PANCREATIC SOLID MASSES: SHOULD WE USE ENDOSCOPIC ULTRASOUND FINE-NEEDLE ASPIRATION WITHOUT RAPID ONSITE EVALUATION?

Aims Current ESGE guideline recommends fine-needle aspiration (FNA) and biopsy (FNB) equally for sampling of solid pancreatic masses, however, suggests FNB needles when rapid onsite evaluation (ROSE) is not available. We aimed to compare diagnostic accuracy of cytology, cellblock and both of samples obtained by FNA in the absence of ROSE.

Methods Retrospective cohort study including consecutive patients submitted to EUS-FNA of pancreatic solid lesions at an oncology centre between January/2006 and October(2021. Data were collected from electronic medical reports. Final diagnosis was based on surgical pathology or clinical follow-up. Patients with cytology and cellblock specimen considered ‘insufficient for diagnosis’ were excluded (n=12).

Results A total of 177 patients were included [median age: 67 (17-83) years, male:107 (61%)]. Most lesions were located at the pancreatic head 58 (33%) and body 57 (32%). The median size was 32.5 (7.7-103) mm. Most lesions were adenocarcinoma [71 (40%)] and neuroendocrine tumours [36 (20%)]. Sensitivity, specificity, positive and negative predictive values and accuracy, for the diagnosis of malignancy were 96%, 87%, 99%, 68% and 91% for cytology; 95%, 77%, 97%, 68% and 87% for cellblock and 98%, 87%, 99%, 81% and 93% for both, respectively. Diagnostic accuracy was higher for a number of passes superior to 3 (93% vs. 91%, P=0.04). No difference was found between needle sizes (P=0.59).

Conclusions Combined cytological and histological analysis for diagnosing pancreatic solid lesions increases the diagnostic yield of conventional EUS-FNA without ROSE. This combined analysis exceeds the target standard for tissue sampling during EUS-FNA.

Publication History

Article published online:
14 April 2022