Pancreatic cancer—new hope for early detection

Abstract

The authors report on the diagnostic yield and accuracy of endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS FNA) of pancreatic masses in patients who have had negative cytology on prior CT-guided biopsy or ERCP sampling. One hundred two patients with suspected pancreatic cancer with prior negative cytology (by CT or ERCP) were prospectively identified and underwent EUS FNA. A median of 3.4 passes were performed with a 22- or 23-gauge needle. Histological diagnosis from the FNA sample was reported as positive, inconclusive, or negative. A composite gold standard of surgical pathology, a positive FNA, or clinical follow-up (median = 24 months) was employed to determine the final diagnosis. FNA was technically possible in all 102 patients. The prevalence of pancreatic cancer in the tested population was 59.8% (n = 61). The performance characteristics of EUS FNA were determined: sensitivity, 93.4%, and specificity, 82.9%. The posterior probability of pancreatic cancer was 93.5% after positive EUS FNA and 6.9% after negative FNA. Complications occurred in three of the 103 patients: gastric bleeding that resolved spontaneously in two patients and self-limited pancreatitis in one. The authors conclude that EUS FNA may play a valuable role in the evaluation of a pancreatic mass if the clinical suspicion of cancer is strong despite a negative result on other biopsy methods.