A prospective evaluation of EUS guided fine needle aspiration (FNA) biopsy for diagnosing pancreatic masses (PM) with comparison to CT and ERCP cytology

F. Gress, R. Hawes, S. Ikenberry, T. Savides, Stuart Sherman, Glen Lehman

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Abstract

INTRODUCTION: EUS-guided FNA has been reported to be an accurate modality for obtaining tissue diagnosis of suspicious PM. There is currently no data comparing the diagnostic accuracy of EUS guided FNA to other current methods used to diagnose these masses, including CT guided FNA and ERCP cytology. AIMS OF THE STUDY: To prospectively assess the diagnostic accuracy of EUS guided FNA for PM in patients with a negative CT FNA and/or ERCP cytology. METHODS: We prospectively studied patients with suspected PM in whom a CT or an ERCP suggested a mass, however all cytology was negative. EUS was initially performed to evaluate the PM with either radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) endosonography followed by EUS-guided FNA with one of these instruments. Data was collected with regards to diagnostic accuracy, number of passes, cytology results and complications. EUS FNA was performed using either a 23-gauge 4 cm needle (Wilson-Cooke, Winston-Salem, NC) or a 22-gauge 10 cm needle (GIP/Mediglobe, Tempe, AZ). RESULTS: 102 patients underwent EUS-guided FNA of suspicious PM. The mean size of these masses was 3.4 × 3.3 cm and the mean # of passes was 3.4 (range=2 - 9), 30% (30/102 patients) went to surgery and allowed for correlation to pathology. There were 4 false negatives in the EUS FNA group that went to surgery with 3 of these showing only chronic pancreatitis on EUS FNA; however, at surgery there was evidence of malignancy in a small focus of the resected pancreas. The overall diagnostic accuracy of EUS FNA was 81% (83/102). EUS FNA was positive in 57 lesions and 25 were confirmed malignant at surgery. Benign lesions were verified by surgical path or long-term follow up with a mean of 13 months (range 5 months to 24 months). There were three patient-related complications noted in this study: bleeding occurred in two patients and pancreatitis following EUS FNA developed in one patient. Our overall complication rate was 2.9% (3/102). EUS FNA sensitivity was 90% and specificity 100%. EUS FNA provided a positive cytologie diagnosis in 83/102 suspicious PM with negative CT FNA or ERCP cytology. SUMMARY: EUS FNA was successful in diagnosing PM in 81% of patients when ERCP cytology and CT FNA were negative. CONCLUSIONS: 1) EUS in conjunction with FNA is an accurate means of evaluating PM when CT FNA or ERCP cytology is negative and appears to be an effective method of diagnosing and staging pancreatic malignancies. 2) The presence of chronic pancreatitis appears to negatively affect the diagnostic accuracy of EUS FNA 3). EUS with FNA appears to be an effective method of diagnosing and staging pancreatic malignancies.

Original languageEnglish
Pages (from-to)422
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996

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Endoscopic Retrograde Cholangiopancreatography
Fine Needle Biopsy
Cell Biology
Chronic Pancreatitis
Needles
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

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A prospective evaluation of EUS guided fine needle aspiration (FNA) biopsy for diagnosing pancreatic masses (PM) with comparison to CT and ERCP cytology. / Gress, F.; Hawes, R.; Ikenberry, S.; Savides, T.; Sherman, Stuart; Lehman, Glen.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 422.

