Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a well-established method for the diagnosis of solid pancreatic lesions. However, the diagnostic yield of EUS-FNA for pancreatic lesions varies at around 70-90%. Samples from EUS-FNA consist of cells and tissues that can be analyzed separately, and the results can be combined for a final diagnosis. To investigate the effect of cytological and histological analysis of EUS-FNA samples on the final diagnosis, and identify factors that may affect the accuracy of the cytological, histological, and overall analysis. A single-center prospective observational study was conducted at a tertiary university hospital from July 2018 to June 2019. Patients who underwent EUS-FNA for pancreatic solid lesions with a 22-gauge EUS-FNA needle were included in our study. Liquid-based cytological analysis of the specimen and histological analysis of the whitish core were performed, and factors that affected the diagnostic accuracy of each analysis were evaluated. In 63 EUS-FNA samples, the overall diagnostic accuracy was 87.3%, which was significantly higher than the cytological accuracy of 73.8% (p = 0.031) and the histological accuracy of 69.8% (p = 0.001). Factors that affected the results differed in each group: 1) cytological analysis: size, location, and approach method; 2) histological analysis: specimen weight; and 3) overall analysis: size, location, and approach method. Histologic evaluation of core material obtained from EUS-FNA improved diagnostic accuracy, and factors that affected each result were analyzed. Further studies with prospective randomized trials are recommended to support our data.
Highlights
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a well-established method for the diagnosis of solid pancreatic lesions
In 63 EUS-FNA samples, the overall diagnostic accuracy was 87.3%, which was significantly higher than the cytological accuracy of 73.8% (p = 0.031) and the histological accuracy of 69.8% (p = 0.001)
Histologic evaluation of core material obtained from EUS-FNA improved diagnostic accuracy, and factors that affected each result were analyzed
Summary
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a well-established method for the diagnosis of solid pancreatic lesions. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a well-established and safe method for tissue acquisition from solid pancreatic lesions. Ever since Vilmann et al first reported the use of EUS-FNA in a solid pancreatic lesion, it has become one of the most important endoscopic procedures in the diagnosis of benign and malignant tumors, as well as in the staging of malignancies of the gastrointestinal tract and adjacent structures, including the pancreas.[1] the diagnostic yield of the procedure varies at around 70–90%, and is affected by several factors such as lesion location or size, characteristics of the target lesion, various procedural techniques and devices, tissue-processing method, the availability of cytology staff or rapid on-site evaluation (ROSE), and the experience of the endosonographer.[2,3] The fact that the diagnostic yield is sometimes as low as 70% in expert hands can result in high medical costs from extra procedures and/or imaging studies, and the uncertainty in diagnosis can cause treatment delay. The development of diagnostic techniques, such as the fanning technique and the slow-pull technique, and new endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB), have brought a certain degree of success in this regard.[2,4,5] Even though recent meta-analysis results have not been consistent enough to confirm the superiority of EUS-FNB over EUS-FNA, its ability to provide core tissue specimens with preserved architecture provides advantages, especially in diagnosing lymphoma, gastrointestinal stromal tumors (GIST) and autoimmune pancreatitis, as well as in molecular and genetic analyses for precision medicine.[2,6,7] the EUS-FNB needle has several technical disadvantages compared to the EUS-FNA needle due to its stiffness and targeting difficulties, especially during the transduodenal approach, and an ideal technique for EUS-FNB has not yet been established.[8,9]
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