Sistema gastrointestinal y digestivo

Abstracto

EUS Guided Fine-needle Aspiration (EUS Guided FNA) of Pancreatic Masses: Experiences from the Beginning of the Era and Implications to the Present Day

Rolf D. Klingenberg-Noftz, Leimin Sun, Nils Homann, Diether Ludwig

Background: The work-up of pancreatic mass lesions requires an orchestrated employment of different diagnostic means. The “best”, meaning the most sufficient and goal achieving diagnostic pathway, remains to be established and has to be adopted according to each individual patient. The technique of endoscopic ultrasound (EUS) has been established with a high yield of diagnostic value regarding pancreatic lesions. In combination with fine needle aspirations of the suspected area guided by EUS (EUS guided FNA) the diagnostic value of pancreatic lesions is boosted with regard to the final diagnosis in a clinical setting.

Patients and Methods: During a 36-month period, 142 consecutive patients were referred to us for suspected pancreatic disease and evaluated for this study. Work-up for pancreatic lesions was performed including EUS and EUS-guided FNA. Definite diagnosis was established by explorative/curative laparoscopy/laparotomy or follow-up for up to 36 months in the aftermath of first admission. Results regarding diagnostic precision of EUS guided FNA cytology were evaluated retrospectively and correlated with other diagnostic means performed.

Results: 142 patients underwent work-up for pancreatic mass lesions of unknown genesis. EUS guided FNA was performed in all patients with a total of 13 (9.2%) minor complications (local control achieved), 2 (1.4%) major complications (1× bleeding, 1× perforation) and no fatal complication. Cytology obtained by EUS guided FNA found malignancy in 52(37%) and absence of malignant disease in 70 (49%) cases. Cytology has not rendered a definite result in 20 (14%) cases. Final diagnosis resulted in 42% (n = 59) malignant disease, 42% (n = 60) benign disease, 10 cases (7%) remained without definite diagnosis and 13 patients (9%) left hospitalization or were lost to follow-up before completing the diagnostic work-up. Sensitivity of EUS guided FNA regarding malignant pancreatic disease was 83.7%, the specificity was 95.1% (positive predictive value 93.2%, negative predictive 87.9%).