Needle Aspiration Of Pancreatic Masses Research Articles

The efficacy of rapid on-site evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses.

BackgroundEndoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has become the preferred method to diagnose pancreatic masses due to its minimally invasive approach and diagnostic accuracy. Many studies have shown that rapid on-site evaluation (ROSE) improves diagnostic yield by 10–30%; however, more recent studies have demonstrated effective diagnostic accuracy rates without ROSE. Our study aims to examine whether the current standard of performing ROSE after each FNA pass adds diagnostic value during EUS-guided FNA of pancreatic masses.MethodsWe conducted a retrospective case series on patients who underwent EUS-guided FNA of pancreatic masses between February 2011 and October 2014. All cases were performed by one of three endoscopists at Emory University Hospital. Patient demographics, radiologic details of pancreatic masses and pathology reports of the biopsied pancreatic masses were examined.ResultsA total of 184 procedures performed in 171 patients were reviewed. The final pathology reports of the biopsied pancreatic masses showed 128 (70%) with confirmed malignancy. Only 64 (50%) of these 128 cases initially showed malignant cells during ROSE. Among these 64 cases, 23% required 5 or more FNA passes to first detect malignant cells.ConclusionsThe use of ROSE during EUS-guided FNA of pancreatic masses may increase the diagnostic yield, since malignant cells were often detected during later FNA passes that would otherwise be missed if tissue sampling stopped prematurely. In addition, sample preparation for ROSE may be suboptimal, since malignant cells were only detected in 50% of cases.

Su1341 The Efficacy of Rapid On-site Evaluation During Endoscopic Ultrasound Guided Fine Needle Aspiration of Pancreatic Masses

Su1341 The Efficacy of Rapid On-site Evaluation During Endoscopic Ultrasound Guided Fine Needle Aspiration of Pancreatic Masses

The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: a prospective multicenter randomized controlled trial.

Observational data on the impact of on-site cytopathology evaluation (OCE) during endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic masses have reported conflicting results. We aimed to compare the diagnostic yield of malignancy and proportion of inadequate specimens between patients undergoing EUS-FNA of pancreatic masses with and without OCE. In this multicenter randomized controlled trial, consecutive patients with solid pancreatic mass underwent randomization for EUS-FNA with or without OCE. The number of FNA passes in the OCE+ arm was dictated by the on-site cytopathologist, whereas seven passes were performed in OCE- arm. EUS-FNA protocol was standardized, and slides were reviewed by cytopathologists using standardized criteria for cytologic characteristics and diagnosis. A total of 241 patients (121 OCE+, 120 OCE-) were included. There was no difference between the two groups in diagnostic yield of malignancy (OCE+ 75.2% vs. OCE- 71.6%, P=0.45) and proportion of inadequate specimens (9.8 vs. 13.3%, P=0.31). Procedures in OCE+ group required fewer EUS-FNA passes (median, OCE+ 4 vs. OCE- 7, P<0.0001). There was no significant difference between the two groups with regard to overall procedure time, adverse events, number of repeat procedures, costs (based on baseline cost-minimization analysis), and accuracy (using predefined criteria for final diagnosis of malignancy). There was no difference between the two groups with respect to cytologic characteristics of cellularity, bloodiness, number of cells/slide, and contamination. Results of this study demonstrated no significant difference in the diagnostic yield of malignancy, proportion of inadequate specimens, and accuracy in patients with pancreatic mass undergoing EUS-FNA with or without OCE.

Endoscopic Ultrasonography Fine Needle Aspiration in Pancreatic Masses: A Study Comparing 22-gauge and 25-gauge Needle in the Same Patient

