Pitfalls in Endoscopic Ultrasound-Guided Fine-Needle Aspiration and How to Avoid Them

Stelow, Edward B.; Bardales, Ricardo H.; Stanley, Michael W.

doi:10.1097/01.pap.0000155053.68496.ad

Cited by 63 publications

(52 citation statements)

References 114 publications

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“…16,126-131 Description of false positive results for the EUS-FNA cytologic analysis is extremely rare, mostly as incidental finding in several studies. 133 The sensitivity and accuracy of EUS-FNA are better than those of ERCP brushings 134 or CT/ ultrasound-guided FNA for the pancreatic cancer diagnosis. 135 A recent prospective randomized study comparing CT or ultrasound-guided FNA with EUS-FNA showed that EUS-FNA is the preferred modality, especially for tumors smaller than 3 cm that have not been identified by previous ultrasound or CT examinations.…”

Section: Eus-fnamentioning

confidence: 99%

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

Săftoiu

Vilmann

2008

J of Clinical Ultrasound

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Early diagnosis of pancreatic cancer remains a difficult task, and multiple imaging tests have been proposed over the years. The aim of this review is to describe the current role of endoscopic ultrasound (EUS) for the diagnosis and staging of patients with pancreatic cancer. A detailed search of MEDLINE between 1980 and 2007 was performed using the following keywords: pancreatic cancer, endoscopic ultrasound, diagnosis, and staging. References of the selected articles were also browsed and consulted. Despite progress made with other imaging methods, EUS is still considered to be superior for the detection of clinically suspected lesions, especially if the results of other cross-sectional imaging modalities are equivocal. The major advantage of EUS is the high negative predictive value that approaches 100%, indicating that the absence of a focal mass reliably excludes pancreatic cancer. The introduction of EUS-guided fine needle aspiration allows a preoperative diagnosis in patients with resectable cancer, as well as a confirmation of diagnosis before chemoradiotherapy for those that are not. This comprehensive review highlighted the diagnostic capabilities of EUS including the newest refinements such as contrast-enhanced EUS, EUS elastography, and 3-dimensional EUS. The place of EUSguided biopsy is also emphasized, including the addition of molecular marker techniques.

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Section: Eus-fnamentioning

confidence: 99%

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

Săftoiu

Vilmann

2008

J of Clinical Ultrasound

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“…Although EUS-guided FNA is an excellent tool for the diagnosis of a wide variety of pancreatic lesions, pitfalls in cytomorphological interpretation can sometimes lead to misdiagnoses. PanIN, IPMN and MCN all can contain high-grade dysplastic epithelial cells that are morphologically similar to the tumor cells of pancreatic adenocarcinoma [7][8][9] . Cytomorphological criteria that can reduce the risk of overdiagnosing pancreatic adenocarcinoma by FNA have not been adequately defined in the cytology literature.…”

Section: Introductionmentioning

confidence: 99%

Cytomorphological Features Useful to Prevent Errors in the Diagnosis of Pancreatic Adenocarcinoma by Fine Needle Aspiration Cytology

Chi

Cramer

et al. 2016

Acta Cytologica

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Objectives: Endoscopic ultrasound-guided fine-needle aspiration (FNA) is now widely used as a primary tool to diagnose pancreatic neoplasms. However, criteria that can reduce the risk of overdiagnosing pancreatic adenocarcinoma by FNA have not been adequately defined in the literature. This study aims to identify characteristic cytomorphological features that are helpful in distinguishing pancreatic adenocarcinoma from its mimics. Study Design: Five false-positive FNA cases (group A) diagnosed as adenocarcinoma (4 cases) and suspicious for adenocarcinoma (1 case) by FNA, were identified by searching our laboratory information system. Cytomorphological features of group A cases were compared to 12 true-positive, histologically confirmed FNA cases (group B). Results: Subsequent histological follow-ups of 5 misdiagnosed FNA cases showed 2 cases of intraductal papillary mucinous neoplasm with focal high-grade dysplasia, 1 case attributed to tumor contamination from a gastroesophageal junction adenocarcinoma, and 2 cases of pancreatic intraepithelial neoplasia (PanIN1/reactive change and PanIN2, respectively). Cytomorphological features present in both groups A and B included nuclear enlargement/overlapping, mild to moderate anisonucleosis, granular chromatin and prominent nucleoli. However, 1 or more of these 4 characteristic morphological features such as 3-dimensional cluster with cell disorientation, isolated malignant cells, irregular nuclear contour/nuclear grooves/notches (>5% atypical cell population), and marked nuclear size variation 1:4 or higher was mainly present in adenocarcinoma. Conclusions: A combination of at least 2 of these 4 characteristic cytomorphological features needs to be present before rendering an unequivocal diagnosis of adenocarcinoma. Using these strict cytological criteria would have eliminated these false-positive diagnoses.

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“…Metastases were seen in regional lymph nodes, liver, and omentum. Ozguven et al (2015) in there study found that one of therepatients had vascular and perineuralinvasion, and she was well after 2 years following operation [3].Conservative resection with safe margins is the treatment of choice if feasible [5]. In most cases, distal pancreatectomy would be sufficient.…”

Section: Microscopic Findingsmentioning

confidence: 99%