When to puncture, when not to puncture: Pancreatic masses

Abstract

Endoscopic ultrasound (EUS) has evolved to become a crucial tool for the evaluation of pancreatic diseases, among them solid pancreatic lesions. However, its ability to determine whether a lesion is malignant or not is difficult to establish based only in the endosonographic image. EUS-guided fine needle aspiration (EUS-FNA) allows obtaining a cytological and/or histological sample from pancreatic lesions, with a high overall accuracy and low complication rates. Although the clinical usefulness of EUS-FNA for pancreatic diseases is widely accepted, the indications for tissue diagnosis of pancreatic lesions suspected to be malignant is still controversial. This review highlights the diagnostic accuracy and complications of EUS-FNA, focusing on its current indications.

Delayed Hemorrhage from Gastroduodenal Artery Pseudoaneurysm following Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Head Mass

“…1 In a recent prospective study of adverse events of EUS-FNA, puncture of https://doi.org/10.15279/kpba.2018.23. 4.165 cystic lesions was similarly complicated in solid masses compared with previous studies. 2 Severe hemorrhage associated with the procedure was rarely reported.…”

“…However, recent studies reported that the complication rate for cystic lesions was comparable to that of solid lesions and the rate of severe complications such as perforation, infection or hemorrhage is extremely rare and the overall mortality rate was near 0.2%. 2,4,8 Periprocedural planning based on a comprehensive review of the clinical records and imaging studies can minimize the complications. lines have yet to be established.…”

“…3 In spite of the safety, the indication is based on the risk-benefit analysis for patient management and in balancing complications and benefits of diagnostic yield. 4,5 Most reported bleeding events after EUS-FNA occurred within a few days. Delayed hemorrhage associated with iatrogenic pancreatic pseudoaneurysm after EUS-FNA was not reported until recently to our knowledge.…”

The Challenging Diagnosis of Pancreatic Masses: Not All Tumors Are Cancers

“…In the elderly, the identification of pancreatic masses is usually considered sufficient for the diagnosis of pancreatic cancer and therefore only palliative and supportive care is prescribed. According to several guidelines [ 1 , 2 ], fine needle ago-biopsy is recommended only for patients with unresectable lesions to confirm the diagnosis and aid in decision-making regarding chemotherapy and radiation therapy. Therefore, in aged patients the risk-benefit assessment of this procedure and the lack of chemotherapy indications generally preclude any invasive biopsies.…”

Endoscopic ultrasound (EUS) guided fine needle biopsy (FNB) with the Procore™ needle provides inadequate material for the histological diagnosis of early chronic pancreatitis

“…A histological grading of pancreatic inflammation and fibrosis has the additional potential benefit of being used as an endpoint in future therapeutic trials. The implementation of tissue acquisition via EUS in solid pancreatic lesions has had a major impact on the diagnosis and subsequent management of pancreatic cancer (8)(9)(10)(11)(12). Moreover, EUS-guided fine needle aspiration (FNA) or biopsy (FNB) is safe and reliable (13)(14)(15).…”