Search CDDW 2009 Abstracts
Return to Table of Contents
YIELD OF ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION IN PATIENTS PRESENTING WITH PANCREATIC ABNORMALITIES
P Kazemi, N Amiri, E Lam, J Telford, R EnnsUniversity of British Columbia, Vancouver, British Columbia
Aims: Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) is a relatively new method for acquiring tissue samples for cytological assessment. The objective of our study was to determine the safety, sensitivity, and specificity of EUS-FNA for detection of pancreatic malignancies.
Methods: Retrospective chart review was completed on all patients who underwent pancreatic EUS/FNA from 01/06-06/08 years. All procedures were performed by one of two echoendosonographers (EL, JT) under conscious sedation. All patients had prior radiological imaging that raised suspicion of a pancreatic neoplasm.
Results: Eighty five charts were reviewed by the time of abstract submission. Mean number of FNA samples obtained in each procedure was 2. Aspirations were performed using 22-gauge and 19-gauge needles in 75% and 25% of patients, respectively. Sixty-nine percent of the FNAs were done transduodenally, and 31% were performed transgastrically. The mean age at presentation was 64.5 (range 28-87, 62% male). Presenting symptoms were abdominal discomfort (44%), jaundice (32%) and weight loss (26%). Major diagnostic procedures prior to EUS/FNA included CT (88%), ERCP (44%), and abdominal U/S (39%). There were no complications following any of the EUS-FNA procedures. EUS identified a distinct mass in 64 patients. Of these, 5% were less than 1 cm, 67% were 1-3 cm, and 16% were above 3 cm. The size of the mass was not specified in 13%. Sixty percent of masses were detected in the pancreatic head, 13% in the uncinate, 13% in the body, 7% in the neck, and 7% in the tail. On cytological examination, 33% were determined as benign (class I), 12% as reactive (class II), 13% as suspicious for malignancy (class III), 4% as likely malignant (class IV), and 28% as malignant (class V). In 9 (11%) of samples, there was insufficient tissue for a diagnosis. The final diagnosis was based on surgical and/or clinical outcome. The final diagnosis was unknown in 31 patients. In the 54 with a known final diagnosis, 33 (61%) had a malignancy while 21 (39%) had a benign condition. Of the 33 patients with a malignancy, 25 had a positive FNA biopsy result (class III or higher), 6 had a benign/reactive biopsy result, and 2 had inadequate tissue. In those patients with a benign condition, 15 had a benign/reactive biopsy result while 5 had biopsies with insufficient tissue. Based on these results, the sensitivity, specificity, and the positive and negative predictive values were 75%, 100%, 100%, and 72%, respectively.
Conclusions: EUS-FNA is a safe, specific, and sensitive method for tissue diagnosis of patient with pancreatic lesions. Technical and procedural improvements may be needed to increase tissue yield and thus obtain higher sensitivities.