Features of chronic pancreatitis by endoscopic ultrasound influence the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration of small pancreatic lesions.

Abstract

In chronic pancreatitis (CP) patients, diagnosis of small pancreatic lesions by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is challenging. Thus, the aim of the present study was to investigate whether CP influences the diagnostic ability of EUS-FNA for pancreatic lesions ≤10mm. One hundred and seventeen patients who underwent EUS-FNA for pancreatic lesions ≤10mm in size were enrolled. Patients were classified into two groups based on features of CP observed by EUS (EUS-CP features) in accordance with the Rosemont classification. The CP group was defined as cases consistent with CP or suggestive of CP, and the non-CP group was defined as cases indeterminate for CP or normal. Factors influencing the diagnostic accuracy of EUS-FNA and CP status in pancreatic tumors were also investigated. Diagnostic ability of EUS-FNA (overall cases, non-CP vs CP) had sensitivity (80.4%, 96.7% vs 57.1%; P<0.001), specificity (100%, 100% vs 100%; P>0.05), and accuracy (91.5%, 98.6% vs 80.4%; P=0.001). In multivariate analysis of factors influencing the accuracy of EUS-FNA, CP significantly lowered the accuracy (P=0.048; odds ratio [OR]=9.21). Among pancreatic cancer patients, the number of CP patients was significantly higher than the number of patients with benign lesions (P=0.023). In multivariate analysis, lobularity without honeycombing was more frequently observed in cases of pancreatic cancer (P=0.018; OR, 12.65). Endoscopic ultrasound-guided FNA offers high accuracy for small pancreatic lesions ≤10mm. However, in cases with CP, the diagnostic ability of EUS-FNA is significantly reduced.