Faming Zhang, Vivek Kumbhari, Alan H Tieu, Mohamad H El Zein, Ahmed A Messallam,Vikesh K Singh, Anne Marie Lennon, Marcia I Canto, Anthony N Kalloo, Mouen A Khashab
Background and study aims There is no consensus on how to manage patients with a high probability of pancreatic cancer, based on their clinical presentation and imaging, but have a non-diagnostic endoscopic ultrasound - fine needle aspiration. Our aim was to evaluate the yield of a single or if necessary multiple endoscopic ultrasound - fine needle aspiration procedures for the cytological diagnosis of a pancreatic mass. Patients and methods Retrospective review of patients undergoing endoscopic ultrasound - fine needle aspiration for the evaluation of a pancreatic mass at an academic tertiary-care center. The cytological diagnosis for each procedure was classified as either “diagnostic” or “non-diagnostic.” Our protocol was to perform repeat endoscopic ultrasound - fine needle aspiration until a diagnostic result was obtained up to a maximum of 3 procedures. The final diagnosis was established on review of their cytopathology, clinical progression and/or surgical pathology. Results Between 2006 and 2010 there were 241 patients who underwent 288 endoscopic ultrasound - fine needle aspiration. Repeat procedures were undertaken in 43 (17.8%). The sensitivity of the initial endoscopic ultrasound - fine needle aspiration was 74.1%, which increased to 86.9% if repeat procedures were included. Pancreatic adenocarcinoma was the final diagnosis in 87.6% of patients. Inadvertent resection of benign lesions occurred in 6 (2.5%). On multivariate analysis, age >65 (OR 2.8, p=0.008) was the sole independent predictor of a diagnostic specimen. The operating characteristics of the first and repeated endoscopic ultrasound - fine needle aspiration were not significantly different. Conclusions Repeat endoscopic ultrasound - fine needle aspiration is appropriate in patients with an initial non-diagnostic result. Further investigation is required to determine techniques in which the diagnostic yield can be increased at the subsequent procedure.
