Diagnosis Of Solid Pancreatic Tumors Research Articles

Accuracy of endoscopic ultrasound-guided tissue acquistion in the cyto-histological diagnosis of solid pancreatic tumors: Analisys of a large prospective registry

Accuracy of endoscopic ultrasound-guided tissue acquistion in the cyto-histological diagnosis of solid pancreatic tumors: Analisys of a large prospective registry

A review of contrast-enhanced harmonic endoscopic ultrasonography for pancreatic solid tumors.

Endoscopic ultrasonography (EUS) is superior to other imaging modalities in the detection of pancreatic masses, although differentiating the types of pancreatic masses detected on EUS remains challenging. However, the value of contrast-enhanced harmonic EUS (CH-EUS) using ultrasound contrast agents for this differentiation has been reported. CH-EUS plays a pivotal role in analysis of small lesions that can only be detected with EUS. Recently, CH-EUS was used for staging and/or determining the resectability of pancreatic cancer in several clinical trials. In addition, it is used to estimate the response of pancreatic cancer to chemotherapy and to determine the prognosis in cases of pancreatic cancer and pancreatic neuroendocrine neoplasms. It is also postulated that CH-EUS improves the diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) through complementary diagnoses using CH-EUS and EUS-FNAB, or CH-EUS-guided EUS-FNAB. Thus, CH-EUS has been employed for various qualitative diagnoses, including differentiation of pancreatic masses. Second-generation contrast agents such as Sonazoid are used clinically for ultrasound diagnostic imaging of liver and breast disease. The positioning of CH-EUS with Sonazoid as a test for the diagnosis of solid pancreatic tumors is an issue for further studies.

Endoscopic Ultrasound (EUS) Guided Elastography.

Endoscopic ultrasound (EUS) is an essential technique for the management of several diseases. Over the years, new technologies have been developed to improve and overcome certain limitations related to EUS-guided tissue acquisition. Among these new methods, EUS-guided elastography, which is a real-time method for the evaluation of tissue stiffness, has arisen as one of the most widely recognized and available. At present, there are available two different systems to perform an elastographic evaluation: strain elastography and shear wave elastography. Strain elastography is based on the knowledge that certain diseases lead to a change in tissue hardness while shear wave elastography monitored shear-wave propagation and measures its velocity. EUS-guided elastography has shown in several studies high accuracy in differentiating benign from malignant lesions from many different locations, mostly in the pancreas and lymph nodes. Therefore, nowadays, there are well-established indications for this technology, mainly for supporting the management of pancreatic diseases (diagnosis of chronic pancreatitis and differential diagnosis of solid pancreatic tumors) and characterization of different diseases. However, there are more data on new potential indications for the near future. In this review, we will present the theoretical bases of this technology and we will discuss the scientific evidence to support its use.

Accuracy of EUS-guided fine needle aspiration with rapid onsite evaluation versus eus-guided biopsy for the cyto-histological diagnosis of solid pancreatic tumors

Accuracy of EUS-guided fine needle aspiration with rapid onsite evaluation versus eus-guided biopsy for the cyto-histological diagnosis of solid pancreatic tumors

Diagnostic and Interventional Role of Endoscopic Ultrasonography for the Management of Pancreatic Neuroendocrine Neoplasms.

Pancreatic neuroendocrine neoplasms (PanNENs) are relatively rare, but their incidence has increased significantly in the last decades. Precise diagnosis and prognostic stratification are crucial for proper patient management. Endoscopic ultrasound (EUS) is the modality of choice for diagnosis of solid pancreatic tumors, showing a higher tumor detection rate than other imaging modalities, especially for small size lesions. EUS also serves as a guide for preoperative sampling and other interventions. EUS-tissue acquisition is a safe and highly accurate technique for cyto/histological diagnosis of PanNENs with a well-demonstrated correlation between Ki-67 proliferation index values and tumor grading on EUS and surgical specimens according to the WHO 2017 classification. Furthermore, the possibility of a preoperative EUS-guided fine needle tattooing or fiducial markers placement may help the surgeon to locate small and deep tumors, thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery. Finally, locoregional ablative treatments using either ethanol injection or radiofrequency ablation have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected patients unfit for surgery with functioning or non-functioning PanNENs. This article review highlights the current role of EUS in PanNENs management, focusing on the present and future applications of EUS-guided interventions.

