How to improve the success of endoscopic ultrasound guided fine needle aspiration cytology in the diagnosis of pancreatic lesions

Abstract

Key words: endoscopic ultrasound guided fine needle aspiration cytology, pancreatic lesions, diagnosis Abbreviations: EUS, endoscopic ultrasonography; EUS-FNA, EUS-guided fine needle aspiration cytology Endoscopic ultrasonography (EUS) is highly accurate for assessing the pancreatic parenchyma and ductal system. Currently, it is the most sensitive imaging procedure for detecting small solid pancreatic masses. EUS-guided fine needle aspiration cytology (EUS-FNA) is a safe and highly accurate tool for the diagnosis of pancreatic malignancy. Prior to perform an EUS-FNA one should wonder whether the benefits outweigh the potential risks of the procedure. Therefore, it is important to take into account whether the procedure will influence patient management. The diagnostic yield and success rate of EUS-FNA in pancreatic lesions varies greatly depending on many factors including: the characteristics of the lesion itself (location of the mass and consistency of the lesion), technical factors (type of needle size, use of stylet, use of suction and number of needle passes performed) and the availability of immediate cytological assessment of the specimen. The aim of this review is to analyze all these factors for optimizing specimen collection and diagnostic efficiency in dealing with solid pancreatic masses.

Rapid on‐site evaluation for endoscopic ultrasound‐guided fine‐needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures

“…5 These and other studies have described the advantages of ROSE in EUS-FNA of the pancreas. 1,[6][7][8] The lack of ROSE has been reported to be associated with low EUS-FNA sensitivity. 9 To the best of our knowledge, none of the studies published to date that examined the use of ROSE versus not using ROSE for EUS-FNA of the pancreas examined its impact on second procedures.…”

Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: A review

“…For negative interpretations, a multidisciplinary team or individual in charge of the patient's care must perform the “triple test,” ie, an assessment that includes the clinical presentation, radiologic findings, and cytology diagnosis. If any one of the elements of the “triple test” is discrepant, it is mandatory to reassess that component, and if found on review to be sound, then the overall diagnosis and other elements have to be reassessed . Pancreatic EUS‐FNA has a very high specificity with very few false‐positive interpretations; however, false‐negative interpretations are not uncommon due to sampling and interpretive errors, which affect the sensitivity of the test.…”

Postbrushing and fine‐needle aspiration biopsy follow‐up and treatment options for patients with pancreatobiliary lesions: The papanicolaou society of cytopathology guidelines

“…The multidisciplinary team or individual in charge of the patient's care must perform the “triple test,” i.e., an assessment that includes the clinical presentation, radiologic findings, and cytopathology. If any one of the elements of the “triple test” are discrepant it is mandatory to reassess that component, and if found on review to be sound, then the overall diagnosis and other elements have to be reassessed . For example, if EUS demonstrates biliary or pancreatic duct dilation, or radiology finds regional lymphadenopathy, it is more likely that there is a malignancy despite a non‐diagnostic or negative cytology report.…”

“…For cystic pancreatic lesions greater than 2 cm, a cytobrush passed down a 19‐gauge needle may be added to routine FNA. In certain instances, core biopsy to obtain adequate tissue can be performed with a 22–25 Gauge FNA needle, although it is more usual to gain core biopsy type samples with needles 19 gauge and larger …”