Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Masses: A Learning Curve

Abstract

Background: Studies assessing the number of procedures needed to achieve competence with EUS-FNA of solid pancreatic masses are lacking. Our purpose was to examine the success of EUS-FNA of solid pancreatic masses based on case number and volume performed during third tier eus training. Methods: The diagnostic accuracy, the number of passes and the complication rate were prospectively evaluated with 300 consecutive EUS-FNA of solid pancreatic masses performed by a single endosonographer over a 3-year period. The procedures were divided into three groups of 100 procedures each. The endosonographer had undergone a third tier EUS fellowship where 45 pancreatic EUS-FNA where performed. Results: Three hundred EUS-FNA were performed over the 3 year period (median age 63, 64% males). There were no statistically significant differences among the three groups with regard to age, gender, race, location, or size of the mass. Diagnostic accuracy of the EUS-FNA procedure increased over the period (Gp1, 93.0%; Gp2, 93.8%; Gp3, 94.5%); Median number of passes showed a decreasing trend over the three-year study period despite increasing trend of number of procedures performed (r = − 0.14, p = 0.42). The median number of passes was less for groups two and three compared to group one. (p = 0.01) For obtaining a malignancy diagnosis, group one (median, 3.0) was significantly different from group two (median, 2.0; p = 0.0003) and three (median, 2.0; p = 0.004) while no significant difference between group two and three (p = 0.41) was observed. Complications fell from 7% (7/100) in gp1 to 5% (5/100) in gp2 and 1% (1/100) in gp3 (p=0.01). Summary: The recommended number (25-50) of procedures appears adequate as a threshold for training in EUS-FNA of the pancreas. The learning curve however continues after fellowship.