Repeat endoscopic ultrasound fine needle aspiration after a first negative procedure is useful in pancreatic lesions

Abstract

Background and Objectives:There is no consensus about the ideal method for diagnosis in patients who have already undergone endoscopic ultrasound fine needle aspiration (EUS-FNA), and the inconclusive material is often obtained. The aim was to evaluate the diagnostic yield of the second EUS-FNA of pancreatic lesions.Materials and Methods:A retrospective analysis of prospectively collected data of patients with EUS-FNA of pancreatic lesions is performed. All patients who underwent more than one EUS-FNA for the evaluation of suspected pancreatic cancer over a 7-year period were included in the analysis.Results:A total of 296 EUS-FNAs of the pancreas were performed in 257 patients. The diagnostic yield with the first EUS-FNA was 78.6% (202/257). Thirty-nine (13.3%) FNAs were repeated in 34 patients; 17 (50%) patients were women. The mean ± standard deviation (SD) age was 58.8 ± 16.1 years. The location of the lesions in the pancreatic gland, from which the second biopsies were taken, was head of the pancreas, n = 28 (82.4%), body of the pancreas, n = 3 (8.8%), and tail, n = 3 (8.8%). The mean ± SD of the size of the lesion was 36.3 ± 14.6 mm. The second EUS-FNA was more likely to be positive for diagnosis in patients with an “atypical“ histological result in the first EUS-FNA (odds ratio [OR]: 4.04; 95% confidence interval [CI]: 0.9–18.3), in contrast to patients with a first EUS-FNA reported as “normal” (OR: 0.21; 95% CI: 0.06–0.71). Overall, the diagnostic yield of the second EUS-FNA was 58.8% (20/34) with an increase to 86.3% overall (222/257).Conclusion:Repeat EUS-FNA in pancreatic lesions is necessary in patients with a negative first EUS-FNA because it improves the diagnostic yield.

Analysis of the diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in patients with a suspected pancreatic malignancy

“…Several investigators report that a second EUS-FNA can yield a definitive diagnosis in 58.8% to 92.8% of cases of suspected pancreatic cancer with an inconclusive initial cytology (26)(27)(28). Our study showed that repeated EUS-FNA can confirm malignancy in up to 50% of cases when the original biopsy was non-diagnostic.…”

A Blood-Based Multi Marker Assay Supports the Differential Diagnosis of Early-Stage Pancreatic Cancer

“…Type, size and localization of the lesion in the pancreas, experience of the endoscopist, and number of passes of the needle through the lesion and the dense tumor stroma impact on outcome of EUS-guided FNA of pancreatic lesions. Thus, inconclusive pathological results in tissue or cells obtained for diagnosis are reported in up to 30 % of case 10. Accordingly, the diagnostic accuracy of EUS-guided FNA of PDAC is 76 % - 90 %, the false negative rate is about 15 % 11.…”

High-resolution endoscopic ultrasound imaging and the number of needle passages are significant factors predicting high yield of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses without an on-site cytopathologist

“…[6–8] EUS-FNA has a reported sensitivity of 54% to 95%, a specificity of 71% to 100%, and an accuracy of 85% to 90%. [6,8–12] The foundation for the diagnostic accuracy of EUS-FNA is obtaining adequate tissue, and it could be influenced by several variables, including the size of the lesion, location of the lesion, needle gauge, needle type, use of a stylet and suction, number of needle passes, the endosonographer's skill and experience, and on-site cytopathology evaluation. [13,14] …”