7009 Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: one year md anderson cancer center experience.

Abstract

Aim: A prospective evaluation of EUS-FNA of solid pancreatic lesions over a one-year period at a quarternary referral center. Methods: 104 consecutive patients undergoing EUS for suspected pancreatic malignancy at MDACC from 11/1/98 to 10/31/99 were prospectively entered into this study. Procedures were performed using the Pentax FG36-UX echoendoscope, Hitachi EUB-525 processor and Wilson-Cook EUS N-1 22 gauge FNA needle. Passes were made until the endosonographer felt adequate material had been obtained. The aspirate was collected by a cytopathology technician who smeared slides in the room. Examination of the slides was performed by a cytopathologist after the procedure had been completed. Final diagnosis was based on biopsy results, surgical specimen, or clinical follow-up. Data collected included size of mass, number of needle passes, complications of procedure, and final diagnosis. 20 patients with pancreatic cysts on EUS were excluded from further analysis. Results: The average age of patients was 64.6 years. The average size of the mass was 3.2cm (range 1.3 - 7cm). The average number of needle passes was 2.5 (range 1 - 5) per patient. No complications occurred. 79 of 84 patients had malignant pancreatic tumors. EUS-FNA correctly identified 73 while cytology showed atypia in one and suspicious for malignancy in another. In the remaining 4 malignant lesions, FNA was non diagnostic due to poor cellularity. There were no false positives. Of the 5 benign lesions, no mass was seen on EUS. 3 of the 5 benign lesions were shown to have chronic pancreatitis. Of the 4 patients with non - diagnostic FNA specimens later proven to be malignant, one had chronic pancreatitis with no mass seen on EUS while 3 had masses clearly identified by EUS. 2 of these 4 patients were found to have adenocarcinoma while the other 2 had a neuroendocrine tumor. Of the 2 patients with atypia or suspicious lesions, surgical resection specimen showed an islet cell carcinoma in one and adenocarcinoma in the other. Among patients in whom adequate cellularity was obtained (counting atypia and suspicious findings on FNA as signs of malignancy), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 100%, 100%, 100%,100%, and 95% respectively. Conclusions: EUS-FNA in the hands of an experienced endosonographer is a remarkably powerful tool with a high sensitivity and specificity at diagnosing pancreatic cancer.