EUS-FNA In Patients Research Articles

Contrast-Enhanced Harmonic Endoscopic Ultrasound-Guided Fine-Needle Aspiration versus Standard Fine-Needle Aspiration in Pancreatic Masses: A Propensity Score Analysis.

Background: Whether endoscopic ultrasound (EUS) contrast-enhanced fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses remains unclear. The aim of this study was to compare these two techniques on a series of patients with solid pancreatic lesions. Methods: 362 patients underwent EUS-FNA (2008–2019), after the propensity score matching of two groups were compared; 103 treated with CH-EUS-FNA (group 1) and 103 with standard EUS-FNA (group 2). The primary outcome was the diagnostic accuracy. Secondary outcomes were sensitivity, specificity, and sample adequacy. Results: Diagnostic sensitivity was 87.6% in group 1 and 80% in group 2 (p = 0.18). The negative predictive value was 56% in group 1 and 41.5% in group 2 (p = 0.06). The specificity and positive predictive values were 100% for both groups. Diagnostic accuracy was 89.3% and 82.5%, respectively (p = 0.40). Sample adequacy was 94.1% in group 1 and 91.2% in group 2 (p = 0.42). The rate of adequate core histologic samples was 33% and 28.1%, respectively (p = 0.44), and the number of needle passes to obtain adequate samples were 2.4 ± 0.6 and 2.7 ± 0.8, respectively (p = 0.76). These findings were confirmed in subgroup analyses, conducted according to lesion size and contrast enhancement pattern. Conclusions: CH-EUS-FNA does not appear to be superior to standard EUS-FNA in patients with pancreatic masses.

A268 PREOPERATIVE EUS-GUIDED FNA IS ASSOCIATED WITH BETTER OVERALL SURVIVAL IN RESECTABLE PANCREATIC CANCER WHEN COMPARED TO UPFRONT SURGERY WITHOUT PREOPERATIVE TISSUE ACQUISITION: A SYSTEMIC REVIEW AND META-ANALYSIS

Abstract Background Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the standard of care in advanced pancreatic cancer. In resectable disease, preoperative EUS-FNA can help to identify benign etiology and other cancers while preventing unnecessary surgery. However, concerns regarding tumor seeding and pancreatitis have led some experts to advocate for upfront surgery without tissue sampling. Aims To conduct a systematic review and meta-analysis of the risks and benefits of performing pre-operative EUS-FNA in patients with suspected, resectable pancreatic cancer. Methods A literature search was performed up to April 2019 using MEDLINE, EMBASE, and ISI Web of Knowledge databases with terms specified for pancreatic neoplasm and FNA. All fully published adult studies that compared preoperative EUS-FNA to EUS without FNA in resectable pancreatic cancer for short- and long-term outcomes were included. Results were reported as Odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CI) using a random effects model. Heterogeneity, publication bias and quality of studies were evaluated. Sensitivity analyses were performed. The primary outcome is overall survival. Secondary outcomes include cancer free survival, tumor recurrence and seeding, and post FNA adverse events. Results An initial search yielded 2814 citations. Six retrospective studies were included with 1155 patients in the EUS-FNA group vs 2067 patients in the comparator group. Overall survival was reported in three studies (n=2701: 796 EUS-FNA, 1905 non-FNA). Patients with preoperative EUS-FNA had better overall survival compared to the non-FNA group (WMD, 4.40 months [0.02 to 8.78]). In adenocarcinoma patients (2 studies, n=2050), there was no significant difference in overall survival (WMD, 2.94 months [-3.87 to 9.74]). Cancer-free survival did not differ significantly between the two groups (WMD, 2.08 months [-2.22 to 6.38]). Moreover, EUS with FNA was not associated with increased rates of tumor recurrence (OR, 0.55 [0.30–1.02]) or peritoneal carcinomatosis (OR, 0.81 [0.56–1.18]). Post-FNA pancreatitis was rare (1.7%), with all patients treated conservatively. Sensitivity analyses yielded similar findings across the different outcomes tested. Conclusions In this meta-analysis, preoperative EUS-FNA in resectable pancreatic cancer was associated with significantly greater overall survival when compared to the non-FNA group with no significant difference in rate of tumour recurrence and/or peritoneal seeding. These findings are limited by the retrospective nature of the included studies; randomized controlled trials are needed to confirm these results. Funding Agencies None