Quantitative perfusion analysis and time intensity curve analysis in differential diagnosis of solid pancreatic tumors by contrast-enhanced ultrasound. A pilot study

Quantitative perfusion analysis and time intensity curve analysis in differential diagnosis of solid pancreatic tumors by contrast-enhanced ultrasound. A pilot study

Liquid-based cytology for the diagnosis of solid pancreatic tumors with endoscopic ultrasound-guided fine-needle aspiration: Can we dismiss conventional smear?

Digestive EndoscopyVolume 29, Issue 7 p. 814-814 Letters, Techniques and Images Liquid-based cytology for the diagnosis of solid pancreatic tumors with endoscopic ultrasound-guided fine-needle aspiration: Can we dismiss conventional smear? Carlos Bernardes, Carlos Bernardes Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, PortugalSearch for more papers by this authorDiana Carvalho, Diana Carvalho Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, PortugalSearch for more papers by this authorGonçalo Ramos, Gonçalo Ramos Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, PortugalSearch for more papers by this author Carlos Bernardes, Carlos Bernardes Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, PortugalSearch for more papers by this authorDiana Carvalho, Diana Carvalho Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, PortugalSearch for more papers by this authorGonçalo Ramos, Gonçalo Ramos Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, PortugalSearch for more papers by this author First published: 03 July 2017 https://doi.org/10.1111/den.12915Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume29, Issue7November 2017Pages 814-814 RelatedInformation

Quantitative Perfusion Analysis and Time Intensity Curve Analysis in Differential Diagnosis of Solid Pancreatic Tumors by Contrast-Enhanced Ultrasound. A Pilot Study

Contrast-enhanced ultrasound began to develop rapidly in recent years inRussia. Due to the physical properties of contrast agents it is possible to differentiate malignant and benign lesions. However, this method only involves a subjective evaluation of the obtained results. For the objectification of ultrasound with contrast enhancement implemented the function “TIC-analysis” (time intensity curve analysis). The aim: to assess the clinical value of the TIC-analysis in the differential diagnosis of adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis by contrast – enhanced ultrasound.Materials and methods. In A.V. Vishnevsky Institute of surgery contrast – enhanced ultrasound and TIC-analysis was performed on 23 patients with focal lesions of the pancreas. All patients were operated on, tumors were verified morphologically: adenocarcinoma of the pancreas in 18 (78%) patients, chronic pseudotumoral pancreatitis – in 5 (22%) patients.Results. The results about intensity of the tumors obtained by the TIC analysis do not allow to differentiate these pathological processes statistically significant (p > 0.05), which, in all probability, due to the fact that pancreatic adenocarcinoma and chronic pseudotumoral pancreatitis have similar morphological characteristics in the form of pronounced desmoplastic stromal response and fibrosis-hyalinosis, respectively. The “Time to peak| parameter allowed us to determine statistically significant that pancreatic adenocarcinoma had an early accumulation of contrast agent (average 16 sec) and early washout (from an average of 17 sec); the chronic pseudotumoral pancreatitis had the slow accumulation of contrast agent (average 85 sec) and slow washout (from an average of 86 seconds) (p < 0.05).Conclusion. The “Time to peak” parameter at ultrasound examination with echocontrast allows statistically significantly differentiate adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis.

Differential diagnosis of solid pancreatic masses: contrast-enhanced harmonic (CEH-EUS), quantitative-elastography (QE-EUS), or both?

Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Sixty-two consecutive patients (mean age 64.3 years, range 32-89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n = 45), neuroendocrine tumor (n = 3), inflammatory mass (n = 10), pancreatic metastasis (n = 2), autoimmune pancreatitis (n = 1), and a mucinous cystadenocarcinoma (n = 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4-99.7), 85.5% (95% CI: 74.7-92.2), 91.9% (95% CI: 82.5-96.5), and 91.5% (95% CI: 83.6-99.5), respectively. The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone.

