Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses

Abstract

Aim-To assess the feasibility and diagnostic accuracy of endoscopic ultrasound guided fine needle biopsy (EUS-FNAB) in patients with solid pancreatic masses. Methods-Ninety nine consecutive patients with pancreatic masses were studied. Histological findings obtained by EUS-FNAB were compared with the final diagnosis assessed by surgery, biopsy of other tumour site or at postmortem examination, or by using a combination of clinical course, imaging features, and tumour markers. Results-EUS-FNAB was feasible in 90 patients (adenocarcinomas, n = 59; neuroendocrine tumours, n = 15; various neoplasms, n = 6; pancreatitis, n = 10), and analysable material was obtained in 73. Tumour size (> or < 25 mm in diameter) did not influence the ability to obtain informative biopsy samples. Diagnostic accuracy was 74.4% (adenocarcinomas, 81.4%; neuroendocrine tumours, 46.7%; other lesions, 75%; p<0.02). Overall, the diagnostic yield in all 99 patients was 68%. Successful biopsies were performed in six patients with portal hypertension. Minor complications (moderate bleeding or pain) occurred in 5% of cases. Conclusions-EUS-FNAB is a useful and safe method for the investigation of pancreatic masses, with a high feasibility rate even when lesions are small. Overall diagnostic accuracy of EUS-FNAB seems to depend on the tumour type. (Gut 2000;46:244-249)

Endoscopic ultrasound-guided fine-needle aspiration biopsy

“…Some authors reported a lower diagnostic accuracy for neuroendocrine tumors than for adenocarcinomas, possibly because of obscuring blood in the aspirate of the neuroendocrine neoplasms. 16 However, our experience differed. The diagnostic accuracy for both primary pancreatic adenocarcinomas and neuroendocrine neoplasms (Fig.…”

Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma

“…17,20,21 It is superior to other imaging modalities, especially when tumors are smaller than 2 cm. 7,22 Based on imaging alone, whereas EUS is highly sensitive in detecting malignancy, it is not specific.…”

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

“…120 Several studies have assessed EUS-FNA receiver operating characteristics by including only pancreatic cancer patients. [121][122][123][124][125][126][127][128][129][130][131][132] The initial reports showed a sensitivity of 85-95%, with a specificity close to 100%. 3, [121][122][123][124][125] The reports from the past 5 years also showed a high sensitivity of the procedure between 80% and 95%, with a specificity of 100%.…”

“…[152][153][154] Minimal bleeding at biopsy site is clinically insignificant, although it occurs in as many as 4% of cases. 125 More severe bleeding is rare, with only 2 episodes described after EUS-FNA of pancreatic lesions, one of which resulted in death. 155 Acute extraluminal hemorrhage at the site of the EUS-FNA has been reported with a frequency of 1.3%, but with no clinically recognizable consequences.…”