Endoscopic ultrasound-guided fine-needle aspiration of the pancreas: A retrospective study of 1000 cases

Ashley A. Ibrahim, Harvey M. Cramer, Howard H. Wu

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3 Citations (Scopus)

Abstract

Introduction: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has emerged as a superior method for the diagnosis of pancreatic tumors. Very few large studies have been published. We retrospectively examined 1000 cases to determine the sensitivity and specificity of EUS-guided FNA for solid and cystic lesions. Materials and methods: EUS-guided FNA was performed in 1000 patients. Air-dried aspirates were reviewed immediately to ensure adequacy, and ethanol-fixed aspirates were reviewed the following day. The rendered diagnoses were placed into various categories and compared to subsequent histologic and clinical follow-up data. Results: Of the 1000 cases, 579 were solid lesions. The FNA diagnoses of the solid lesions were benign (B) 229 (39.5%), atypia (A) 22 (3.8%), suspicious (S) 27 (4.7%), malignant (M) 260 (44.9%), tumor (T) 1 (0.2%), and nondiagnostic (ND) 40 (6.9%). The sensitivity, specificity, positive predictive value, and negative predictive value for solid lesions were 97%, 97%, 99%, and 94%, respectively. There were 421 cystic lesions. The FNAs of the cystic lesions were classified as follows: B 342 (81.2%), A 5 (1.2%), S 4 (1%), M 7 (1.7%), T 46 (10.9%), and ND 17 (4.0%). The sensitivity, specificity, positive predictive value, and negative predictive value to identify mucinous tumors and malignancy for cystic lesions were 46%, 98%, 94%, and 87%, respectively. Conclusions: At our institution, EUS-guided FNA of solid pancreatic lesions is both sensitive and specific for the diagnosis of both primary and metastatic tumors. For cystic lesions, FNA is not as sensitive, but its specificity remains high.

Original languageEnglish (US)
Pages (from-to)227-235
Number of pages9
JournalJournal of the American Society of Cytopathology
Volume3
Issue number5
DOIs
StatePublished - Sep 1 2014

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreas
Retrospective Studies
Neoplasms
Fine Needle Biopsy
Sensitivity and Specificity
Ethanol
Air

Keywords

  • Cystic neoplasms
  • Endoscopic ultrasound
  • Fine-needle aspiration
  • Pancreas
  • Solid neoplasms

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

@article{a5990fd789604c92af35cf00dd6227ba,
title = "Endoscopic ultrasound-guided fine-needle aspiration of the pancreas: A retrospective study of 1000 cases",
abstract = "Introduction: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has emerged as a superior method for the diagnosis of pancreatic tumors. Very few large studies have been published. We retrospectively examined 1000 cases to determine the sensitivity and specificity of EUS-guided FNA for solid and cystic lesions. Materials and methods: EUS-guided FNA was performed in 1000 patients. Air-dried aspirates were reviewed immediately to ensure adequacy, and ethanol-fixed aspirates were reviewed the following day. The rendered diagnoses were placed into various categories and compared to subsequent histologic and clinical follow-up data. Results: Of the 1000 cases, 579 were solid lesions. The FNA diagnoses of the solid lesions were benign (B) 229 (39.5{\%}), atypia (A) 22 (3.8{\%}), suspicious (S) 27 (4.7{\%}), malignant (M) 260 (44.9{\%}), tumor (T) 1 (0.2{\%}), and nondiagnostic (ND) 40 (6.9{\%}). The sensitivity, specificity, positive predictive value, and negative predictive value for solid lesions were 97{\%}, 97{\%}, 99{\%}, and 94{\%}, respectively. There were 421 cystic lesions. The FNAs of the cystic lesions were classified as follows: B 342 (81.2{\%}), A 5 (1.2{\%}), S 4 (1{\%}), M 7 (1.7{\%}), T 46 (10.9{\%}), and ND 17 (4.0{\%}). The sensitivity, specificity, positive predictive value, and negative predictive value to identify mucinous tumors and malignancy for cystic lesions were 46{\%}, 98{\%}, 94{\%}, and 87{\%}, respectively. Conclusions: At our institution, EUS-guided FNA of solid pancreatic lesions is both sensitive and specific for the diagnosis of both primary and metastatic tumors. For cystic lesions, FNA is not as sensitive, but its specificity remains high.",
keywords = "Cystic neoplasms, Endoscopic ultrasound, Fine-needle aspiration, Pancreas, Solid neoplasms",
author = "Ibrahim, {Ashley A.} and Cramer, {Harvey M.} and Wu, {Howard H.}",
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doi = "10.1016/j.jasc.2014.04.005",
language = "English (US)",
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TY - JOUR

T1 - Endoscopic ultrasound-guided fine-needle aspiration of the pancreas

T2 - A retrospective study of 1000 cases

AU - Ibrahim, Ashley A.