The Value of MRI in Diagnosis of Solid Pancreatic Tumors

Aim: To investigate the value of 3.0 T MRI in the diagnosis of solid pancreatic tumor. Materials and Methods: Aggregate of 36 patients were enlisted with suspected or proven as solid pancreatic tumors were collected from the first affiliated Hospital of Anhui Medical University Teaching Hospital during the period of January 2012 to August 2015, contained 20 cases of pancreatic adenocarcinoma, 7 cases of pancreatic neuroendocrine tumors (PNETs), 5 cases of pancreatic metastases, 4 cases of solid pseudopapillary tumors (SPTP). All the patients performed with plain scan and multiphasic contrast enhanced imaging on 3.0 T MR, 23 cases performed with MRCP. The data of clinic and imaging were retrospectively analyzed. Results: Pancreatic adenocarcinoma was irregular in shape, lesion was hypo intense in 10 cases, slightly hypo intense in 9 cases and isointense in one case on T1WI. 10 tumor showed slightly enhancement in arterial phase, and all of tumors showed moderate enhancement during portal and delayed phase; 19 cases showed double duct sign, and one case showed distal pancreatic duct dilation. Of the 7 cases with PNETs, the margin was well defined in six well differentiated lesions and ill-defined in one pancreatic neuroendocrine carcinoma; six tumors were marked enhancement in arterial phase and one tumor was moderate enhancement in pancreatic parenchyma in all of three phases. The mean diameter of SPTP was 5.2 cm. The solid part of tumors was hyperintense on T1WI and slightly hyper intense on T2WI, with progressively enhancement. 4 SPTPs had capsule which were hyperintense on T1WI and T2WI exhibited moderate enhancement. Of the 5 pancreatic metastases, one cases had only one lesion, two cases had multiple lesions and two cases showed diffuse pancreatic enlargement, one case showed heterogenous slightly enhancement, two case showed peripheral rim enhancement, two case showed marked enhancement in arterial, then wash-out in delayed and portal phases. Conclusion: MRI is valuable for diagnosis and distinguishing solid pancreatic tumors.

Differential diagnosis of solid pancreatic masses: Contrast-enhanced harmonic EUS (CEHEUS), quantitative EUS-elastography (QE-EUS) or both?

Background: Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Methods: Sixty-two consecutive patients (mean age 64.3 years, range 32–89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Results: Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n1⁄4 45), neuroendocrine tumor (n1⁄4 3), inflammatory mass (n1⁄4 10), pancreatic metastasis (n1⁄4 2), autoimmune pancreatitis (n1⁄4 1), and a mucinous cystadenocarcinoma (n1⁄4 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4–99.7), 85.5% (95% CI: 74.7–92.2), 91.9% (95% CI: 82.5–96.5), and 91.5% (95% CI: 83.6–99.5), respectively. Conclusion: The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone.

EUS Elastography: Advances in Diagnostic EUS of the Pancreas

Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. Endoscopic ultrasonography elastography (EUS-EG) is a promising imaging technique with a high degree of accuracy for the differential diagnosis of solid pancreatic tumors. Recent introduction of second generation EUS-EG allows for the quantitative analysis of tissue stiffness. Here, we review our knowledge and preliminary experience with the use of EUS-elastography for the diagnosis of pancreatic disease.

Relationship of Pancreatic Mass Size and Diagnostic Yield of Endoscopic Ultrasound-Guided Fine Needle Aspiration

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is central to discerning the diagnosis of solid pancreatic tumors through tissue acquisition. Test performance is affected by a number of factors including location of mass within the pancreas, presence of onsite cytology technologist, and number of passes with the needle. The influence of tumor size has not been well studied. The objective of the current study was to determine whether the size of mass affects the diagnostic accuracy for solid pancreatic lesions aspirated under EUS guidance. Data were collected retrospectively on all patients with solid pancreatic masses undergoing EUS-FNA from June 2003 to August 2010. The cytology samples were reported as positive, suspicious for malignancy, atypical, negative, or nondiagnostic. The gold standard for a cytological diagnosis was histological confirmation or clinical follow-up of more than 6months with repeat imaging. Patients were divided into five groups based upon lesion size as follows: (a) less than 1cm, (b) 1-2cm, (c) 2-3cm, (d) 3-4cm, and (e) greater than 4cm. Performance characteristics of EUS-FNA including sensitivity, specificity, and accuracy were compared for each group. Accuracy was defined as the ratio of the sum of true-positive and true-negative values divided by the number of lesions. We identified 583 patients with solid pancreatic lesions in which EUS-FNA was performed and adequate cellularity was obtained (47% men, mean age 65±1.4 (SE) years). Overall, 486 (83%) of lesions were pancreatic adenocarcinoma, 18 (3%) were neuroendocrine tumors, 12 (2%) were lymphomas, and 67 (12%) were benign lesions. The median size of the mass was 3cm (range, 0.5-7cm). A mean of 4.9 passes (range, 1-9 passes) was needed to obtain adequate samples from lesions. The overall yield of obtaining adequate samples for diagnosis was 85%. When stratified by size, the EUS-FNA sensitivity for lesions with size <1, 1-2, 2-3, 3-4, and >4cm was 40, 75.9, 86.9, 93.2, and 91.6%, respectively; EUS-FNA sensitivity strongly correlate with tumor size (p<0.001). Similarly, the accuracy of EUS-FNA increased as lesion size increased, ranging from 47% for tumors less than 1cm to 88% for tumors greater than 4cm (p<0.05). Location of tumor and number of needle passes did not significantly influence EUS-FNA performance characteristics. The sensitivity and diagnostic accuracy of EUS-FNA for solid pancreatic lesions is strongly correlated with tumor size. Sensitivity and accuracy decrease significantly for tumors that are smaller than 1cm.

