Background and aim:Tumors of pancreas are rare but serious disease with a poor prognosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an effective technique to obtain cytology and define diagnosis. The aim of this study is to evaluate the accuracy and impact of EUS-FNA in preoperative diagnosis of pancreatic tumors. Material and methods:We preoperatively performed EUS-FNA in 110 pts with pancreatic masses. All EUS-FNA cases were performed under sedation with propofol, employing 22-gauge and 25-gauge needles. The circular probe of the endoscope (Olympus GF UE 160) gave the first vision, the linear one (Olympus GF UTC 140 AL) monitored the puncture. For each lesion were performed two steps with the needle and about 15 movements forward-backward for every single puncture performed. The pathologist, who wasn’t onsite, obtained a sample for cytopathological diagnosis, in 30 minutes. Results:Of the 110 pts enrolled (March 2009-March 2012, ages 33–87 yrs, M/F ratio 1.1:1), we obtained a positive cytology in 71 pts, while in 9 pts cytology was negative. However, of these masses (59/71 advanced cancer, 12/71 non-advanced cancer), 67 were ductal adenocarcinoma, 4 were cystic neoplasms. Despite the operator experience, 30 samples were nondiagnostic. The sensitivity, specificity, accuracy in diagnosis were 95% (95% CI: 88.59–99.16), 100% (95% CI: 47.83–100), 94%, respectively. The accuracy was 63% (35/55) and 80% (44/55) for the samples obtained with the 22 and 25-gauge needle, respectively (p=0.056). Furthermore, positive (PPV) and negative predictive value (NPV) were 100% and 62%, respectively. Conclusions:Our study showed that a positive cytology can be obtained in 74% of cases. All pts have undergone EUS-FNA without complication. The cytological diagnosis allowed to refer patients to surgical or medical therapy, as the case. EUS-FNA is an accurate tool in investigating pancreatic masses (accuracy=94%), is specific, sensitive, but since it has a low NPV requires histological confirmation when there is a strong clinical suspicion.

ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION ROLE IN PREOPERATIVE DIAGNOSIS OF PANCREATIC TUMORS

R. Catanzaro;GIANGRECO, EMILIANO;F. Palermo;MANGIAFICO, SANTI;ALBERGHINA, NADIA;G. Bonanno
2013

Abstract

Background and aim:Tumors of pancreas are rare but serious disease with a poor prognosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an effective technique to obtain cytology and define diagnosis. The aim of this study is to evaluate the accuracy and impact of EUS-FNA in preoperative diagnosis of pancreatic tumors. Material and methods:We preoperatively performed EUS-FNA in 110 pts with pancreatic masses. All EUS-FNA cases were performed under sedation with propofol, employing 22-gauge and 25-gauge needles. The circular probe of the endoscope (Olympus GF UE 160) gave the first vision, the linear one (Olympus GF UTC 140 AL) monitored the puncture. For each lesion were performed two steps with the needle and about 15 movements forward-backward for every single puncture performed. The pathologist, who wasn’t onsite, obtained a sample for cytopathological diagnosis, in 30 minutes. Results:Of the 110 pts enrolled (March 2009-March 2012, ages 33–87 yrs, M/F ratio 1.1:1), we obtained a positive cytology in 71 pts, while in 9 pts cytology was negative. However, of these masses (59/71 advanced cancer, 12/71 non-advanced cancer), 67 were ductal adenocarcinoma, 4 were cystic neoplasms. Despite the operator experience, 30 samples were nondiagnostic. The sensitivity, specificity, accuracy in diagnosis were 95% (95% CI: 88.59–99.16), 100% (95% CI: 47.83–100), 94%, respectively. The accuracy was 63% (35/55) and 80% (44/55) for the samples obtained with the 22 and 25-gauge needle, respectively (p=0.056). Furthermore, positive (PPV) and negative predictive value (NPV) were 100% and 62%, respectively. Conclusions:Our study showed that a positive cytology can be obtained in 74% of cases. All pts have undergone EUS-FNA without complication. The cytological diagnosis allowed to refer patients to surgical or medical therapy, as the case. EUS-FNA is an accurate tool in investigating pancreatic masses (accuracy=94%), is specific, sensitive, but since it has a low NPV requires histological confirmation when there is a strong clinical suspicion.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/363621
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