Endosonography-guided fine needle aspiration biopsy of solid pancreatic masses – accuracy and impact on the treatment of 358 patients

Czech version

Authors: M. Kliment ^1,2; O. Urban ^1,2; M. Loveček ³; M. Straka ⁴; D. Žiak ⁵; P. Falt ^1,2; P. Fojtík; J. Dvořáčková ^6,2
Authors‘ workplace: Vzdělávací a výzkumný institut AGEL, o. p. s., Vítkovická nemocnice a. s., Centrum péče o zažívací trakt, Ostrava ¹; Lékařská fakulta Ostravské univerzity v Ostravě ²; Chirurgická klinika, FN Olomouc ³; Chirurgické oddělení, Onkologické centrum J. G. Mendela, Nový Jičín ⁴; CGB Laboratoř, Patologie, FN Ostrava Ústav patologie, FN Ostrava ⁵; Ústav patologie, FN Ostrava ⁶
Published in: Gastroent Hepatol 2013; 67(5): 431-437
Category: Digestive Endoscopy: Original Article

Overview

The aim of our study
was to evaluate the accuracy, safety and benefit of EUS-FNA in diagnosing and treating patients with unclear solid pancreatic mass. Diagnostic accuracy of EUS-FNA was evaluated through the comparison of EUS-FNA cytology with either histology of rescted specimen or clinical and radiological follow-up. The benefit was defined as impact of EUS-FNA cytology on subsequent treatment. In a cohort of 358 patients with a solid pancreatic mass, the sensitivity and specificity of EUS-FNA in diagnosing pancreatic cancer was 93% (95% CI: 89.2–95.6) and 90.1% (95% CI: 80.1–95.6), respectively. Complications ocured in 2.2% of patients. False-negative cytology was less frequent in EUS-FNA with rapid on-site cytopathology evaluation (ROSE) compared with EUS-FNA without ROSE (3.9% vs 14.3%; p = 0.006). The positive and negative impact of EUS-FNA on subsequent treatment was observed in 63.9% and 0.5% of patients, respectively. In 3.4% of patients with pancreatic cancer, EUS-FNA diagnosed either subtle malignant ascites or liver metastases (mean ± SD: 8,9 ± 3,5 mm), that were not detected on previous contrast-enhanced CT scans. We have confirmed that EUS-FNA is accuarate and safe method in diagnosing pancreas carcinoma and has positive impact on subsequent treatment in 2/3 of patients with unclear solid pancreatic mass. ROSE significantly increases the accuracy of the method.

Key words:
endosonography – fine needle aspiration biopsy – pancreatic mass – pancreas carcinoma

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
19. 8. 2013

Accepted:
16. 9. 2013

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