Research output: Contribution to journalArticle

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title = "A prospective evaluation of EUS guided fine needle aspiration (FNA) biopsy for diagnosing pancreatic masses (PM) with comparison to CT and ERCP cytology",
abstract = "INTRODUCTION: EUS-guided FNA has been reported to be an accurate modality for obtaining tissue diagnosis of suspicious PM. There is currently no data comparing the diagnostic accuracy of EUS guided FNA to other current methods used to diagnose these masses, including CT guided FNA and ERCP cytology. AIMS OF THE STUDY: To prospectively assess the diagnostic accuracy of EUS guided FNA for PM in patients with a negative CT FNA and/or ERCP cytology. METHODS: We prospectively studied patients with suspected PM in whom a CT or an ERCP suggested a mass, however all cytology was negative. EUS was initially performed to evaluate the PM with either radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) endosonography followed by EUS-guided FNA with one of these instruments. Data was collected with regards to diagnostic accuracy, number of passes, cytology results and complications. EUS FNA was performed using either a 23-gauge 4 cm needle (Wilson-Cooke, Winston-Salem, NC) or a 22-gauge 10 cm needle (GIP/Mediglobe, Tempe, AZ). RESULTS: 102 patients underwent EUS-guided FNA of suspicious PM. The mean size of these masses was 3.4 × 3.3 cm and the mean # of passes was 3.4 (range=2 - 9), 30{\%} (30/102 patients) went to surgery and allowed for correlation to pathology. There were 4 false negatives in the EUS FNA group that went to surgery with 3 of these showing only chronic pancreatitis on EUS FNA; however, at surgery there was evidence of malignancy in a small focus of the resected pancreas. The overall diagnostic accuracy of EUS FNA was 81{\%} (83/102). EUS FNA was positive in 57 lesions and 25 were confirmed malignant at surgery. Benign lesions were verified by surgical path or long-term follow up with a mean of 13 months (range 5 months to 24 months). There were three patient-related complications noted in this study: bleeding occurred in two patients and pancreatitis following EUS FNA developed in one patient. Our overall complication rate was 2.9{\%} (3/102). EUS FNA sensitivity was 90{\%} and specificity 100{\%}. EUS FNA provided a positive cytologie diagnosis in 83/102 suspicious PM with negative CT FNA or ERCP cytology. SUMMARY: EUS FNA was successful in diagnosing PM in 81{\%} of patients when ERCP cytology and CT FNA were negative. CONCLUSIONS: 1) EUS in conjunction with FNA is an accurate means of evaluating PM when CT FNA or ERCP cytology is negative and appears to be an effective method of diagnosing and staging pancreatic malignancies. 2) The presence of chronic pancreatitis appears to negatively affect the diagnostic accuracy of EUS FNA 3). EUS with FNA appears to be an effective method of diagnosing and staging pancreatic malignancies.",
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T1 - A prospective evaluation of EUS guided fine needle aspiration (FNA) biopsy for diagnosing pancreatic masses (PM) with comparison to CT and ERCP cytology

AU - Gress, F.

AU - Hawes, R.

AU - Ikenberry, S.

AU - Savides, T.

AU - Sherman, Stuart

AU - Lehman, Glen

PY - 1996

Y1 - 1996

N2 - INTRODUCTION: EUS-guided FNA has been reported to be an accurate modality for obtaining tissue diagnosis of suspicious PM. There is currently no data comparing the diagnostic accuracy of EUS guided FNA to other current methods used to diagnose these masses, including CT guided FNA and ERCP cytology. AIMS OF THE STUDY: To prospectively assess the diagnostic accuracy of EUS guided FNA for PM in patients with a negative CT FNA and/or ERCP cytology. METHODS: We prospectively studied patients with suspected PM in whom a CT or an ERCP suggested a mass, however all cytology was negative. EUS was initially performed to evaluate the PM with either radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) endosonography followed by EUS-guided FNA with one of these instruments. Data was collected with regards to diagnostic accuracy, number of passes, cytology results and complications. EUS FNA was performed using either a 23-gauge 4 cm needle (Wilson-Cooke, Winston-Salem, NC) or a 22-gauge 10 cm needle (GIP/Mediglobe, Tempe, AZ). RESULTS: 102 patients underwent EUS-guided FNA of suspicious PM. The mean size of these masses was 3.4 × 3.3 cm and the mean # of passes was 3.4 (range=2 - 9), 30% (30/102 patients) went to surgery and allowed for correlation to pathology. There were 4 false negatives in the EUS FNA group that went to surgery with 3 of these showing only chronic pancreatitis on EUS FNA; however, at surgery there was evidence of malignancy in a small focus of the resected pancreas. The overall diagnostic accuracy of EUS FNA was 81% (83/102). EUS FNA was positive in 57 lesions and 25 were confirmed malignant at surgery. Benign lesions were verified by surgical path or long-term follow up with a mean of 13 months (range 5 months to 24 months). There were three patient-related complications noted in this study: bleeding occurred in two patients and pancreatitis following EUS FNA developed in one patient. Our overall complication rate was 2.9% (3/102). EUS FNA sensitivity was 90% and specificity 100%. EUS FNA provided a positive cytologie diagnosis in 83/102 suspicious PM with negative CT FNA or ERCP cytology. SUMMARY: EUS FNA was successful in diagnosing PM in 81% of patients when ERCP cytology and CT FNA were negative. CONCLUSIONS: 1) EUS in conjunction with FNA is an accurate means of evaluating PM when CT FNA or ERCP cytology is negative and appears to be an effective method of diagnosing and staging pancreatic malignancies. 2) The presence of chronic pancreatitis appears to negatively affect the diagnostic accuracy of EUS FNA 3). EUS with FNA appears to be an effective method of diagnosing and staging pancreatic malignancies.

