FINE-NEEDLE ASPIRATION OF THE PANCREAS - IN QUEST OF ACCURACY

Percutaneous fine needle aspiration (FNA) is the diagnostic method of choice for patients with a pancreatic mass. A positive cytologic diagn osis allows administration of neoadjuvant therapy in patients with res ectable disease and avoids laparotomy in patients with locally advance d or metastatic disease. Ninety patients underwent computed tomographi cally guided FNA of the pancreas, and the results were compared to the final histologic diagnosis. The initial sensitivity for diagnosis of pancreatic adenocarcinoma was 70%. To improve our diagnostic accuracy, 19 independent cytologic criteria were evaluated for each case. Multi variate logistic-regression analysis identified three major criteria ( nuclear crowding and overlapping, nuclear contour irregularity, irregu lar chromatin distribution) and four minor criteria (nuclear enlargeme nt, single epithelial cells, necrosis, mitoses) as the most important predictors of malignancy. In the presence of two or more major or one major and three minor criteria, the sensitivity and specificity for th e diagnosis of pancreatic adenocarcinoma were 100%. Objective applicat ion of these criteria improved our diagnostic sensitivity to 90%.