Endoscopic ultrasound-guided fine-needle aspiration for splenomegaly and focal splenic lesion: is it safe, effective and necessary?

splenomegaly and/or focal splenic lesions (FSL) have limited histopathologic studies due to the risk posed by splenic punctures. Percutaneous biopsies with a fine needle are difficult, especially due to interposition of gases, ascites, obesity or a history of abdominal surgery. On the other hand, endoscopic ultrasound (EUS) takes advantage of the proximity of the gastric wall to the spleen in order to puncture and visualize the needle and its movements in real time. to describe the initial experience and results obtained with EUS-FNA in patients with splenomegaly or FSL. this was a descriptive observational study. EUS-FNA of the spleen was performed with a slow-pull technique, which avoided fanning with an average of 3 needle passes. Biopsies were sent in Cytorich RedTM solution for analysis by cytology and cell block. punctures were performed in 15 patients (9 females) and the median age was 67 years (range 44-86). Patients studied due to an enlarged spleen or splenic FSL, in the context of fever of an unknown origin, adenopathies and abnormal weight loss were included. A conclusive diagnosis was achieved by EUS-FNA in 10 patients (66.7 %), 4 were large cell type B non-Hodgkin's lymphoma and one Hodgkin's lymphoma. There were no immediate or delayed complications related to the procedure. EUS-guided splenic punctures appear to be safe, effective and may be necessary in some clinical settings in order to complete the etiologic filiation of splenomegaly of an uncertain origin or FSL and to rule out malignancy.

Diagnostic adequacy and safety of endoscopic ultrasound-guided fine-needle aspiration in patients with lymphadenopathy in a large cohort.

Background and study aims The role of endoscopic-ultrasound (EUS) guided fine-needle aspiration (FNA) in patients with lymphadenopathy in terms of diagnostic adequacy and safety in large population is not well defined. The aim of this study was to evaluate diagnostic adequacy and safety of EUS-FNA in patients with lymphadenopathy. Patients and methods Retrospective study from October 2010 to September 2015 at tertiary care center in Delhi-NCR. We analyzed data from 1005 EUS- FNAs of lymph nodes. Results The study cohort comprised 1005 lymph nodes in 865 patients; 68 % were males, mean age was 50 ± 14 years. Indications of FNA were to look for etiology of pyrexia of unknown origin or staging of malignancy mainly. FNA was taken from mediastinal nodes (n = 528, 52.5 %) and intra-abdominal nodes (n = 477, 47.5 %). Median size of nodes at long axis and short axis was 17 (12 – 25.7) and 10 (8 – 15) mm respectively. Adequate material by FNA was obtained in 92.8 % cases. The cytopathologic diagnosis were malignancy in 153 (15.2 %), granulomatous change in 452 (42 %), and reactive lymphadenopathy in 328 (35.6 %). There was statistically significant difference seen between groups with pathological and reactive lymph nodes regarding size at long and short axis, hypoechoic nature, well defined borders and presence of necrosis and calcification. Procedure-related adverse effects were encountered in 6 patients (0.8 %). Four patients had mild mucosal bleeding in chronic liver disease patients and two had mild hepatic encephalopathy related to sedation. Conclusion EUS-FNA of lymph nodes has good diagnostic adequacy and safety.

Mo1267 Safety and Efficacy of EUS-FNA in Patients 80 Years of Age and Older

Data specifically evaluating EUS-FNA in the elderly is lacking, although EUS-FNA has been widely accepted as a safe and effective modality to obtain tissue samples for various lesions. The aim of the present study was to evaluate the safety and efficacy of EUS-FNA in patients 80 years and older.

