Safety and effectiveness for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic solid and/or cystic lesions

Background: The pathological diagnosis of pancreatic tumors is important to ensure that proper treatment is given and the optimum prognosis is achieved. EUS-FNA is currently the standard method for tissue acquisition and pathological diagnosis of pancreatic mass lesions. The diagnostic yield of pancreatic EUS-FNA has been reported to exhibit a sensitivity of 54%-96% with high specificity and diagnostic accuracy of 83%-95%. However, it occasionally causes serious complications, and factors that increase the susceptibility to such adverse events remain unknown. Method: This single-center retrospective study included 74 consecutive patients with pancreatic solid or cystic lesions who underwent EUS-FNA procedures from Jan 2013 to Jan 2015. The inclusion criteria were: the presence of solid and/or cystic pancreatic masses revealed by computed tomography (CT) and/or MRI and EUS. The mean age of pts: 66yrs (37 – 91 y), 29 male, 45 female. The lesions located of pancreatic head 83.8% (62 pts), and pancreatic body or tail in 16.2% (12 pts). The mean tumor-size was 32 mm (10 – 65 mm), cystic vs. solid lesion in 23% (17 pts) – 77% (57 pts). We registered all patients undergoing EUS-FNA with a standard 22 G (85%) and 19 G (15%) needle. Retrospectively analized the sensitivity and specificity of FNA and the presence/absence of post-procedural adverse events. Result: The cytological diagnosis were C 2 – 3 in 32 pts, C 4 – 5 in 42 pts. The final clinical (surgical) diagnosis was chronic pancreatitis by 15/74 pts. The remained 59 pts had malignant disease. The sensitivity of cytological diagnosis was 71.2% and specificity 82.8%. The incidence of post-procedural adverse events, including moderate to mild pancreatitis, mild abdominal pain, and mild bleeding, was 4%. Conclusion: EUS-FNA provides an accurate preoperative diagnosis of pancreatic tumors, compared to other imaging modalities, with a dignostic accuracy of 75 – 95%. Major complications of EUS-FNA are rare but can include pancreatitis, bleeding, and post procedural pain.