Cytopathologist and endoscopist collaboration: the example of endoscopic ultrasound guided fine needle aspiration in biliary and pancreatic diseases

Abstract

Endoscopic ultrasound guided fine needle aspiration has become the most accurate modality for characterization of pancreatic cystic and solid lesions, differential diagnosis of indeterminate pancreatic masses and locoregional staging of pancreatic and extrahepatic biliary tumours. It should not only be performed in the primary mass but also in distant lymph nodes, ascites, liver, adrenal and mediastinal metastatic locations. Experienced groups reach a sensitivity rate over 85% with 90-100% specificity, a positive predictive value of 98-100%, a negative predictive value of 44-80%, and an accuracy of 75-84% in evaluation of pancreatic masses. Morbidity (acute pancreatitis, infection, haemorrhage, perforation) is very low being around 1-2% and risk of peritoneal seeding was shown to be significantly lower than CT guided fine needle aspiration. The performance of this technique is dependent on the endoscopist and cytopathologist experience, the location, size and consistency of the tumour and the number of passes in the lesion. Although it remains debated if the presence of the cytopathologist on site improves the performances, collaboration and interaction between the endoscopist and the pathologist are crucial to improve overall results.