Predictors of Malignancy and Recommended Follow-Up for Patients with Negative Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspected Pancreatic Lesions

Abstract

For patients undergoing EUS-FNA for a suspected pancreatic lesion, a negative or nondiagnostic FNA does not provide conclusive evidence for the absence of cancer. Patients for whom vascular invasion and lymphadenopathy are detected on EUS are more likely to have a true malignant lesion and should be followed closely. When a patient has been monitored for six months or more with no cancer being diagnosed, there appears to be much less chance that a pancreatic malignancy is present.

Ultrasound-guided percutaneous fine-needle aspiration of solid pancreatic neoplasms: 10-year experience with more than 2,000 cases and a review of the literature

“…Negative results of pancreatic US-FNA, therefore, should be viewed with caution, and radiological and clinical findings should be always taken into account during cytologic examination. In this regard, a study by Spier et al [18] suggested that in patients with a definite solid lesion with imaging features suspicious for malignancy such as invasion of the adjacent vessels or the presence of peripancreatic lymph nodes-despite negative FNA-the FNA result should be considered as false negative FNA, and the patients followed closely, with an early repeat attempt at tissue acquisition and repeat imaging, or strongly considered for direct referral for an intra-operative sample. Moreover, these authors reported that in the majority of patients with a false-negative FNA who were diagnosed with cancer, the diagnosis was made within 90 days after FNA.…”

“…Beyond 3 months post-FNA, if a patient has not been diagnosed with cancer despite clinical suspicion or imaging findings, it is unlikely that the patient has an underlying malignancy that was missed at the time of FNA. Thus, after a negative FNA in patients who do not have suspicious imaging findings, it is reasonable to perform one or two follow-up CT/MRI examinations in the first 3-6 months after a negative FNA, but longer-term surveillance is rarely needed [18].…”

Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos)

“…Regardless of the results, all the patients should be followed for more than 6 months. 24 Moreover, routine use of cytology and microhistology in association with EUS-FNA lead to the preoperative description of various pancreatic masses: neuroendocrine tumors and metastases (eg, melanoma, renal cell carcinoma) as well as other rare tumors of the pancreas (eg, lymphoma, small cell carcinoma, angiomyolipoma, solid pseudopapillary tumors). [27][28][29][30][31][32] Previous studies clearly showed that pancreatic adenocarcinoma is a relatively hypovascular tumor, although more than 65% of the patients have detectable vessels inside.…”

Pancreatic fine-needle aspiration cytopathology: an analysis of the CAP NGC program for pancreatic FNA 2003–2011

“…7 This does present some problems when viewed through the filter of recent understanding. This is especially true when considering entities with variable malignant potential including mucinous cystic lesions [8][9][10] and neuroendocrine tumors. In this program, a mucinous cystic neoplasm corresponded to samples with extracellular mucin and morphologically benign mucinous epithelial cells.…”