Background: It remains unclear whether the 22- and 25-gauge needles have equal diagnostic yields in endoscopic ultrasonography–fine needle aspiration of pancreatic masses. Methods: Patients presenting with pancreatic solid masses were prospectively included between July 2010 and June 2012. Each patient underwent ultrasonography–fine needle aspiration using two different needle sizes (22- and 25-gauge needles) during the same endoscopic session, the 25 and 22 needle sequence being randomized. Cytological preparations included smear cytology, ThinPrep and Cell Block. Specimens were analyzed for diagnosis, cellularity, amount of blood and digestive contamination. Final diagnosis was reached by the final pathological report, clinical and radiological follow-up. Results: Thirty-seven patients were included among them 34 subjects had malignant pancreatic neoplasm on final diagnosis. Pancreatic masses were located in the head of pancreas in 73% of cases. The mean size of the lesions was 34.6 ± 14.4 mm. Diagnostic yields of the 25- and 22-gauge needles were 85.3% (95%CI: 72.6-98) and 88.2% (95%CI:76.7-99.7) respectively (p > 0.05). Diagnosis was obtained with smear cytology alone in 58.8% patients with the 22-gauge needle and in 55.9% patients with the 25-gauge needle, in 64.5% patients with Cell Block for both needles and in 76.5% with ThinPrep for both needles. The quality of specimens was comparable with the two needles. No complication occurred. Conclusion: The 25- and 22-gauge needles carry the same diagnostic yield when performing ultrasonography– fine needle aspiration of solid pancreatic masses. ISRCTN69545565 Controlled trials.

Clinical analysis of 250 cases of ultrasound-guided percutaneous fine needle aspiration of pancreatic mass

Objective To assess the accuracy and safety of cytopathological diagnosis of ultrasound guided fine needle aspirated(US-FNA)pancreatic masses.Methods From January 2008 to February 2013,250 pancreatic mass cases underwent US-FNA and with cytopathological diagnosis were retrospectively analyzed.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calculated.The stratified analysis of accuracy was compared by Pearson x2 test.Results Among 250 patients,the results of US-FNA cytological analysis indicated that cancer cells were found in 221 cases; atypical cells in two cases; nine cases were suspicious cancer and all of them were confirmed malignant in the end.Among the 18 patients with negative diagnostic results (epithelial cell proliferated in two cases,tissue liquefaction necrosis in two cases,inflammatory cells in one case and 13 cases without malignant cells) 12 cases were finally proved malignant and six cases were benign (three cases of pancreatic benign tumor,one case of pancreatic pseudocyst,one case of pancreatic tuberculosis and one case of pancreatitis).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of US-FNA in pathological diagnosis were 90.57％,100.00％,100.00％,20.68％ and 90.80％,respectively.The results of stratified analysis indicated that the diagnostic accuracy of US-FNA in mass with diameter ≥3 cm was significantly higher than that with diameter ＜3 cm,but the difference wasn't statistically significant (P＞0.05).Among 250 patients,45 patients had slight abdominal pain and all were self healing.No other complications were found.All patients were followed up until death or at least six months and no peritoneal spread through needle tract seeding was detected after long time follow-up.Conclusions The US-FNA in pancreatic mass diagnosis has a high accuracy and a good safety with low cost and easy operation.It is a good choice for the pathological diagnosis of unresectable pancreatic lesion. Key words: Ultrasonography; Biopsy, fine-needle; Pancreatic neoplasm

Mo1451 The Contrast Enhanced Endoscopic Ultrasound Increases the Diagnostic Accuracy of the Fine Needle Aspiration in Pancreatic Masses

The global accuracy of fine needle aspiration endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85%. The contrast agents during EUS may highlight the vessels and the necrotic parts of the pancreatic masses, but their incremental role in diagnosis is not known.

Severe Bleeding and Perforation Are Rare Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Masses: An Analysis of 3,090 Patients from 212 Hospitals

Background/AimsEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for the pathological diagnosis of pancreatic masses, but patients are susceptible to severe bleeding and perforation. Because the incidence and severity of these complications have not been fully evaluated.MethodsWe aimed to evaluate severe bleeding and perforation after EUS-FNA for pancreatic masses using large-scale data derived from a Japanese nationwide administrative database.ResultsIn total, 3,090 consecutive patients from 212 low- to high-volume hospitals were analyzed. Severe bleeding requiring transfusion or endoscopic treatment occurred in seven patients (0.23%), and no perforation was observed. No patient mortality was recorded within 30 days of EUS-FNA. The rate of severe bleeding in low-volume hospitals was significantly higher than that in medium- and high-volume hospitals (0.48% vs 0.10%, p=0.045).ConclusionsSevere bleeding and perforation following EUS-FNA for pancreatic masses are rare, and the procedure is safe.

