Tu1648 Evaluating the Efficacy of a New FDA Approved EUS Core Biopsy Needle and Different Fine Needle Biopsy (FNB) Techniques to Yield the Best Core Specimen in a Live Porcine Model

Abstract

Tu1647 Impact of EUS-FNA for Preoperative Para-Aortic Lymph Node Staging in Patients With Pancreato-Biliary Neoplasm Akira Kurita*, Yuzo Kodama, Tsutomu Chiba Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan; Department of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan Background: In patients with pancreato-biliary neoplasms, para-aortic lymph node (PALN) metastasis is highly associated with their poor prognosis. However, effective methods for preoperative PALN staging has not been established yet. Objective: To compare the diagnostic ability of 18 F-fluorodeoxyglucose positron-emission tomography with computed tomography (PET/CT), endoscopic ultrasonography (EUS), and EUS-guided fine needle aspiration (EUS-FNA) as to PALN metastasis.Design, Setting, and Patients: Prospective, nonrandomized single center trial performed in 1 referral hospital in Japan. Between December 2010 and March 2014, a total of 208 patients with preoperative pancreato-biliary neoplasms were assessed for study eligibility. Of all them, consecutive 52 patients were enrolled in this study. Intervention: PET/CT, EUS, and EUS-FNA were performed sequentially as a single combined procedure. Main Outcomes Measure: Primary outcome was to compare the diagnostic ability of PET/CT, EUS, and EUS-FNA. Results: Of all 208 patients with a operable pancreato-biliary neoplasm, 52 patients with 71 nodes, 20 patients (38.5%) with 29 nodes (40.8%) had malignant lymph nodes. EUS-FNA revealed the highest sensitivity and specificity for the diagnosis of PALN (sensitivity 96.6% [28/29]; 95% confidence interval, 82.2%-99.9%, and specificity 100% [40/40]; 95% confidence interval, 91.2%-100%) in the three modalities. Of all 20 patients with PALN metastases, preoperative EUS-FNA or PET/CT could make correct diagnosis in 19 (36.5%) or 14 (26.9%) patients, respectively. This indicated that 5 more patients could have avoided unnecessary laparotomy by using EUS-FNA as compared to PET/CT. Conclusions: EUS-FNA is an ideal diagnostic modality for preoperative PALN staging in patients with pancreato-biliary neoplasms. From its significant clinical benefits of reducing unnecessary surgery, EUS-FNA should be added to the standard preoperative examinations for pancreato-biliary neoplasms. Diagnostic values for PALN staging by each modality AB544 Sensitivity 95% CI GASTROI Specificity 95% CI NTESTINAL Positive Predictive Value ENDOSCOPY Negative Predictive Value Volume 81, No Accuracy