Su1378 Procore Histology Needles (19-Gauge and 22 Gauge) vs Standard Cytology Needles (22-Gauge and 25-Gauge) in the Differential Diagnosis of Solid Pancreatic Tumors

Su1378 Procore Histology Needles (19-Gauge and 22 Gauge) vs Standard Cytology Needles (22-Gauge and 25-Gauge) in the Differential Diagnosis of Solid Pancreatic Tumors Julio Iglesias-Garcia, Ihab Abdulkader, Raquel Souto, Jose Larino-Noia, Jeronimo Forteza, Enrique Dominguez-Munoz Gastroenterology, University Hospital of Santiago, Santiago de Compostela, Spain; Foundation for Research in Digestive Diseases, Santiago de Compostela, Spain; Pathology, University Hospital of Santiago, Santiago de Compostela, Spain Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an efficacious technique for sampling pancreatic solid lesions. However, cytology possesses limitations to its final yield and accuracy, which may be overcome if histological specimens are provided to the pathologist. Aim of the study was to evaluate the accuracy of the newly developed 19-gauge and 22-gauge Procore needles, compare to the standard FNA needles. Methods: 83 consecutive patients (mean age 65.5 10.6 years, range 42-86, 47 male), who underwent EUS for the evaluation of solid pancreatic masses were prospectively included in the study. EUS were performed using a convex array echoendoscope (Pentax EG-3870UTK), connected to an ultrasound equipment (Hitachi). Biopsies were performed with the new 19-gauge and 22-gauge Procore needles (Cook Medical Inc, Limerick Ireland). FNA were performed with the standard 22-gauge and 25-gauge (Cook Medical Inc, Limerick Ireland). With Procore needles, sample obtained was recovered into cytolit and processed for histological analysis, after one pass. With standard cytology needles, samples were recoverd into slides and fixed for cytological evaluation, following the standard methodology. Results were compared to the gold standard of surgical histopathology, or global clinical and radiological assessment and follow-up in non-operated cases. Results are shown as mean or percentage (95%CI), and compared by chi-square test. Diagnostic accuracy was also evaluated. Results: Size of solid pancreatic masses was 41.5 19.8 mm (mean SD). 50 tumors were located in the head of the pancreas, 29 in the body, and 4 in the tail. 38 punctures (45.8%) were performed with Procore needles (21 with 19-gauge and 17 with 22-gauge), and 45 (54.2%) with standard cytology needles (25 with 25gauge and 20 with 22-gauge). In 36 cases (85.96%) diagnosis proved to be correct with Procore needles (94.7%) (16/17 with 22-gauge, and 20/21 with 19gauge), while with the standard needles diagnosis proved to be correct in 36 cases (80.0%) (15/20 with 22-gauge, and 21/25 with 25-gauge) (p 0.046). Conclusion: Performing a EUS-guided biopsy with the new Procore needles is more accurate than with the standard cytology needles.

T1392 Immunohistochemistry of Pancreatic EUS-FNA Samples for the Differential Diagnosis of Solid Pancreatic Tumors

T1392 Immunohistochemistry of Pancreatic EUS-FNA Samples for the Differential Diagnosis of Solid Pancreatic Tumors

Pancreatic fusocellular sarcoma: The importance of endoscopic ultrasound-guided fine needle aspiration in the differential diagnosis of solid pancreatic tumors

