Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) Biopsy of Solid Pancreatic Lesions: Review of 681 Cases
Guoping Cai, Berrin Ustun, Ahmed Alomari, Gillian H Levy, Malini Harigopal, Harry R Aslanian, Uzma Siddiqui, David Chhieng. Yale University School of Medicine, New Haven, CT
Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy is increasingly used in the diagnosis of pancreatic lesions. Although EUS-FNA has a high specificity in diagnosing malignancy, the reported sensitivity is variable. FNA diagnosis can be achieved by cytomorphologic evaluation alone but ancillary studies may be needed in some cases. Rapid on-site evaluation helps ensure adequate sampling appropriate specimen triage, thus enhancing diagnostic performance. In this study, we retrospectively reviewed our experience in diagnosing solid pancreatic lesions via EUS-FNA biopsy.
Design: The electronic database of cytopathology was searched for pancreatic lesions diagnosed by EUS-FNA during the period from January 2005 to June 2011. We identified 1,143 cases, of which 681 were solid lesions. The final cytology diagnoses included non-diagnostic, negative, indeterminate (atypical and suspicious), neoplasm, and malignant (primary or metastatic). Most cases had rapid on-site evaluation performed. Histopathologic follow-up was available for comparison in 151 cases (22%).
Results: Of 681 cases, 23 cases (3%) were non-diagnostic. Negative, indeterminate, neoplastic, and malignant diagnoses were rendered in 115 (17%), 59 (9%), 58 (9%), and 426 (62%), respectively. Cytologic diagnoses and histopathologic follow-ups were compared in 151 cases (see Table 1). The overall concordance rate for negative, neoplastic and malignant diagnoses was 92%. One of 93 cases that were cytologically diagnosed as malignant showed autoimmune pancreatitis in the follow-up. Neoplastic or malignant diagnosis was seen in 6 of 11 cases that had a negative cytological diagnosis. The calculated sensitivity, specificity, positive predictive value, and negative predictive value were 95%, 83%, 99%, and 45%.
|Cytologic Diagnosis||n||Negative||Benign Neoplasm||Malignant|
|Negative||11||5 (46%)||2 (18%)||4 (36%)|
|Indeterminate||23||3 (13%)||2 (9%)||18 (78%)|
|Neoplasm||22||0||19 (86%)||3 (14%)|
|Malignant||93||1 (1%)||0||92 (99%)|
|Total||151||11 (7%)||23 (15%)||117 (78%)|