Su1378 The Usefulness of Slow-Pull Back Technique of Eus-Fna in Patients With Pancreatic Mass; a Prospective Comparative Study

Su1378 The Usefulness of Slow-Pull Back Technique of Eus-Fna in Patients With Pancreatic Mass; a Prospective Comparative Study

Rendimiento diagnóstico de repetir la biopsia guiada por ultrasonido endoscópico después de una primera biopsia negativa en pacientes con lesiones no pancreáticas

IntroductionEndoscopic ultrasound has been a useful method for the evaluation of pancreatobiliary pathology for more than a decade, however it is not unusual to find inconclusive pathological results in tissue obtained for diagnosis. The factors affecting diagnostic performance include; endosonographist experience, the volume of procedures performed, type, size and location, amongst others. The aim of this study was to evaluate the diagnostic performance of the second EUS-FNA in non-pancreatic lesions. Material and methodsA retrospective cross-sectional study that includedpatients>18 years who underwent EUS-FNA over a period of 8 years. Results150 procedures were performed in 132 patients with non-pancreatic lesions. Finally, the diagnosis was obtained by EUS-FNA in 114/132 patients for a diagnostic yield of 86.6%. In total, the biopsy median (minimum/maximum interval) was 1 (1-5). The diagnostic yield of the first EUS-FNA was 77.3% (102/132). With the second EUS-FNA 11/16 patients had a histological diagnosis (11/16=68.7%; global 85.6%). No complications were reported. ConclusionRepeat EUS-FNA in patients with non-pancreatic lesions is necessary in patients with a first negative EUS-FNA because it improves the diagnostic yield.

Pancreatic cystic lesions: comparison of preoperative cytological results by eus-fna with surgical pathologist diagnosis

Introduction: The preoperative cytological examination of pancreatic cystic lesions with endoscopic ultrasound and fine needle aspiration biopsy [Endoscopic Ultrasonography (EUS)-Fine Needle Aspiration (FNA)] is of great importance for avoiding unnecessary surgery.Aim: The aim of the present study was to show the importance of EUS-FNA in patients with cystic pancreatic lesions by comparing its results with surgical pathology diagnosis, intending by the selection of appropriate patients for surgery, to reduce preoperative morbidity and mortality and long duration of hospitalization conditions which are responsible for hospital infections as well as public health costs.Material and Methods: This was a prospective observational study. The studied sample consisted of 40 patients with pancreatic cysts. For data collection a specific registration form was used; the demographic characteristics, imaging methods and their results, the symptoms, any previous episodes of pancreatitis, the visualization with EUS, cytological analysis of fluid of pancreatic cysts, and CEA levels and fluid amylase, whenever was possible, as well as the pathologist results of the resected lesions were recorded. Data analysis was performed with the Statistical Package for Social Sciences (SPSS).Results: The sample included 40 patients, 17 men (42.5%) and 23 women (57.5%). The overall operating characteristics of EUS-FNA for pancreatic lesions which were resected, were as follows: sensitivity specificity 81.8% 100.0%, positive predictive value of 100%, negative predictive value 66.0% and 86.7% diagnostic accuracy.Conclusions: The present study confirmed that the EUS-FNA is the method which has high accuracy to select the appropriate patients with pancreatic cystic lesions for therapeutic pancreatectomy.

EUS-guided fine needle biopsy sampling using a novel fork-tip needle: a case-control study.

EUS-guided fine needle biopsy (FNB) sampling and FNA are important methods for obtaining core tissues and cytologic aspirates. To improve the specimen quality for pathologic evaluation, a novel EUS-FNB Shark Core (SC) needle has been designed to acquire core tissue during EUS procedures. We compared the histology yield of EUS-FNB sampling using the SC needle (EUS-FNB-SC) to EUS-FNA in patients who had solid pancreatic and nonpancreatic lesions. This was a retrospective case-control study design. Between July 2012 and July 2015 all patients who had EUS-FNB-SC and EUS-FNA were reviewed through a hospital EUS database. Consecutive samples from EUS-FNB-SCs were matched in a 1:3 ratio by lesion site (eg, pancreatic head) and needle gauge (ie, 19 gauge, 22 gauge, 25 gauge) to recent random samples of EUS-FNA. The procedures were performed with rapid onsite evaluation. For study purposes specimen slides were evaluated by 2 cytopathologists for histologic yield using a standard scoring system (0= no material, 1-2= cytologic, 3-5= histologic). The main objectives were to assess the histologic yield of the samples and compare the median number of passes required to obtain core tissue by using EUS-FNB-SC and EUS-FNA needles. Of the 156 patients included in study, 25% patients (n= 39) were in the EUS-FNB-SC group and 75% (n= 117) in the EUS-FNA group. According to standard scoring criteria for histology, the median histology score for EUS-FNA was 2 (sufficient for cytology but not histology) and for EUS-FNB-SC was 4 (sufficient for adequate histology). Ninety-five percent of the specimens obtained from the EUS-FNB-SC group were of sufficient size for histologic screening, compared with 59% from the EUS-FNA group (P= .01). The median number of passes required to achieve a sample was significantly lower in the EUS-FNB-SC group compared with the EUS-FNA group (2 passes vs 4 passes, P= .001). There was significant difference in the median number of passes to all lesion sites and needle gauges. The histology yield was significantly higher using the EUS-FNB-SC needle compared with the EUS-FNA needle. Additionally, fewer passes were required to obtain histology cores when using EUS-FNB-SC.