In the presence of a pancreatic tumor, the main diagnostic problem is to determine the benign o malignant nature of the lesion, and then to evaluate its resectability. A preoperative biopsy was usually rejected based on the fact that negative results do not exclude malignancy, that such biopsy may hamper the possibility of curative surgery because of potential seeding along the biopsy s trajectory, that surgical morbidity and mortality are low, and also because of the high diagnostic sensitivity of the various imaging techniques. Biopsy for solid pancreatic tumors was limited to irresectable tumors, and isolated cases with suspicion of tuberculosis, lymphoma or neuroendocrine tumors. Nowadays the performance of a pancreatic biopsy is becoming essential for the correct management of solid lesions, and is useful not only to establish malignancy, but also for a better knowledge of all kind of pathologies and, thus, for better therapeutic management. In this context, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has proven a safe technique with a low rate of complications and a diagnostic accuracy superior to other procedures, this being considered the method of choice for the study of solid pancreatic lesions. An illustrative example is the case we report in this article -a patient diagnosed of a solid, locally advanced-stage pancreatic tumor with imaging techniques (abdominal ultrasounds and EUS) under EUS-guided FNA; the procedure could establish a final diagnosis of pancreatic fusocellular sarcoma.

Endosonographic Diagnosis of Solid Pancreatic Tumors: A Retrospective Analysis from a Tertiary Referral Center

The sensitivity of endosonography for pancreatic tumors is good, but differentiation between malignant and benign lesions remains a challenge. We, therefore, analyzed the correlation between endosonographic findings and pancreatic carcinoma in a population with a high prevalence of chronic pancreatitis. 171 endosonographic examinations were retrospectively evaluated using 22 dichotomous criteria. Final diagnosis was defined by the results of pancreas resection or by clinical follow-up (median: 41 months). A sum score was established after multivariate analysis. Final diagnosis was carcinoma, chronic pancreatitis, neuroendocrine tumor and normal pancreas in 67, 65, 9, and 38 subjects (prevalence 39 %, 38 %, 5 %, 22 % respectively) After multivariate analysis, carcinoma was significantly correlated with six endosonographic criteria and age, which resulted in the following score (yes = 1, no = 0): (dilated pancreatic duct) + (vascular infiltration) + (suspicious lymph nodes) + (tumor edge with pseudopodia-like extensions) + (age > 50 years) - (increased pancreas parenchyma echogenicity) - (tumor diameter < 10 mm) + 3. After receiver operating characteristic analysis, the area under the curve was 0.85. For score values of 5 (4) or more, sensitivity was 0.63 (0.93), specificity 0.91 (0.55), positive predictive value 0.82 (0.57), negative predictive value 0.79 (0.92), positive likelihood ratio 7.24 (2.05), and negative likelihood ratio 0.41 (0.14). A simple and potentially useful score for the prediction of pancreatic cancer based on six endosonographic criteria and patient age was established. Distribution of final diagnoses in the patient population argues for the score's applicability in clinical practice of a tertiary referral center and warrants prospective validation.

Role of EUS-guided FNA in the Diagnosis of Solid Pancreatic Lesions. A Single Center Experience

Introduction: Mass lesions of the pancreas can be malignant or benign, which is often difficult to differentiate. Differentiating these tumors is essential for optimal management and outcome. The purpose of this study was to retrospectively evaluate the accuracy of EUS-FNA in cytologic diagnosis of pancreatic solid lesions. Methods: A retrospective review was done to identify patients who underwent EUS from year 2002 to year 2005 for an abnormal pancreatic imaging (mass lesion, fullness or prominent head of pancreas). EUS-FNA was performed using 22-gauge needle. Onsite cytopatholgist was available to determine the adequacy of the sample. Results: 320 patients underwent EUS for an abnormal pancreatic image. Out of these, 123 patients had a solid pancreatic lesion and had EUS-FNA performed. The cytopathology results of EUS-FNA are as shown in table 1. Surgical confirmation of pancreatic adenocarcinoma was available in 41 out of 72 patients. Follow up of patients with atypical cytology on subsequent surgery revealed pancreatic malignancy in 4 patients. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA in the diagnosis of solid pancreatic tumors at our center is 89.13%, 100%, 100% and 27.5% respectively.

Endoscopic Ultrasonography in Pancreatobiliary Disease Using Radial Instruments

A review is made of clinical studies evaluating the performances of endoscopic ultrasonography (EUS) in pancreatobiliary disease using radial instruments. EUS is more accurate than conventional ultrasonography and CT scans for the diagnosis of solid pancreatic tumors, chronic pancreatitis, and causes of obstruction of the common bile duct. EUS is a promising technique for both idiopathic pancreatitis and cystic lesions of the pancreas.