VALUE OF ENDOSCOPIC ULTRASOUND GUIDED FINE NEEDLE ASPIRATION (FNA) IN THE DIAGNOSIS OF SOLID PANCREATIC MASSES

Aims To determine the performance of endoscopic ultrasound guided FNA of solid pancreatic tumors.

Methods A Retrospective study, over a period of 3 years, included all patients who had FNA of pancreatic solid masses. Endoscopic ultrasound guided FNA was performed under sedation, using fine needle of 22G or 19G, depending on the location of pancreatic masses. The techniques used were Slow Pull and aspiration (10-20cc). The samples were spread on slides and/or put in cytolytã. Number of passage during all the procedure was three, except if it was a hemorrhagic specimen.

Results Sixty-one patients were included, 64% (n = 39) had solid masses of pancreas. Mean age was 61 years (31-87) with a male predominance of 64%. The location of the mass was cephalic (n = 20), uncinate (n = 8), isthmus (n = 1), corporeal (n = 6), corporeo-caudal (n = 4). The average number of passage by the fine needle was 2.54. Histological findings (±immunostaining) were dominated by pancreatic adenocarcinoma in 53.8, undifferentiated tumor proliferation in 5.1%, atypical cells in 7.6%, one case (2.5%) of pseudopapillary and solid pancreatic tumor (TPPS), one case of pancreatic lymphoma, and one case of autoimmune pancreatitis .The sample was acellular in 20%. Only one case was hemorrhagic, and only one case had normal pancreatic tissue. No complication related to the procedure was observed.

Conclusions According to our study, endoscopic ultrasound guided fine needle aspiration (FNA) has a positive diagnosis in 80%. Patients with negative diagnosis required a second diagnostic method depending on the context (ultrasound-guided percutaneous biopsy, CT-guided biopsy or surgical biopsy) after discussion in a multidisciplinary team approach.