a pseudo-tumor were a history of alcohol consumption and pancreatitis, and normal alkaline phosphatase levels. Conclusions: The diagnostic accuracy of pancreatic masses in the background of chronic pancreatitis was low. When EUS-FNA produced inconclusive results, the histories of alcohol consumption, pancreatitis, and serum levels of alkaline phosphatase are useful for making a final diagnosis. (Korean J Gastroenterol 2018;71:153-161)

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“…In these studies, no significant difference in diagnostic accuracy was noted according to the size of the FNA needle, but the 25-G needle easily punctured small mobile SELs and the 19-G needle showed excellent differentiation between GIST and leiomyoma by enabling tissue procurement for immunohistochemical studies (Figure 8C, D). The average reported accuracy of EUS-FNA in the diagnosis of SELs lesions is approximately 80% [108][109][110]. The development of new EUS-FNB needles promises better GI SET diagnosis rates [111].…”

Section: Histologic Assessment Of Subepithelial Lesionsmentioning

confidence: 99%

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Al-Lehibi¹,

Bamakhrama²

2017

Endoscopic Ultrasound - From Usual to Special

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A subepithelial lesion (SET) is defined as a lesion, bulge or impression visible within the lumen of the gastrointestinal tract that is covered by normally appearing mucosa and usually found incidentally during routine endoscopy. Such a lesion could be either an intramural mass or an impression caused by extramural structures. The old terminology has recently been replaced by the term "subepithelial lesion" because intramural lesions may arise and can be located in any layer of the GI wall underneath the epithelium. The most common SELs are gastrointestinal stromal tumors (GISTs), leiomyomas, lipomas, granular cell tumors (GCTs), pancreatic rests and carcinoid tumors. The prognosis varies from benign to potentially malignant. While the majority of the lesions are considered benign, some tumors such as GISTs and carcinoids have a strong propensity for malignant transformation. Endoscopic ultrasonography (EUS) is the most accurate diagnostic method for distinguishing between extraluminal compressions and intramural lesions and plays a critical role in the detection and management of SELs. This is because EUS can reveal the precise sonographic nature of the lesion even though sometimes there are complex cases, which are difficult to diagnose by EUS alone. Performing routine biopsies and obtaining tissue samples for diagnosis can be difficult because SELs are located beneath the normal epithelial layer. Mostly, EUS allows the practitioner to extract an optimal tissue sample since it allows fine-needle aspiration (FNA) and fine-needle biopsy (FNB) both of which provide good results. With immunocytochemical staining, all these techniques increase the accuracy of the diagnosis. Evaluation of subepithelial lesions by means of EUS imaging will provide further characterization of the lesion to help guide us in appropriate differential diagnosis and further management. In this chapter, we provide a systematic EUS-guided approach to the diagnosis, management and later surveillance for SELs, as well as presenting updated diagnostic techniques that may help physicians to appropriately manage these subepithelial lesions.

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EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement

Cited by 147 publications

References 12 publications

Feasibility of Identifying Pancreatic Cancer Based on Serum Metabolomics

Feasibility of Identifying Pancreatic Cancer Based on Serum Metabolomics

Predictors of Malignancies in Patients with Inconclusive or Negative Results of Endoscopic Ultrasound-guided Fine-needle Aspiration for Solid Pancreatic Masses

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

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