AU - Cramer, Harvey M.

AU - Wu, Howard H.

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Introduction: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has emerged as a superior method for the diagnosis of pancreatic tumors. Very few large studies have been published. We retrospectively examined 1000 cases to determine the sensitivity and specificity of EUS-guided FNA for solid and cystic lesions. Materials and methods: EUS-guided FNA was performed in 1000 patients. Air-dried aspirates were reviewed immediately to ensure adequacy, and ethanol-fixed aspirates were reviewed the following day. The rendered diagnoses were placed into various categories and compared to subsequent histologic and clinical follow-up data. Results: Of the 1000 cases, 579 were solid lesions. The FNA diagnoses of the solid lesions were benign (B) 229 (39.5%), atypia (A) 22 (3.8%), suspicious (S) 27 (4.7%), malignant (M) 260 (44.9%), tumor (T) 1 (0.2%), and nondiagnostic (ND) 40 (6.9%). The sensitivity, specificity, positive predictive value, and negative predictive value for solid lesions were 97%, 97%, 99%, and 94%, respectively. There were 421 cystic lesions. The FNAs of the cystic lesions were classified as follows: B 342 (81.2%), A 5 (1.2%), S 4 (1%), M 7 (1.7%), T 46 (10.9%), and ND 17 (4.0%). The sensitivity, specificity, positive predictive value, and negative predictive value to identify mucinous tumors and malignancy for cystic lesions were 46%, 98%, 94%, and 87%, respectively. Conclusions: At our institution, EUS-guided FNA of solid pancreatic lesions is both sensitive and specific for the diagnosis of both primary and metastatic tumors. For cystic lesions, FNA is not as sensitive, but its specificity remains high.

AB - Introduction: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has emerged as a superior method for the diagnosis of pancreatic tumors. Very few large studies have been published. We retrospectively examined 1000 cases to determine the sensitivity and specificity of EUS-guided FNA for solid and cystic lesions. Materials and methods: EUS-guided FNA was performed in 1000 patients. Air-dried aspirates were reviewed immediately to ensure adequacy, and ethanol-fixed aspirates were reviewed the following day. The rendered diagnoses were placed into various categories and compared to subsequent histologic and clinical follow-up data. Results: Of the 1000 cases, 579 were solid lesions. The FNA diagnoses of the solid lesions were benign (B) 229 (39.5%), atypia (A) 22 (3.8%), suspicious (S) 27 (4.7%), malignant (M) 260 (44.9%), tumor (T) 1 (0.2%), and nondiagnostic (ND) 40 (6.9%). The sensitivity, specificity, positive predictive value, and negative predictive value for solid lesions were 97%, 97%, 99%, and 94%, respectively. There were 421 cystic lesions. The FNAs of the cystic lesions were classified as follows: B 342 (81.2%), A 5 (1.2%), S 4 (1%), M 7 (1.7%), T 46 (10.9%), and ND 17 (4.0%). The sensitivity, specificity, positive predictive value, and negative predictive value to identify mucinous tumors and malignancy for cystic lesions were 46%, 98%, 94%, and 87%, respectively. Conclusions: At our institution, EUS-guided FNA of solid pancreatic lesions is both sensitive and specific for the diagnosis of both primary and metastatic tumors. For cystic lesions, FNA is not as sensitive, but its specificity remains high.

KW - Cystic neoplasms

KW - Endoscopic ultrasound

KW - Fine-needle aspiration

KW - Pancreas

KW - Solid neoplasms

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U2 - 10.1016/j.jasc.2014.04.005

DO - 10.1016/j.jasc.2014.04.005

M3 - Article

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VL - 3

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EP - 235

JO - Journal of the American Society of Cytopathology

JF - Journal of the American Society of Cytopathology

SN - 2213-2945

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