Does General Anesthesia Increase the Diagnostic Yield of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Masses?

Ootaki, Chiyo*; Stevens, Tyler†; Vargo, John†; You, Jing‡; Shiba, Ayako*; Foss, Joseph*; Borkowski, Raymond*; Maurer, Walter* Author Information

Mo1507 The Utility of the Contrast Enhanced Endoscopic Ultrasound in Guiding Fine Needle Aspiration for Pancreatic Masses

The global accuracy of fine needle aspiration endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85%. The use of the contrast agents during EUS may highlight the vessels and the necrotic parts of the pancreatic masses, which could lead to obtaining larger and less bloody pancreatic samples.

A prospective, randomized trial comparing 25-gauge and 22-gauge needles for endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

Objectives. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is widely performed for pancreatic masses. The 25-gauge needle (25G) might be easier to be manipulated and expected to be associated with fewer complications since it is thinner and more flexible than the 22-gauge needle (22G) although obtaining adequate specimens is questioned. In this randomized trial, the authors tried to compare prospectively 25G and 22G in diagnostic accuracy, manipulability from the operator's viewpoint and procedure-related complications. Material and methods. A total of 188 consecutive patients undergoing EUS-FNA for solid or cystic pancreatic masses were consecutively enrolled and 94 patients were randomized to either 25G or 22G group, respectively. Results. Baseline characteristics were similar except that more masses of 25G group were located in the head or uncinate process of pancreas than those from 22G group. Although there was no difference in diagnostic accuracy (89.4% vs. 88.3% with p = 0.82), 25G was easier to be manipulated (p = 0.004) and related with fewer procedure-related complications (10.6% vs. 3.2% with p = 0.004). Conclusions. 25G can be chosen in preference to 22G when performing pancreatic EUS-FNA because 25G was significantly superior to 22G in terms of manipulability and complications although both were effective for accurate diagnosis.

Does General Anesthesia Increase the Diagnostic Yield of Endoscopic Ultrasound-guided Fine Needle Aspiration of Pancreatic Masses?

: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the pancreas has become the preferred method for tissue diagnosis for pancreatic solid masses. The yield of EUS-FNA in this setting is influenced by multiple factors. We hypothesized that general anesthesia (GA) may improve EUS-FNA yield by improving patient cooperation and stillness during the procedure. Our objective was to assess the association between the sedation method employed and the diagnostic yield of EUS-FNA. : A retrospective cohort study was conducted involving consecutive patients who received EUS-FNA for diagnosis of a solid pancreatic mass at the Cleveland Clinic (Cleveland, OH) gastrointestinal endoscopy units from 2007 to 2009. We compared the diagnostic yield of EUS-FNA between patients receiving GA provided by an anesthesiologist (GA group) and patients receiving conscious sedation (CS) provided by a qualified registered nurse (CS group). : Of 371 patients, a cytological diagnosis was obtained in 73/88 patients (83%) in the GA group and 206/283 patients (73%) in the CS group. Anesthesiologist-delivered GA was associated with an increased odds of having a successful diagnosis as compared with CS (adjusted odds ratio [95% CI]: 2.56 [1.27-5.17], P = 0.01). However, the incidence of complication during or after the procedure was not different between the groups (P > 0.99). : Anesthesiologist-delivered GA was associated with a significantly higher diagnostic yield of EUS-FNA. GA should be considered a preferred sedation method for EUS-FNA of a solid pancreatic mass.

Dynamic telecytopathology for on-site preliminary diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

We evaluated dynamic telecytopathology for on-site-evaluation of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of the pancreas. Realtime images of stained cytology smears were assessed by a cytopathologist while communicating with the on-site operator by telephone. A total of 55 consecutive cases was assessed; preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 69%, 7% and 24%. We also reviewed 55 consecutive cases of EUS-guided FNA of pancreas which had had conventional microscopic on-site evaluation prior to the introduction of telecytopathology. Preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 60%, 9% and 31%. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Neuroendocrine neoplasms and well-differentiated adenocarcinoma were diagnostically challenging for both telecytopathology and conventional microscopy. Telecytopathology was similar in accuracy of preliminary diagnosis to conventional microscopy during EUS-FNA of pancreas.

