Predictors of Malignancies in Patients with Inconclusive or Negative Results of Endoscopic Ultrasound-guided Fine-needle Aspiration for Solid Pancreatic Masses.
10.4166/kjg.2018.71.3.153
- Author:
Hyewon JEONG
1
;
Chan Sun PARK
;
Ki Bae KIM
;
Joung Ho HAN
;
Soon Man YOON
;
Hee Bok CHAE
;
Sei Jin YOUN
;
Seon Mee PARK
Author Information
1. Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea. smpark@chungbuk.ac.kr
- Publication Type:Original Article
- Keywords:
Pancreatic cancer;
Chronic pancreatitis;
Endosonography;
Fine needle aspiration
- MeSH:
Adenocarcinoma;
Alcohol Drinking;
Alkaline Phosphatase;
Biopsy, Fine-Needle*;
Diagnosis;
Endoscopic Ultrasound-Guided Fine Needle Aspiration;
Endosonography;
Follow-Up Studies;
Humans;
Needles;
Pancreatic Ducts;
Pancreatic Neoplasms;
Pancreatitis;
Pancreatitis, Chronic
- From:The Korean Journal of Gastroenterology
2018;71(3):153-161
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: This study analyzed the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic solid masses in patients with or without chronic pancreatitis as well as the clinical parameters relevant to a malignancy when EUS-FNA was negative or inconclusive. METHODS: A total of 97 patients, who underwent EUS-FNA for solid pancreatic masses over 2 years at a single institution, were evaluated. All patients underwent EUS-FNA for 3-5 passes with 22 or 25 G needles without an on-site cytopathologist. The final diagnosis was obtained by surgery or compatible clinical outcomes for a more than 12 month follow-up. The diagnostic yields in the patients with or without chronic pancreatitis were compared and the histories and laboratory data relevant to pancreatic ductal adenocarcinoma (PDAC) or pseudo-tumor were analyzed. RESULTS: The final diagnoses were adenocarcinoma in 88 patients (90.7%) and inflammatory pseudo-tumor in 9 (9.3%). The results of EUS-FNA were adenocarcinoma (74), suspicious (7), atypical (5), negative (10), and inadequate specimen (1). The diagnostic accuracies were 76.9% and 91.6% in patients with or without chronic pancreatitis, respectively. Among the 23 cases with non-diagnostic results of EUS-FNA, PDAC was finally diagnosed in 5 out of 7 suspicious, 3 out of 5 atypical, and 5 out of 10 negative cytology cases. The clinical parameters related to a pseudo-tumor were a history of alcohol consumption and pancreatitis, and normal alkaline phosphatase levels. CONCLUSIONS: The diagnostic accuracy of pancreatic masses in the background of chronic pancreatitis was low. When EUS-FNA produced inconclusive results, the histories of alcohol consumption, pancreatitis, and serum levels of alkaline phosphatase are useful for making a final diagnosis.
