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.

Pancreatic Adenocarcinoma	72 (58.53%)
Neuro Endocrine Tumor	13 (10.56%)
Mucinous adenocarcinoma	1 (0.08%)
Intraductal Papillary adenocarcinoma	2 (1.62%)
Atypical Cells	18 (13.84%)
Benign pancreatic tissue	21 (17.07%)

Table 1. Cytopathology results of EUS-FNA performed on solid pancreatic lesions

Conclusion: EUS-FNA is a minimally invasive and safe procedure to evaluate patients with pancreatic solid tumors and can provide accurate tissue diagnosis. Patients with atypical cell aspirates should be evaluated further for underlying pancreatic malignancy.