Pancreatic Pseudocyst after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Mass

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is well known as a safe diagnostic procedure. We report the first case of pancreatic pseudocyst after EUS-FNA of the pancreatic body mass. A 60-year-old male underwent EUS-FNA for incidentally detected pancreatic solid mass which was suspected as neuroendocrine tumor. Two weeks later, the patient visited emergency room with acute abdominal pain and right upper quadrant tenderness; leukocytosis and elevated C-reactive protein, amylase, and lipase levels were noted. Computed tomography discovered newly developed 11.5×9.5 cm sized cystic mass communicating with the main pancreatic duct. Cyst fluid analysis revealed amylase level of 3,423 U/L and fluid culture isolated Streptococcus parasanguinis. The cystic mass corresponds with pancreatic pseudocyst. FNA induced main pancreatic duct injury and fluid leakage may cause it. Endoscopists who perform EUS-FNA must remember that pancreatic main duct injury can occur as one of severe complications and that it could be treated successfully with endoscopic internal drainage.

Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: The utility and impact on management of patients

Objective. It is controversial whether endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is beneficial in all patients with suspected pancreatic cancer. The aim of this study was to assess diagnostic yield, safety and impact of EUS-FNA on management of patients with solid pancreatic mass. Material and methods. Consecutive patients undergoing EUS-FNA of solid pancreatic mass were enrolled. Gold standard for final diagnosis included histology from surgical resection. In patients without surgery, clinical evaluation methods and repeated imaging studies were used for the comparison of initial cytology and final diagnosis. Patients were followed-up prospectively focusing on subsequent treatment. Results. Among 207 enrolled patients, final diagnosis was malignant in 163 (78.6%) and benign in 44 (21.4%). The sensitivity, specificity and accuracy of EUS-FNA in diagnosing pancreatic cancer were 92.6% (95% CI: 87.20–95.96), 88.6% (95% CI: 74.64–95.64) and 91.8% (95% CI: 87.24–94.81), respectively. No major and five (2.4%) minor complications occurred. Of 151 true-positive patients by EUS-FNA, 57 (37.7%) were surgically explored, of whom 28 (49.1%) underwent resection. Ten of 12 patients with false-negative cytology were explored based on detection of mass on EUS, of whom two had a delay due to false-negative cytology without curative treatment. From the whole study cohort, EUS-FNA had positive and negative impacts on subsequent management in 136 (65.7%) and 2 (0.9%) patients, respectively. Conclusions. EUS-FNA provides accurate diagnosis in 92% and has positive therapeutic impact in two-thirds of patients with solid pancreatic mass. Despite negative cytology, surgical exploration is recommended in clinical suspicion for pancreatic cancer and solid mass on EUS.

Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Masses in a Veteran Population

Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Masses in a Veteran Population

Role of pancreatic endoscopic ultrasonography in 2010

Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the role of EUS in the clinical management of patients with pancreatic disease. Major indications of EUS are: (1) Detection of common bile duct stones (e.g. in acute pancreatitis); (2) Detection of small exo- and endocrine pancreatic tumours; and (3) Performance of fine needle aspiration in pancreatic masses depending on therapeutic consequences. EUS seems to be less useful in cases of chronic pancreatitis and cystic pancreatic lesions. Moreover the constant improvement of computed tomography has limited the role of EUS in pancreatic cancer staging. On the other hand, new therapeutic options are available due to EUS, such as pancreatic cyst drainage and celiac plexus neurolysis, offering a new field in which new techniques may arise. So the main goal of this review is to determine the exact role of EUS in a number of pancreatic and biliary diseases.