Is endoscopic ultrasonography-guided fine needle aspiration trailblazing in tissue sampling of adrenal masses?

Is endoscopic ultrasonography-guided fine needle aspiration trailblazing in tissue sampling of adrenal masses?

Analysis of complications after EUS-FNA in patients with obstructive jaundice and drained with plastic biliary stents or self-expandable metal stent (SEMS): do complications differ between the type of stent?

Analysis of complications after EUS-FNA in patients with obstructive jaundice and drained with plastic biliary stents or self-expandable metal stent (SEMS): do complications differ between the type of stent?

Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions

Few studies have evaluated the impact of biliary stents on EUS-guided FNA. To compare diagnostic yield of EUS-FNA in patients with or without biliary stents. Retrospective study. Tertiary referral center. Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years. The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis. Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001). Retrospective study. The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.

Use of endoscopic ultrasound to reduce the need for SpyGlass cholangioscopy and improve its diagnostic yield.

169 Background: The accuracy of SpyGlass cholangioscopy (SGC) guided biopsy is only modest (60%) due to extrinsic lesion causing ductal stricture. Endoscopic ultrasound (EUS) can visualise the biliary tree and acquire tissue via fine needle aspiration (FNA). The aim is to evaluate the utility of EUS-FNA in patients who were referred for SGC for biliary strictures. Methods: The clinical impact of EUS-FNA was prospectively examined in 17 patients (10M; 56.2±1.9 yrs) who were referred for SGC to investigate difficult biliary strictures over 15 months. All patients had endoscopic retrograde cholangiography and biliary stenting with negative ductal brushing. Any mass lesion(s) or pathological node(s) found on EUS were biopsied. SGC and ductal biopsy were only performed if EUS-FNA could not provide a diagnosis. The results were compared to the surgical specimens or the positive histo-cytological findings from biopsies. Results: EUS examination was able to identify all ductal or peri-ductal abnormalities responsible for the biliary strictures, with sonographic diagnoses of cholangiocarcinoma (n=10), autoimmune pancreatitis (n=2), choledochocyst related stricture (1); pancreatic cancer (n=1), gallbladder cancer (n=1), Mirrizi’s syndrome (n=1) and colorectal metastasis (n=1). EUS-FNA was possible in 13 (76%) cases and provided tissue diagnosis in 9 (59%) patients, which can potentially avoid the need for SGC and cost saving of ~$ 48,000. SGC examination was successful in 7/8 patients, with 100% correct tissue diagnosis from Spybite biopsy (4 cholangio-carcinomas, 1 autoimmune pancreatitis, 1 biliary villous adenoma, 1 hepatoma, 1 high grade dysplastic choledochocyst). SpyScope intubation was not possible in a patient with long-standing primiary sclerosing cholangitis who had tight stricturing of the entire extra-hepatic duct. Overall, tissue diagnosis was established in 94% (16/17) patients. Conclusions: EUS able to detect 100% ductal or peri-ductal abnormalities responsible for biliary strictures referred for SGC. Together with FNA, EUS provides correct diagnosis and avoids the need for SGC in 59% of cases, resulting in significant cost saving but also improving the yield of SpyGlass guided biopsy.

