INTRAOPERATIVE FINE-NEEDLE ASPIRATION OF PANCREATIC AND EXTRAHEPATIC BILIARY MASSES

Intraoperative fine needle aspiration (IFNA) of masses of the pancreas and extrahepatic biliary system provides a method of rapid tissue dia gnosis with a much lower complication rate than either wedge or large bore needle biopsies. Few series include IFNA of extrahepatic biliary system masses in their analyses. We retrospectively evaluated all IFNA of pancreatic, extrahepatic biliary and ampullary masses at the Unive rsity of Virginia from March 1981 to December 1991 to assess the diagn ostic accuracy of this procedure. Ninety-nine IFNA were performed-75 o f the pancreas, 17 of the extrahepatic biliary system and seven of the ampulla. All aspirations were performed with direct visualization or palpation of the tumor, or both, using several passes with a 22 gauge needle. A diagnostic ''positive'' or ''negative'' reading was rendered in 90 of 99 IFNA. Carcinoma was confirmed by positive tissue diagnosi s or clinical course consistent with cancer. Benign disease was confir med by negative pathologic factors from a resected specimen or confirm atory clinical course of at least 18 months. Diagnosis was confirmed b y these criteria in 82 patients. Thirty-four of 43 patients with confi rmed carcinoma of the pancreas had positive cytologic factors by IFNA. Three pancreas IFNA were deemed as ''suspicious'' and six as ''unsati sfactory.'' Two patients with ''suspicious'' findings had pathological ly confirmed well-differentiated carcinoma. Carcinoma of the ampulla a nd extrahepatic biliary tract was detected by IFNA in 17 of 18 confirm ed patients. The overall sensitivity of positive or negative IFNA in t his series is 90 percent, with 100 percent specificity and 92 percent accuracy. IFNA has a positive predictive value of 100 percent and nega tive predictive value of 74 percent. We conclude that IFNA is a highly accurate diagnostic procedure and represents the preferred technique of obtaining an intraoperative tissue diagnosis in masses of the pancr eas, extrahepatic biliary tract and ampulla. Positive IFNA may definit ively guide surgical decision-making; however, we caution that negativ e IFNA cannot be relied on definitively to exclude the diagnosis of ca rcinoma.