PANCREATIC MASSES: VALUE OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION IN CLINICAL PRACTICE

Background and aim:Management of patients with suspect pancreatic lesion is often difficult. The aim of this study is to retrospectively assess the accuracy and impact of EUS-FNA on clinical practice. Material and methods:All patients that had undergone EUS-FNA of suspect pancreatic mass from March 2009 to May 2011 were enrolled. The cytopathologist was not on site. Gold standard for final diagnosis included: histology from surgical resection and/or any clinical or radiological sign of progression in patients not operated. All treatments after EUS-FNA consistent with final diagnosis, such as surgical resection, chemotherapy, biliary drainage or prevention from unnecessary surgery were regarding as having positive impact on the treatment. Delayed treatment due to false-negative EUS-FNA was regarding as having negative impact on treatment. Results:74 patients underwent EUS-FNA with both 22- and 25- Gauge needles. In 55 of 74 cases (74%) FNA gave adequate samples for cytopathological diagnosis. Cytological diagnosis was malignant in 47 of 55 cases (85%) and benign in 8 of 55 cases (14%) The sensitivity, specificity and accuracy in diagnosing pancreatic cancer were 94% (95% CI: 83.44-98.74), 100% (95% CI: 39.76-100), and 93% (95% CI: 87.24-95.74), respectively. Positive and negative predictive values were 100% (95% CI: 92.45-100) and 57% (95% CI: 18.42-90.11) respectively. No complications occurred. EUS-FNA performed with 22 or 25 Gauge needles had the same diagnostic accuracy. Finally EUS-FNA had positive impact on subsequent treatment in 52 of 74 cases (70%), of whom 28 received chemotherapy, 10 biliary drainage with stent, 9 were considered operable and 5 had a negative diagnosis. 4 of 74 cases (5%) had negative impact. Conclusions:EUS-FNA is a safe practice with the accuracy of 93% and can have a positive impact on management of patients with suspected pancreatic mass in the 70% of cases. Because EUS-FNA has a low negative predictive value (57%) surgical exploration is recommended in high clinical suspicion for pancreatic cancer.