EUS guided fine needle aspiration is useful in diagnostic evaluation of indeterminate proximal biliary strictures

Background and Aim: Determination of the etiology of proximal biliary strictures (PBS) still remains a challenge. Even though EUS-FNA is potentially useful, its role in diagnostic evaluation of PBS is still not established due to a lack of sufficient data. We sought to determine the performance characteristics of EUSFNA in patients with obstructive jaundice (ObJ) and PBS. Patients and Methods: This is a retrospective analysis and included patients with ObJ and PBS with non-diagnostic brush cytology, who underwent EUS-FNA in our university based practice from March 2002 to February 2009. We evaluated the final diagnoses in study patients and the performance characteristics of EUS-FNA for identifying malignant PBS. Final diagnosis was based on surgical pathology or clinical follow-up of at least 12 months. Results: The study included 28 patients (17 male, 11 female) with mean age of 62.4 ± 14.9 years. The strictures ranged from 10 - 70 mm in length. CT scan identified a hilar mass in 9 patients. EUS-FNA identified malignancy in 12 patients. 18 patients were finally diagnosed to have a malignant stricture and 10 patients had a benign stricture. There were 6 false negative diagnoses. The accuracy of EUS-FNA for diagnosis of cholangiocarcinoma was 78.6%, with 66.6% sensitivity, 100% specificity, 62.5% NPV and 100% PPV. Conclusions: EUS-FNA can diagnose malignancy in 66.6% of jaundiced patients with PBS and non-diagnostic brush cytology and may have a role in their further diagnostic evaluation.

Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy

This retrospective cohort study analyzes the potential risks associated with preoperative fine needle aspiration (FNA) biopsy guided by endoscopic ultrasonography (EUS) in patients undergoing distal pancreatectomy. Excluding 204 patients with acute or chronic pancreatitis and those with previous pancreatic resections, 230 consecutive patients with primary pancreatic neoplasms underwent elective distal pancreatectomy between 2002 and 2009. The most common indications were adenocarcinoma (28%), intraductal papillary mucinous neoplasm (IPMN; 20%), and endocrine neoplasms (17%). Two-way statistical comparisons were performed between patients who did (EUS(+)) or did not (EUS(-)) undergo preoperative EUS-FNA. Distal pancreatectomy was performed open in 118 patients (56%) and laparoscopically in 102 patients (44%). No differences were observed in age, sex, American Society of Anesthesiologists class, operative time, or blood loss between the EUS(+) (n = 179) and EUS(-) (n = 51) groups. Splenectomy was performed in 162 patients (70%) and was more common in the EUS(+) group. With the exception of adenocarcinoma (n = 57 [32%] EUS(+) vs n = 6 [12%] EUS(-); P < .01), the final pathologic diagnosis did not differ significantly between the EUS groups. Postoperative complications were more common in the EUS(+) patients with cystic neoplasms (43% vs 16% EUS(-); P = .04). EUS-FNA caused pancreatitis in 2 patients preoperatively. No differences in overall or recurrence-free survival were noted between cancer patients in the EUS groups. Patterns of tumor recurrence were not associated with EUS-FNA. Preoperative EUS-FNA is not associated with adverse perioperative or long-term outcomes in patients undergoing distal pancreatectomy for solid neoplasms of the pancreas. The potentially detrimental long-term impact of preoperative EUS-FNA in patients with resectable pancreatic adenocarcinoma was not observed, but will require additional study.

Endoscopic Ultrasound Staging and Guided Fine Needle Aspiration Biopsy in Patients with Resectable Pancreatic Malignancies: A Single-Center Prospective Experience

Background: Endoscopic ultrasound staging and guided fine needle aspiration biopsy (EUS-FNA) is a highly accurate diagnostic method, useful in characterizing pancreatic lesions, obtaining definitive tissue diagnosis in patients with suspected pancreatic lesions, and providing accurate locoregional staging that enhances diagnostic certainty and evaluation of appropriateness of surgical intervention. The aims of this study were to evaluate the preoperative contribution of EUS staging and EUS-FNA in patients with suspected resectable pancreatic malignancies. Patients and Methods: A prospective study was conducted in a tertiary referral center. During a 54-month period, a total of 103 consecutive patients were prospectively evaluated with EUS and EUS-FNA. Enrolled in the study were patients with resectable pancreatic lesions, who underwent surgery. Results: The overall operating characteristics of EUSFNA were sensitivity 96.7%, specificity 90.0%, positive predictive value 98.9%, negative predictive value 75.0%, and diagnostic accuracy 96.1%. Conclusion: EUS and EUS-FNA have a high accuracy and positive predictive value in the preoperative determination of resectability in pancreatic cancer.

