ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF MALIGNANT PANCREATIC LESIONS

Purpose: To evaluate the accuracy safety, and clinical utility of endo scopic ultrasound (EUS) guided fine needle aspiration (FNA) of pancrea tic masses. Methods: Forty-seven patients were referred for EUS with a pancreatic mass and suspicion of pancreatic cancer based upon painles s obstructive jaundice, epigastric abdominal pain plus weight loss/ano rexia, or idiopathic pancreatitis. All patients underwent EUS with bot h radial (Olympus UM20) and linear array (Pentax FG32-UA) systems. Aft er TNM staging by EUS, ultrasound directed FNA of the pancreatic mass was performed using a 23 gauge, 4 cm long needle. Results: EUS-guided FNA was performed in all 47 patients. Results: successful targeting = 100%, adequate cellularity = 100%, Findings: adeno Ca = 25, squamous c ell Ca = 1, lymphoma = 1, poorly differentiated Ca = 1, atypical cytol ogy or suspicious for carcinoma = 9, no malignant cells = 10. The sens itivity, specificity, positive predictive value and negative predictiv e value of EUS-guided pancreatic FNA for the diagnosis of malignancy w as 64%, 100%, 100% and 16% respectively. Conclusions: EUS with FNA is useful for detection of malignancy in a pancreatic mass. The procedure appears to have a complication rate of 2%. Impact of this technique o n clinical management of patients needs further evaluation.