Adequacy and Incidence of Primary Pancreatic Cancer on Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) Cytology Samples: A Retrospective Review in Veteran Population at Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMCVAMC)

Abstract

Abstract Introduction Pancreatic cancer is the one of leading causes of cancer-related deaths, accounts for 7% of cancer related deaths, and generally is diagnosed at an advanced stage. The 5-year survival rate is about 62%. There are no current screening recommendations for pancreatic cancer, so primary diagnosis is of the utmost importance. EUS modality for FNA has revolutionized the ability for the early diagnosis and staging of cancers of the gastrointestinal tract as being safe, cost-effective, minimally invasive technology to assess the pancreas. To date, there is no study in English literature assessing the adequacy for diagnosis and ancillary studies on EUS-FNA of pancreatic mass lesions in veterans. The veteran patient population is a unique cohort with different risk factors and demographics. Methods As a part of quality assurance project, a search was conducted to identify all EUS of pancreatic lesions performed at our hospital from February 2, 2011, to March 3, 2019. We evaluated adequacy on the cell blocks and diagnostic accuracy of EUS-FNA among all pancreatic mass lesions. Results Out of the total 130 EUS-FNA pancreas cases, the diagnosis was established in 127 cases (97.6%). Three cases were insufficient and total 26 cases were diagnosed as atypia, suggesting repeat FNA for definitive diagnosis. A definitive diagnosis was made in 101 cases (77.7%). Four cases were suspicious for malignancy. Malignancy/severe dysplasia was diagnosed in total 45 cases, most being primary pancreatic adenocarcinoma (41) and four with other diagnoses. Conclusion EUS-FNA is highly successful for procuring adequate material on the cytology samples for pancreatic lesions. EUS-FNAs for pancreatic lesions have high sensitivity and specificity for diagnosing and directing early, appropriate clinical management in veterans. The percentage of primary pancreatic adenocarcinomas out of total tumors in this veteran population is high (91.1%).