AB - INTRODUCTION: EUS-guided FNA has been reported to be an accurate modality for obtaining tissue diagnosis of suspicious PM. There is currently no data comparing the diagnostic accuracy of EUS guided FNA to other current methods used to diagnose these masses, including CT guided FNA and ERCP cytology. AIMS OF THE STUDY: To prospectively assess the diagnostic accuracy of EUS guided FNA for PM in patients with a negative CT FNA and/or ERCP cytology. METHODS: We prospectively studied patients with suspected PM in whom a CT or an ERCP suggested a mass, however all cytology was negative. EUS was initially performed to evaluate the PM with either radial scanning (UM20, Olympus, Melville, NY) or linear array (FG32UA, Pentax, Orangeburg, NY) endosonography followed by EUS-guided FNA with one of these instruments. Data was collected with regards to diagnostic accuracy, number of passes, cytology results and complications. EUS FNA was performed using either a 23-gauge 4 cm needle (Wilson-Cooke, Winston-Salem, NC) or a 22-gauge 10 cm needle (GIP/Mediglobe, Tempe, AZ). RESULTS: 102 patients underwent EUS-guided FNA of suspicious PM. The mean size of these masses was 3.4 × 3.3 cm and the mean # of passes was 3.4 (range=2 - 9), 30% (30/102 patients) went to surgery and allowed for correlation to pathology. There were 4 false negatives in the EUS FNA group that went to surgery with 3 of these showing only chronic pancreatitis on EUS FNA; however, at surgery there was evidence of malignancy in a small focus of the resected pancreas. The overall diagnostic accuracy of EUS FNA was 81% (83/102). EUS FNA was positive in 57 lesions and 25 were confirmed malignant at surgery. Benign lesions were verified by surgical path or long-term follow up with a mean of 13 months (range 5 months to 24 months). There were three patient-related complications noted in this study: bleeding occurred in two patients and pancreatitis following EUS FNA developed in one patient. Our overall complication rate was 2.9% (3/102). EUS FNA sensitivity was 90% and specificity 100%. EUS FNA provided a positive cytologie diagnosis in 83/102 suspicious PM with negative CT FNA or ERCP cytology. SUMMARY: EUS FNA was successful in diagnosing PM in 81% of patients when ERCP cytology and CT FNA were negative. CONCLUSIONS: 1) EUS in conjunction with FNA is an accurate means of evaluating PM when CT FNA or ERCP cytology is negative and appears to be an effective method of diagnosing and staging pancreatic malignancies. 2) The presence of chronic pancreatitis appears to negatively affect the diagnostic accuracy of EUS FNA 3). EUS with FNA appears to be an effective method of diagnosing and staging pancreatic malignancies.

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