Incidents and adverse events of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions

Abstract

AIMTo evaluate the diagnostic value and safety mainly regarding incidents of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic cystic lesions (PCLs).METHODSA total of 150 consecutive patients with suspected PCLs were prospectively enrolled from April 2015 to November 2016. We finally enrolled 140 patients undergoing EUS-FNA. We compared the diagnostic accuracy of EUS-FNA and pathological diagnosis, which is regarded as the gold standard, for PCLs. Patients undergoing EUS-FNA at least 1 wk preoperatively were monitored for incidents and adverse events to evaluate its safety.RESULTSThere were 88 (62.9%) women and 52 (37.1%) men among 140 patients, with a mean age of 50.1 (± 15.4) years. There were 67 cysts located in the head/uncinate of the pancreas and 67 in the body/tail, and 6 patients had at least 1 cyst in the pancreas. There were 75 patients undergoing surgery and 55 undergoing EUS-FNA with interval at least 1 wk before other operations, with 3 patients undergoing the procedure twice. The accuracy of EUS-FNA in differentiating benign and malignant lesions was 97.3% (73/75), while the accuracy of characterizing PCL subtype was 84.0% (63/75). The incident rate was 37.9% (22/58), whereas only 1 AE was observed in 58 cases.CONCLUSIONEUS-FNA is effective and safe for diagnosis of PCLs, however procedure-related incidents are common. Caution should be taken in patients undergoing EUS-FNA.

Evaluation of Pancreatic Lesions With Endoscopic Ultrasound and Fine Needle Aspiration

“…5-8,29-31 However, the negative predictive value of EUS-FNA was relatively low at 50%, which was reported to be 50.9%-85.2% in similar studies. 5,7,30,31 Hence, if a pancreatic lesion has high clinical suspicion of malignancy while the EUS-FNA was negative, other investigations should be offered as part of the workup for malignancy or repeat EUS-FNA should be performed as another attempt for pathological diagnosis.…”

Diagnostic approaches for pancreatic cystic lesions

“…32 They also however reported that 1.7% of patients had an adverse event which interfered with the planned treatment and 37.9% had an incident with signs and symptoms that did not affect the planned treatment. 32 A meta-analysis on the diagnostic accuracy of EUS-FNA cytology has concluded that it had a pooled sensitivity of 63% and a specificity of 88%. 33 The low sensitivity may be explained by the limited numbers and poor quality of aspirated epithelial cells in cyst fluid obtained for cytology.…”

“…It facilitates in vivo microscopy during endoscopic procedures and there is increasing interest in the use of CLE in the diagnosis of biliary strictures and PCLs. 32 CLE allows real-time evaluation of histology with highresolution imaging (1-3.5 μm) without the need for a biopsy and can be used with both ERCP catheters (CholangioFlex probe, Paris, France) and EUS-FNA needles (AQ-Flex 19 probe) 37,38 which at present are manufactured by Cellvisio, Mauna Kea Technologies, Paris, France. 38 As well as real-time use, there is also the benefit of post-procedure review of imaging videos with the ability to play and pause and also measure structure s of interest.…”

“…found that EUS‐FNA used for distinguishing between benign and malignant PCLs had a sensitivity, specificity and diagnostic accuracy of 98.6%, 50.0% and 97.3%, respectively 32 and the accuracy of establishing the PCL subtype was 84.0% 32 . They also however reported that 1.7% of patients had an adverse event which interfered with the planned treatment and 37.9% had an incident with signs and symptoms that did not affect the planned treatment 32 . A meta‐analysis on the diagnostic accuracy of EUS‐FNA cytology has concluded that it had a pooled sensitivity of 63% and a specificity of 88% 33 .…”

“…Confocal laser endomicroscopy (CLE) is a novel diagnostic technique which was first introduced in 2004. It facilitates in vivo microscopy during endoscopic procedures and there is increasing interest in the use of CLE in the diagnosis of biliary strictures and PCLs 32 . CLE allows real‐time evaluation of histology with high‐resolution imaging (1–3.5 μm) without the need for a biopsy and can be used with both ERCP catheters (CholangioFlex probe, Paris, France) and EUS‐FNA needles (AQ‐Flex 19 probe) 37,38 which at present are manufactured by Cellvisio, Mauna Kea Technologies, Paris, France 38 .…”