Endosonography-guided fine needle aspiration biopsy of solid pancreatic masses – accuracy and impact on the treatment of 358 patients

Czech version

Authors: M. Kliment ^1,2; O. Urban ^1,2; M. Loveček ³; M. Straka ⁴; D. Žiak ⁵; Přemysl Falt ^1,2; P. Fojtík; J. Dvořáčková ^6,2
Authors‘ workplace: Vzdělávací a výzkumný institut AGEL, o. p. s., Vítkovická nemocnice a. s., Centrum péče o zažívací trakt, Ostrava ¹; Lékařská fakulta Ostravské univerzity v Ostravě ²; Chirurgická klinika, FN Olomouc ³; Chirurgické oddělení, Onkologické centrum J. G. Mendela, Nový Jičín ⁴; CGB Laboratoř, Patologie, FN Ostrava Ústav patologie, FN Ostrava ⁵; Ústav patologie, FN Ostrava ⁶
Published in: Gastroent Hepatol 2013; 67(5): 431-437
Category: Digestive Endoscopy: Original Article

Overview

The aim of our study
was to evaluate the accuracy, safety and benefit of EUS-FNA in diagnosing and treating patients with unclear solid pancreatic mass. Diagnostic accuracy of EUS-FNA was evaluated through the comparison of EUS-FNA cytology with either histology of rescted specimen or clinical and radiological follow-up. The benefit was defined as impact of EUS-FNA cytology on subsequent treatment. In a cohort of 358 patients with a solid pancreatic mass, the sensitivity and specificity of EUS-FNA in diagnosing pancreatic cancer was 93% (95% CI: 89.2–95.6) and 90.1% (95% CI: 80.1–95.6), respectively. Complications ocured in 2.2% of patients. False-negative cytology was less frequent in EUS-FNA with rapid on-site cytopathology evaluation (ROSE) compared with EUS-FNA without ROSE (3.9% vs 14.3%; p = 0.006). The positive and negative impact of EUS-FNA on subsequent treatment was observed in 63.9% and 0.5% of patients, respectively. In 3.4% of patients with pancreatic cancer, EUS-FNA diagnosed either subtle malignant ascites or liver metastases (mean ± SD: 8,9 ± 3,5 mm), that were not detected on previous contrast-enhanced CT scans. We have confirmed that EUS-FNA is accuarate and safe method in diagnosing pancreas carcinoma and has positive impact on subsequent treatment in 2/3 of patients with unclear solid pancreatic mass. ROSE significantly increases the accuracy of the method.

Key words:
endosonography – fine needle aspiration biopsy – pancreatic mass – pancreas carcinoma

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
19. 8. 2013

Accepted:
16. 9. 2013

Sources

1. Jemal A, Siegel R, Ward E et al. Cancer statistics, 2007. CA Cancer J Clin 2007; 57(1): 43–66.

2. Ghaneh P, Costello E, Neoptolemos JP. Biology and management of pancreatic cancer. Gut 2007; 56(8): 1134–1152.

3. Li D, Xie K, Wolff R et al. Pancreatic cancer. Lancet 2004; 363(9414): 1049–1057.

4. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol 2002; 97(6): 1386–1391.

5. Van Gulik TM, Reeders JW, Bosma A et al. Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer. Gastrointest Endosc 1997; 46(5): 417–423.

6. Voss M, Hammel P, Molas G et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut 2000; 46(2): 244–249.

7. Kliment M, Urban O, Cegan M et al. Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients. Scand J Gastroenterol 2010; 45(11): 1372–1379.

8. Müller MF, Meyenberger C, Bertschinger P et al. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology 1994; 190(3): 745–751.

9. Loveček M, Kliment M, Skalický P et al. Význam endosonografie v předoperačním managementu nemocných s karcinomem hlavy pankreatu. Rozhl Chir 2012; 91(11): 608–613.

10. Nasuti JF, Gupta PK, Baloch ZW. Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: review of 5,688 cases. Diagn Cytopathol 2002; 27(1): 1–4.

11. Dishop MK, Warner BW, Dehner LP et al. Successful treatment of inflammatory myofibroblastic tumor with malignant transformation by surgical resection and chemotherapy. J Pediatr Hematol Oncol 2003; 25(2): 153–158.

12. Raut CP, Grau AM, Staerkel GA et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg 2003; 7(1): 118–126.

13. Giovannini M, Seitz JF, Monges G et al. Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients. Endoscopy 1995; 27(2): 171–177.

14. Eloubeidi MA, Varadarajulu S, Desai S et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg 2007; 11(7): 813–819.

15. Wiersema MJ, Vilmann P, Giovannini M et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997; 112(4): 1087–1095.

16. Eloubeidi MA, Gress FG, Savides TJ et al. Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc 2004; 60(3): 385–389.

17. DeWitt J, LeBlanc J, McHenry L et al. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single-center experience. Am J Gastroenterol 2003; 98(9): 1976–1981.

18. Lee YT, Ng EK, Hung LC et al. Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients. Gut 2005; 54(11): 1541–1545.

19. DeWitt J, Yu M, Al-Haddad MA et al. Survival in patients with pancreatic cancer after the diagnosis of malignant ascites or liver metastases by EUS-FNA. Gastrointest Endosc 2010; 71(2): 260–265.

20. Dumonceau JM, Polkowski M, Larghi A et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2011; 43(10): 897–912.

21. Ngamruengphong S, Xu C, Woodward TA et al. Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. Endoscopy 2013; 45(8): 619–626.