Pancreato-Biliary Malignancy Diagnosed by Endoscopic Ultrasonography in Absence of a Mass Lesion on Transabdominal Imaging: Prevalence and Predictors

Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Pancreatic cancer is diagnosed in some patients by endoscopic ultrasonography (EUS) even in the absence of an obvious mass lesion on transabdominal imaging studies. The purpose of this study was to estimate the prevalence of PBM on EUS-FNA in patients with no obvious mass on transabdominal imaging and identify possible predictors of PBM in this cohort of patients. Three hundred and twenty-six patients (219 female; mean age: 57) with no obvious neoplastic lesion on trans-abdominal imaging underwent EUS. Demographic data, indication of EUS, history of weight loss, smoking, alcohol use, diabetes, cholecystectomy status, CT and USG findings, and liver function tests (LFTs) were reviewed. Thirty patients (9%) were diagnosed with a PBM by EUS-FNA (27 pancreatic adenocarcinoma, three ampullary adenocarcinoma). The mean age of patients diagnosed with PBM was significantly (P < 0.01) higher than controls. The mean size of the tumor was 2.8 cm (range: 0.9-7 cm). Male gender, presence of jaundice, abnormal LFTs, weight loss, and nonspecific trans-abdominal imaging results such as dilated common bile duct (CBD), and abnormal appearing pancreas predicted the presence (P < 0.05) of PBM, whereas patients with previous cholecystectomy and abdominal pain were less likely to have this diagnosis. Normal trans-abdominal imaging does not completely exclude the presence of PBM. Nonspecific pancreatic abnormalities and CBD dilation on trans-abdominal imaging, with jaundice, abnormal LFTs, weight loss, and lack of abdominal pain are predictors of PBM.

Estudo prospectivo e comparativo do escovado obtido pela CPER à ecoendoscopia associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico diferencial das estenoses biliares

To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures. Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results. 46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic--11 biliary) and benign in 9 (8 chronic pancreatitis--1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2% and 52.2% for GP and 51.4% and 58.7% for GIP. Sensitivity and accuracy for EUS-FNA were 52.8% and 58.5%, respectively for GP and 69.4% e 73.2% for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9% and 69.6%, respectively) and GIP (83.8% and 84.8%, respectively) and improved agreement with final diagnosis for both (mostly for GIP). Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.

The Utility of Repeat Endoscopic Ultrasound-Guided Fine Needle Aspiration for Suspected Pancreatic Cancer

Background. The utility of repeat EUS in patients with suspicion for pancreatic cancer after non-diagnostic EUS-FNA study is not well established. Aim. Determine the accuracy of repeat EUS-FNA in patients with suspected pancreatic cancer and prior non-diagnostic EUS-FNA. Methods. Retrospective cohort study. Results. From 2002 to 2008 in our institution 28 patients underwent repeat EUS-FNA for suspected pancreatic cancer. Initial EUS showed a pancreatic mass in 24 (85.71%), no mass in 3 (10.71%) and possible mass in 1 (3.58%). FNA was performed and was negative for malignancy in all patients. Repeat EUS showed pancreatic mass in 27 patients (96.42%) and no mass in 1 (3.58%). FNA was performed in all patients and cytology was positive for malignancy in 6 (21.43%). Out of the 28 patients, 17 (60.71%) were eventually confirmed to have cancer. Overall repeat EUS-FNA correctly determined the true final status in 17 out of 28 patients providing sensitivity for the diagnosis of cancer of 35% (95% CI 14%–62%), specificity 100% (95% CI 72%–100%), and overall accuracy of 61%, (95% CI 28%–72%). Conclusion. Repeat EUS-FNA provides reasonable accuracy and may be worthwhile in patients with suspected pancreatic cancer who had had prior negative EUS-FNA.

Mediastinal-esophageal fistulae after EUS-FNA of tuberculosis of the mediastinum

EUS-FNA has been reported to be a safe and accurate diagnostic method for investigating mediastinal lymph nodes (LNs) in patients with suspected lung cancer and sarcoidosis. The safety record of EUS-FNA in patients with mediastinal tuberculosis (TB) is unknown. We describe a patient with TB who developed mediastinal-esophageal fistulae after EUS-FNA of a tuberculous subcarinal LN.