Clinical Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Pancreatic Masses Using a 25-Gauge Needle System: A Multicenter Experience

Background and Aims: EUS-FNA is now performed routinely in many advanced endoscopy centers and has enhanced the ability to diagnose pancreatic masses. However, there is uncertainty about which needle size is most optimal for EUS-FNA of pancreatic masses. All of the early published data on this topic is based on the use of 22-gauge or 19-gauge EUS-FNA needles. It is postulated that a smaller caliber needle might provide more accurate results and have less complications. We aimed to evaluate our experience in diagnosing pancreatic masses with EUS-FNA using a 25-gauge disposable needle system. Methods: All patients referred for EUS-FNA for pancreatic masses between Feb 2001 and Nov 2007 at three advanced endoscopy centers were reviewed and patients who underwent EUS-FNA using the 25-gauge needle system (EchoTip, Cook Endoscopy, Winton-Salem, NC) were identified. In this IRB exempt study data related to patient demographics, clinical findings, long term follow-up and pathological findings were recorded. In patients who underwent surgery, operative histopathology was compared with the cytopathology from EUS-FNA. Results: A total of 288 patients (mean age 65y, age range 18-91y; 150 M, 138 F) with pancreatic masses detected on CT and/or MRI and confirmed by EUS underwent EUS-FNA with the 25-gauge needle. Adequate samples were obtained in 94% (271/288) of the patients. Pancreatic malignancy was diagnosed on cytopathology in 56% (161/288) and no malignancy was identified in 38% (110/288) of the patients. EUS-FNA sample was inconclusive in 6% (17/28). No complications were reported in our study cohort. Of patients with pancreatic malignancy, 89% (144/161) had adenocarcinoma, while 11% (17/161) had other malignancies. Surgical pathology was available and compared to the EUS-FNA cytopathology in 26 patients. Inconclusive results were considered negative for comparison. There were no false-positive results and 3 false-negative FNA results (1 negative, 2 inconclusive). Sensitivity, specificity, PPV and NPV of FNA were 81%, 100%, 100% and 78% respectively. Conclusions: EUS-FNA with a 25-gauge needle system is a safe and reliable method for tissue sampling in pancreatic masses. There were no complications noted in our study. When compared to previously published studies, there is an expected complication rate of ∼2% with pancreatitis being the most concerning. Our study suggests that perhaps the smaller caliber 25-gauge needle causes less trauma during EUS-FNA and hence less complications. Further studies including randomized trials are needed to determine the comparative accuracy and safety of the 25-gauge needle system against other available needles.

Endoscopic ultrasound–fine needle aspiration (EUS–FNA) for pancreatic lesions: Effectiveness in clinical practice

Background Diagnosis of pancreatic masses is often difficult. Endoscopic ultrasound–fine needle aspiration has been proposed as the best single-step strategy. Aims To prospectively evaluate feasibility, effectiveness and safety of endoscopic ultrasound–fine needle aspiration of pancreatic masses in a consecutive study of unselected patients. Methods Two hundred ninety-three patients were enrolled in two referral Hospitals in Northern Italy. All patients were referred either due to the presence of imaging test abnormalities (suspected or evident masses, or features indirectly suggesting the presence of a mass) or due to clinical or biochemical findings suggesting pancreatic cancer in the absence of positive imaging. All patients underwent linear array endoscopic ultrasound and, when indicated, fine needle aspiration. All procedures were recorded prospectively. The final diagnosis was established at the end of follow-up or when the patients underwent surgery or died. Results Fine needle aspiration was indicated in 246 of 293 cases (84%), considered technically feasible in 232 of 246 cases (94%) and gave adequate samples for histopathological diagnosis in 204 of 232 cases (88%). Endoscopic ultrasound sensitivity, specificity and accuracy were 79, 60 and 72%, respectively; the corresponding figures for endoscopic ultrasound–fine needle aspiration were 80, 86 and 82%. There was good agreement with final diagnosis for endoscopic ultrasound–fine needle aspiration (kappa 0.673, 95%CI 0.592–0.753), greater than that for endoscopic ultrasound alone (kappa 0.515, 95%CI 0.425–0.605). There was one case of intracystic haemorrhage and one case of transient hyperthermia (0.3%). Conclusions Endoscopic ultrasound–fine needle aspiration of pancreatic masses seems to be feasible, effective and safe in this consecutive study of patients.

Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses

Background: Identification, staging, and fine needle aspiration of pancreatic mass lesions are probably the most technically demanding EUS skills. This study evaluated the effect of formal training on the diagnostic accuracy of EUS-guided fine needle aspiration (EUS-FNA) of pancreatic masses and the source of the variability in diagnostic accuracy between initial and later procedures. Methods: Sixty-five patients with pancreatic masses underwent EUS-FNA between April 1998 (introduction of EUS-FNA) and August 1999, 20 of whom were examined by 3 endosonographers without prior experience with EUS-FNA. The initial experience of these 3 endosonographers (April to December 1998; group A patients), which included a formal training period of 2 months, and their later experience (January to August 1999; group B patients) were evaluated. Final diagnoses were determined by surgical pathology or clinical follow-up. All EUS-FNA samples were reviewed by 4 blinded pathologists to determine the contribution of pathologist interpretation to varying EUS-FNA accuracy. Results: After a short training period, there was a significant improvement in EUS-FNA accuracy (33% vs. 91%; p = 0.004). After pathology review, good agreement was identified between original FNA interpretation and that on review (kappa = 0.78; 95% CI [0.5, 1.0]). There were differences between the mean cellularity score (2.8 vs. 1.8, p = 0.01) and mean number of passes (5.1 vs. 2.8, not significant) for correct versus incorrect FNA specimens. Conclusion: Significant improvements in EUS-FNA accuracy can be achieved with a short period of mentored training. EUS-FNA errors during the initial learning phase are primarily due to inadequate specimens. Interpretation of pancreatic EUS-FNA specimens remained consistent before and after training. (Gastrointest Endosc 2002;55:669-73.)

4544 Prospective comparison of 22 gauge versus 19 gauge needle for endoscopic ultrasound directed fine needle aspiration of pancreatic masses: does size matter?

Background: EUS guided FNA allows for accurate diagnosis of pancreatic neoplasms. Yield is hampered by the small amount of tissue obtained with a standard 22 gauge needle. Larger needles may improve diagnosis but may also increase risks. Methods: We prospectively analyzed all patients referred with pancreatic masses over six months. After staging with radial EUS (Olympus GF-UM20), real-time FNA was attempted using curved linear array EUS (Olympus GF-UC30P) with a 22 gauge needle (Wilson Cook EchoTip®) and a 19 gauge needle, (Mediglobe). The order of use was alternated. Smears and cell blocks of aspirates were made immediately and sent for interpretation. Diagnosis was confirmed at surgery, by additional core biopsies or by clinical course. Cytologic diagnosis, needle characteristics and complications were recorded and aspirates blindly reviewed for relative quantity and quality of cellular material. Results: Over six months, 22 patients were referred for EUS of a pancreatic mass. Of these, 20 underwent FNA, 6 with 22 g alone, 1 with 19 g alone and 14 with both, (attempt failed with the stiffer 19g needle in 2 additional cases). 14 of these cases eventually were proven to be cancers. Other diagnoses included one CIS, 2 chronic pancreatitis, 3 cysts or pseudocysts. Average total needle passes per case was 2.7, divided equally between types. 22 g detected 10 of 13 cancers, (77% sens.) with 100% specificity. 19 g detected 8 of 9 cancers (89% sens.) with 100% specificity, when tissue was obtained. Overall sensitivity was 82%. Accuracy with 22 g needle was 79% and 93% with 19 g needle, for an overall accuracy of 85%. Of eight cancers sampled with both needles, three 19 g aspirates were felt to be of better quality, due to increased tissue sampling, preservation of architecture and greater cellularity. Three 22 g. aspirates were felt to be superior due to less blood and better cellularity. Two samples were identical. In several cases, cell blocks of spun aspirates from both needles increased yield. One case of minor bleeding was linked to use of a 19 g needle. In no case was cancer detected with one needle and not the other. Conclusion: 1). Both 19 g and 22 g needles are useful for EUS guided FNA of pancreatic masses. 2). Needle size does not clearly correlate with specimen size or quality. 3). 19 gauge needles were more difficult to place, especially from the duodenum and may be associated with a higher risk of bleeding. 4). Cell blocks of aspirates probably increase diagnostic yield.