Another caveat for endoscopic ultrasound–guided fine needle aspiration

Abstract

To the EditorI read with great interest the editorial by Dr. Tio1Tio TL EUS guided FNA: a few caveats [editorial].Gastrointest Endosc. 1998; 47: 421-423PubMed Google Scholar on endoscopic ultrasound (EUS)–guided fine needle aspiration (FNA). I performed EUS-guided FNA on a patient with a pancreatic mass in the body-tail region with a cytopathologist present in the procedure room to examine the cytologic smears immediately after each pass. The pathologist indicated that there was good cellularity, that pancreatic cells were seen, and that the cells appeared to be normal without evidence of malignancy. The patient had no distant metastases. He had epigastric pain, weight loss, and no risk factors for pancreatitis. The mass appeared to be resectable at EUS examination, and thus the patient underwent surgical exploration with the potential for curative resection if pancreatic cancer was found.During the operation when the abdominal cavity was entered, multiple, metastatic peritoneal nodules were seen. Frozen section examination of these nodules revealed adenocarcinoma suggestive of a pancreatic origin. The tumor was considered unresectable, and the abdomen was closed. The histologic sections from the peritoneal nodule and the cytologic slides from the EUS-guided FNA were compared, and the morphologic features of the cells were found to be very similar. The tumor was so well differentiated that in the needle aspirate, individual cells appeared similar to normal pancreatic cells. Thus it is important to remember that EUS-guided pancreatic FNA may be read as negative for carcinoma in the presence of an extremely well-differentiated malignant neoplasm. To the EditorI read with great interest the editorial by Dr. Tio1Tio TL EUS guided FNA: a few caveats [editorial].Gastrointest Endosc. 1998; 47: 421-423PubMed Google Scholar on endoscopic ultrasound (EUS)–guided fine needle aspiration (FNA). I performed EUS-guided FNA on a patient with a pancreatic mass in the body-tail region with a cytopathologist present in the procedure room to examine the cytologic smears immediately after each pass. The pathologist indicated that there was good cellularity, that pancreatic cells were seen, and that the cells appeared to be normal without evidence of malignancy. The patient had no distant metastases. He had epigastric pain, weight loss, and no risk factors for pancreatitis. The mass appeared to be resectable at EUS examination, and thus the patient underwent surgical exploration with the potential for curative resection if pancreatic cancer was found.During the operation when the abdominal cavity was entered, multiple, metastatic peritoneal nodules were seen. Frozen section examination of these nodules revealed adenocarcinoma suggestive of a pancreatic origin. The tumor was considered unresectable, and the abdomen was closed. The histologic sections from the peritoneal nodule and the cytologic slides from the EUS-guided FNA were compared, and the morphologic features of the cells were found to be very similar. The tumor was so well differentiated that in the needle aspirate, individual cells appeared similar to normal pancreatic cells. Thus it is important to remember that EUS-guided pancreatic FNA may be read as negative for carcinoma in the presence of an extremely well-differentiated malignant neoplasm. I read with great interest the editorial by Dr. Tio1Tio TL EUS guided FNA: a few caveats [editorial].Gastrointest Endosc. 1998; 47: 421-423PubMed Google Scholar on endoscopic ultrasound (EUS)–guided fine needle aspiration (FNA). I performed EUS-guided FNA on a patient with a pancreatic mass in the body-tail region with a cytopathologist present in the procedure room to examine the cytologic smears immediately after each pass. The pathologist indicated that there was good cellularity, that pancreatic cells were seen, and that the cells appeared to be normal without evidence of malignancy. The patient had no distant metastases. He had epigastric pain, weight loss, and no risk factors for pancreatitis. The mass appeared to be resectable at EUS examination, and thus the patient underwent surgical exploration with the potential for curative resection if pancreatic cancer was found. During the operation when the abdominal cavity was entered, multiple, metastatic peritoneal nodules were seen. Frozen section examination of these nodules revealed adenocarcinoma suggestive of a pancreatic origin. The tumor was considered unresectable, and the abdomen was closed. The histologic sections from the peritoneal nodule and the cytologic slides from the EUS-guided FNA were compared, and the morphologic features of the cells were found to be very similar. The tumor was so well differentiated that in the needle aspirate, individual cells appeared similar to normal pancreatic cells. Thus it is important to remember that EUS-guided pancreatic FNA may be read as negative for carcinoma in the presence of an extremely well-differentiated malignant neoplasm.