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

Abstract

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)

Comparison of the Diagnostic Performances of Same-session Endoscopic Ultrasound- and Endoscopic Retrograde Cholangiopancreatography-guided Tissue Sampling for Suspected Biliary Strictures at Different Primary Tumor Sites

“…[1][2][3][4][5][6] Meanwhile, previous reports for EUS-guided tissue sampling (EUS-TS) using fine-needle aspiration or biopsy provide higher diagnostic yields for solid pancreatic masses, and EUS-TS has been increasingly used to overcome the moderate diagnostic yield of ERCP-TS. [7][8][9] Furthermore, in patients with suspected biliary stricture, the diagnostic yield of EUS-TS is reportedly superior to that of ERCP-TS when tissue samples are obtained from lesions in the pancreas, lymph node (LN), and others that cause biliary obstruction.…”

Ethical Considerations of Biopsies in Early-Stage Pancreatic Cancer

“…15 Therefore, even if a biopsy successfully samples a PDAC mass, it may not collect enough malignant cells to confidently make a diagnosis, leading to nondiagnostic results. Previous studies of EUS-FNAs on patients with PDAC have found biopsy results to be atypical, suspicious, or inconclusive in 9%-15% [16][17][18][19] and benign or negative in 4%-11%. [12][13][14][19][20][21] The common occurrence of nondiagnostic biopsy results prompts 6%-16% of patients to get a second biopsy and 1%-2% to get a third 22,23 despite delays and lower yields.…”