ENDOSCOPIC ULTRASOUND-GUIDED REAL-TIME FINE-NEEDLE ASPIRATION BIOPSY OF THE PANCREAS IN CANCER-PATIENTS WITH PANCREATIC LESIONS

Background: Endoscopic ultrasound (EUS) is an important new tool in th e staging of pancreatic malignancies. Using new curved linear-array in struments, real-time fine-needle aspiration biopsy (RTFNA) of pancreat ic lesions can be performed. Methods: Forty-five patients with pancrea tic lesions (22 males and 23 females) underwent staging with the Olymp us EUM-20 (Olympus America Corp, Melville, NY) followed by EUS-RTFNA w ith the Pentax FG-32PUA (Pentax Precision Instrument Corp, Orangeburg, NY) and the 22-gauge GIP needle (GIP Medizin Technik, Grassau, German y). Results: EUS tumor stages were as follows: T0, n = 1; T1, n = 8; T 2, n = 9; and T3 n = 27. Aspiration attempts were unsuccessful in four patients (two technical failures and two inadequate specimens). The r emaining 41 lesions (mean size, 3.3 cm) were aspirated under EUS guida nce (median passes, three) and the cytologic diagnoses were 25 definit e adenocarcinoma, five suspicious for adenocarcinoma (three subsequent ly confirmed and two clinical course consistent with adenocarcinoma), and 11 negative for malignancy. Of 11 negatives, two were found to hav e adenocarcinoma, seven were confirmed benign at surgery (four cystade nomas and three inflammatory), one had a benign pseudocyst, and one ha d abundant inflammatory cells on RTFNA and follow-up time greeter than 12 months with computed tomographic (CT) scans consistent with resolv ing inflammation. There were no false-positive RTFNAs, There were no p rocedure-related complications. Among those with diagnostic EUS-RTFNA (91%), the sensitivity for malignancy (confirmed plus suspicious) was 94% and negative predictive value 82%. Conclusion: EUS-guided RTFNA is a safe and accurate method for performing pancreatic biopsy, it shoul d be considered in patients with suspected pancreatic malignancies in whom a tissue diagnosis is required or when other modalities have fail ed, EUS-RTFNA allows for local staging and tissue diagnosis in one pro cedure. (C) 1991 by American Society of Clinical Oncology.